Dr Abubakar

8/7/2019 Dr Abubakar

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Cause of MS

Rheumatic Carditis. Woman : Man

2:1.



Transmitralflow

Diastolicfillingperiod

Left AtrialPressure and

Development of symptoms

� MV area > 1.5 cm2 : symptoms at rest (-).



D yspnea

Exercise

Infection

Atrialfibrillation with rapid ventricular

response

Pregnancy

EmotionalStress



Mitral stenosis is a continuous,progressive, lifelong disease, usually consisting of a slow, stable course in theearly years followed by a progressive

acceleration later in life.

In developed countries, there is a long

latent period of 20 to 40 years from theoccurrence of rheumatic fever to the onsetof symptoms. Once symptoms develop,there is another period of almost a decade

before symptoms become disabling.





Mortality inuntreated MS

Progressivepulmonary & SystemicCongestion60 ± 70 %

SystemicEmbolism 20

± 30 %

Pulmonary Embolism 10 %

Infection 1 ± 5 %



MILD MODERATE SEVERE

Area (cm2) > 1,5 1,0 ± 1,5 < 1,0

Mean gradient (mmHg) < 5 5 ± 10 > 10

Pulmonary Artery Systolic

Pressure (mmHg)

< 30 30 ± 50 > 50

MitralMitral StenosisStenosis severity caused based on hemodynamicseverity caused based on hemodynamicand natural history dataand natural history data









No medicaltherapy

No Specificmedical therapy

BB or CCB

Digitalis not benefit

Relieve the fixedobstruction

MS + MR

Mild MS +

Asymptomatic patient +Normal SR

High HR



30 ² 40 %MS + AF

Shortens diastolicfilling period

Elevation of L A pressure

10 yr survival rate :25%

Risk of arterialembolization

(stroke)





Anticoagualationat MS

With AF

LA thro us

SevereMS + LA >55or + SEC

Priore olicevents



Marfan syndrome

Idiopathic dilatation of aortae Bicuspid valves

Infective Endocarditis Systemic hypertension

Rheumatic diseaseCalcific degeneration

Myomatous degeneration

Dissection of the ascending

aortae



AorticRegurgitation

Asymptomatic

Normal LVsystolic function

Progression toasymptomatic

and/or LVdysfunction

< 6%/year

Progression toasymptomaticLV dysfunction

< 3,5%/year

Sudden death

< 0,2%/year

LV dysfunction

Progression tocardiac symptoms

>25%/year

Symptomatic

Mortality rate

> 10%/year



A. To confirm the diagnosis of AR if there is anequivocal diagnosis based on physicalexamination

B. To assess the cause of AR and to assess valvemorphology

C. To provide a semiquantitative estimate of theseverity of AR

D. To assess L V dimension, mass, and systolicfunction

E. To assess aortic root size.



CARDIAC CATHETERIZATION

Indication

Assessment of severity of

regurgitation

Aortic root sizewhen noninvasive

tests areinconclusive or

discordant

Before AVR inpatients at risk

for CAD

Assessment of LV function



MEDICAL THERAPY

Vasodilator (sodium nitroprusside, hydralazine, nifedipine,

felodipine, ACE inhibitors)

A. Chronic therapy in patients with severe AR who have

symptoms or LV dysfunction when surgery is not recommendedbecause of additional cardiac or noncardiac factors.

B. Short-term therapy to improve the hemodynamic profile of

patients with severe heart failure symptoms and severe LV

dysfunction before proceeding with AVR.

C. Long-term therapy in asymptomatic patients with severe AR

who have LV dilatation but normal systolic function.





Calcificationof a normal

trileaflet

Congenitalbicuspid

valve





ASProlonged

latentperiod

Morbidity &mortality

are very low

AS Moderate

Jet velocity >3,0/s

Jet velocity of 0,3 m/s

Mean pressure gradientof 7 mmHg per year

valve area of 0,1 cm2

year

regular clinical follow-up is

mandatory in all patients

with asymptomatic mild to

moderate AS.

regular clinical follow-up is

mandatory in all patients

with asymptomatic mild to

moderate AS.



Aortic Sclerosis 25%adults > 65 years

Age

Sex

Smoking

DiabestesMellitus

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