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Mitral Valve Regurgitation
Mitral regurgitation involves blood flowing
back from the left ventricle into the left atrium
during systole.
The Leaflets cannot close completely because
the leaflets and chordae tendineae have
thickened andfibrosed resulting in theircontraction.
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Causes
Most common causes in developed
countries:
Mitral Valve prolapse
Ischemia of the left ventricle
Most common cause in developing
countries:Rheumatic Heart Disease and its
sequelae
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Other conditions that lead to
mitral regurgitation:
Myxomatous changes enlarge and
stretch the left atrium and ventricle.
Infective endocarditis may cause
perforation of of leaflet, or scarringfollowing the infection.
Collagen-Vascular disease
Cardiomyopathy
Ischemic disease
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PATHOPHYSIOLOGY:
Problems in one or more leaflets
Choradae tendinae
Elongate Shorten Tear
Papillary MuscleAnnulus
Rupture Stretch Pulled
out of the position
Inability to Contract
Stretched & Deformedby Calcification
Blood regurgitates in the right atrium during diastole
Blood force back in Left artium
Left atrium stretched, hypertrophy and dilate
Blood flowing in R. Atrium Blood going back to lungs
Pulmonary Congestion
Mitral Regurgitation
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Clinical Manifestations Chronic mitral regurgitation is often asymptomatic
but acute mitral regurgitation
(ex. That resulting from mycardial infarction) usually
manifest as severe congestive heartfailure.
Most common Symptoms: Dyspnea
Fatigue
Weakness
Other symptoms:
Palpitation
SOB on exertion
Cough from pulmunary congestion
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Assessment and Diagnostic
Findings
Systolic murmur is heard as high-
pitched, blowing sound at the apex.
Pulse maybe irregular due extrasystolic
beats or atrial fibrillation.
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Doppler echocardiography
used to diagnose and monitor the
progression of mitral regurgitation.
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This color flow Doppler image was recorded in systole. Flow starts in
the left ventricle (LV) beneath the aorta as laminar flow toward the transducer(homogeneous red color). Just before it reaches the upper portion of the
interventricular septum, the color turns gold as it nears a velocity of 0.55
meters/second (the Nyquist limit on the color bar to the left) and then aliases to
turn blue as the velocity exceeds 0.55 meters/second. As it goes through the
defect, it turns a mosaic of colors and projects into the right ventricle (RV). RA,
right atrium.
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Transesophageal
echocardiography
(TEE) provides the best images of mitralvalve
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Medical Management
Patients with mitral regurgitation benifitfrom afterload reduction (arterial dilation)
by treating with:
ACE inhibitors:
Captopril (Capoten)
Enalapril (Vasotech)
Lisinopril (Prinivil,Zestril)
Ramipril (Altace)
Hydralazine (Apresoline)
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Angiotensin converting enzyme
ARBs Lozartan (Cozar) Valsartan (Diovan)
Carvedilol (Coreg)
Once symptoms of heart failure develop, thepatient needs to restrict his/her activity level
to minimize symptoms.
Beta blockers
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Surgical Management
Mitral Valvuloplasty
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Surgical Management
Valve replacement
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Mitral Stenosis
An obstruction of blood flowing from the left
atrium in to the left ventricle.
It is most often cause of rheumatic endocarditis
-thickens mitral valve leaflets and chordaetendineae.
-leaflets often fuse together.
-eventually the mitral valve orifice narrowsand progressively obstructs blood flow into the
ventricles.
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GY:RHEUMATIC ENDOCARDITIS,
Opening narrows to the width of a pencil
resistance to a narrowed orifice in the L.
Atrium / pressure
Poor ventricular filling
Cardiac Output
L. Atrium dilate and
hypertrophy
Pulmonary circulation
becomes congested
Fatigue
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Clinical manifestation
Dyspnea
Progressive Fatigue
Dry cough or wheezing
Hemoptysis Palpitation
Orthopnea
Paroxysmal Nocturnal Dyspnea Repeated Resp. Infections
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Assessment and Diagnostic
Findings
Pulse weak/irregular
Low pitched rumbling diastolic murmur is
heard at the apex.
Atrial dysrhythmias.
Doppler Echocardiography
Electrocardiography (ECG)
Cardiac Catheterization with angiography.
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Medical Management
Anticoagulants to decrease the risk fordeveloping atrial thrombus and may also
require treatment for anemia.
Avoid strenuous activities and competitivesports
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Surgical Mgt. Valvuloplasty
>a procedure in which a narrowed heart valve is stretched openusing a procedure that does not require open heart surgery.
Percutaneous transluminal
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Percutaneous transluminal
valvuloplasty
A balloon tipped catheter is passed from the femoral vein
into the right atrium. From there, it is threaded to the right ventricle
and on to the pulmonic valve, or the atrial septum is punctured for
access to the mitral or aortic valves. When the balloon is positioned
in the valve, a series of inflation-deflation cycles is required to
enlarge the narrowing.
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CommissurotomyIs a surgicalincision of a commissurein the body, as one made in
the heart at the edges of the commissure formed by cardiac valves,
it l l l t
http://en.wikipedia.org/wiki/Surgicalhttp://en.wikipedia.org/wiki/Commissurehttp://en.wikipedia.org/wiki/Cardiac_valvehttp://en.wikipedia.org/wiki/Cardiac_valvehttp://en.wikipedia.org/wiki/Commissurehttp://en.wikipedia.org/wiki/Surgical8/12/2019 Mitral Stenosis.. Latest
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mitral valve replacement
BIOLOGICAL VALVESMECHANICAL VALVES
Mitral valve replacementis a cardiacsurgical procedure in which a patient's
diseased mitral valve is replaced by a
either a mechanical or bioprosthetic valve.
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MECHANICAL VALVES
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The principle advantage of mechanical valves is their excellent durability. The valves
available today simply do not wear out! Their main disadvantage is that blood has a
tendency to clot on all mechanical valves. If this happens the valve will not function
normally. Therefore, patients with these valves must take anticoagulants (blood thinners)
for life. There is also a small but definite risk of blood clots causing stroke, even whentaking anticoagulants.
BIOLOGICAL VALVESThere are a variety of biological alternatives for mitral valve
replacement. Most are made from pig aortic valves. Their key advantage is that they
have a reduced risk of blood clots forming on the valve itself causing valve dysfunction
or stroke. The key disadvantage of biological or tissue valves is that they have morelimited durability as compared with mechanical valves. They will wear out given enough
time. The rate at which they wear out, however, depends on the patient's age. A young
boy might wear out such a valve in only a few years, while the same valve might last 10
years in a middle aged person, and even longer in a patient over the age of 70. Of
course, as we grow older we expect that we will not need the valve for as many years as
our life expectancy is less. The general consensus is that a tissue valve will not need tobe replaced if used in a patient over the age of 70 years.