By. P.

Dhilip Kumar
The heart consists of 2 atrio ventricular valves,
the mitral & the trucspid valve and 2
semilunar valves, the pulmonic & aortic valve
which are located in 4 strategic locations to
control unidirectional blood flow.
Valvular heart disease is defined as the
alteration in the valve structure and function
which results in stenosis or regurgitation.
Stenosis: It is the constriction or the narrowing
of the valves
Regurgitation: It is defined as the valvular
incompetence or insufficiency resulting in
incomplete closure of the valve leaf lets
causing backward flow of blood.
Defn: It is the constriction of the mitral valves.
Causes:
 Rheumatic heart disease
 Congenital mitral stenosis
 Rheumatoid arthritis
 Systemic lupus erythematosis
 Infective endocarditis
 Due to any inflammatory changes of the mitral valve

Scarring of the mitral valve leaflets

Contractures and adhesions develop between the commissures (opening)

Thickening and shortening of the mitral valve

Obstruction of blood flow b/w left atrium & left ventricle

Increased left atrial pressure & volume

Backflow of blood

Increased pulmonary pressures

Pulmonary hypertrophy
 Dyspnea on exertion
 Hemophtysis
 Fatigue
 Palpitations
 Low pitched diastolic murmur
 Atrial fibrillation
Defn: It is the valvular insufficiency resulting from
incomplete closure of the mitral valves causing
backward flow of blood during systole.
Causes:
 Defect in the structures of mitral valve leaflets
 Weakness or ischemia of papillary muscles
 Myocardial Infarction
 Chronic rheumatic heart disease
 Mitral valve prolapse
 Rupture of chordae tendinae (supporting
structure of the valves)
 Left ventricular failure
 Due to incomplete closure of the mitral valves

Backward flow of blood from left ventricle to left atrium

Increase workload to the left ventricle and atrium to

maintain cardiac output

Left atrial dilatation & hypertrophy

Increases in the pressure & volume of left atrium

Backflow of blood into the pulmonary vasculature

Pulmonary hypertrophy
 Pulmonary edema with frothy sputum in
mouth
 Dryness
 Dehydration
 Confusion
 Lethargy
 Systolic murmur
 Dyspnea
 Palpitation
Defn: It is an abnormality of the mitral valve
leaflets and the papillary muscles or chordae
tendinae that allows the leaflets to buckle back
into the left atrium during systole
Causes:
 Idiopathic
 Family history of prolapse
 Connective tissue disease affecting the valves
 Collagen disorder causing alteration the valve
structure
 Marfan’s Syndrome (pre mature degeneration of
the elastic tissue of the valves and blood vessels)
Due to diverse disease condition of the valves

The structures of the chordae tendinae &

papillary muscles of the mitral valves are
weakened

Mitral valve leaflets buckle back during diastole

Mitral Regurgitation
 Palpitations
 Dyspnea
 Chest pain
 Activity intolerance
 Syncope
 Mid systolic click
 Cardiac murmurs
Defn: It is the constriction and narrowing of the
aortic valves.
Causes:
 Rheumatic fever & Rheumatic heart disease
 Senile fibrocalcific degeneration (calcium
deposits on the aortic valves as the person
ages)
 Coronary artery disease
 Fusion of the commissures
 Calcification of valve leaflets
 Due to any of the above causes
Progressive calcification & scarring of the aortic
valve leaflets
Valves become thickened & stiffened
Narrowing or stenosis of the aortic valve
Obstruction of blood flow from left ventricle to
aorta during systole
Left ventricular hypertrophy
Heart failure
 Angina
 Syncope
 Dyspnea on exertion
 Soft S1 sound
 Diminished or absent S2 sounds
 Systolic crescendo-decrescendo murmur
Defn: It is the incomplete closure of the aortic
valves causing backward flow of blood from aorta
into the left ventricle.
Causes:
 Diseases affecting the valve leaflets
 Infective Endocarditis
 Trauma to aortic valve during cardiac cath
procedures
 Aortic dissection (tear in the intimal layer of the
arterial wall resulting in collection of blood in the
layers of the arterial wall)
 Rheumatic heart disease
 Congenital aortic valve syphilis
 Due to any of the above causes

Incomplete closure of the aortic valve leaflets

Retrograde flow of blood from the ascending aorta to the left ventricle

Volume overload in left ventricle

Left ventricular hypertrophy

Decreased myocardial contractility

Increased blood volume in the left atrium and pulmonary bed

Increased right ventricular pressure & hypertrophy

Heart failure
 Abrupt onset of sudden dyspnea
 Chest pain
 Fatigue
 Shock due to decreased cardiac output
 Exertional dyspnea
 Orthopnea
 Paroxysmal nocturnal dyspnea
 Water hammer pulse
 Heaves- visible pulsation seen on the chest wall
 High pitched diastolic murmur
 Diminished or absent heart sounds
 Systolic ejection click
 History & physical Exmn reveals the presence
of chest pain and abnormal heart sounds
 Chest X-ray reveals heart size, alteration in
pulmonary circulation and calcification of
valves
 ECG to monitor arrhythmias and heart rate
 Echo cardiogram with Doppler imaging to
diagnose systolic and diastolic dysfunction
 Cardiac catheterisation to assess the chamber
pressures and pressure gradients across the
valves.
 Prophylactic antibiotic therapy with penicillin in case
rheumatic heart disease or endocarditis.
Sodium restriction to decrease BP
 Control Heart failure –
-Vaso dilators: nitrates
- Positive ionotropes like digoxin to increase myocardial
contractility
-Diuretics like lasix to decrease pulmonary edema and cause
vasodilation
- Β adrenergic blockers like esmolol to treat hypertension
- Anticoagulant therapy with heparin to prevent thrombus
formation by accumulation of blood in the chambers
- Anti dysrrhythmic drugs like cordarone to treat atrial
fibrillation
Percutaneous Balloon Valvuloplasty: this
procedure is done through cardiac
catheterisation in which the fused
commissures are split open by threading a
balloon tipped catheter through the femoral
artery on the stenotic valve so that balloon
may be inflated and deflated several times in
an attempt to open or separate the valve
leaflets.
 Mitral commissurotomy: this can be open or
closed method
In open method a sternotomy incision is done
and cardio pulmonary bypass is used to
directly visualise the calcification or thrombus
in the stenotic valve and excision of the
debris is done
In Closed method a trans ventricular dilator is
inserted through the femoral access and the
stenotic valve is dialted.
 Valvuloplasty: This involves the repair of the
valves by suturing the torn leaflets or chordae
tendinae or papillary muscles.
 Annuloplasty: this procedure is repair of the
annulus by suturing both the weakened ends
or by using prosthetic rings the annulus is
reconstructed
 Valve Replacement & prosthetic valves: In this
procedure an open sternotomy incision is
done and with the use of cardiopulmonary
bypass the diseased valves are removed and a
prosthetic valve is replaced
 Mechanical valves: It is manufactured from
man made material consisting of combination
of metal alloys, pyrolite carbon and dacron.
These valve repalcement need life long
anticoagant therapy to prevent thrombus
formation in the mechanical valves.
 Biologic Valves: they are constructed from
bovine (cow), Procrine (pig) and human
cardiac tissue. As they resemble the tissue
structure life long anticoagulant therapy is
not indicated in these types of valves.