1. Congenital/Mitral Valve Prolapse
By: Veronica Cardenas & Michelle Hidalgo

2. Congenital- having a particular trait from birth
In the dental office we need to be familiar with both congenital heart defects and mitral valve prolapse. They directly affect decisions we make regarding treatment of our patients.

3. Congenital Heart Disease
Congenital: having a particular trait from birth
Major development of fetal heart occurs between 4th & 7th weeks of gestation, most defects occur during this time.
Environmental, genetic, chromosomal influences
Genetic predisposition

4. Types of defects
Congenital defects of the heart can affect almost any of the cardiac structures or cental blood vessels
Most common types:
Patent Ductus arteriosus 6-8%
Arterial Septal defects 6-8%
Ventricular Septal defects 20-30%
At least 35 types identified currently

5. Patent Ductus Arteriousus
Shunt is open between the aorta and pulmonary artery
Normally closes with fibrous tissue within the first 2-3 weeks of life
Causes heart to over compensate in attempt to provide oxygenated blood, which in turn makes it overburdened.
Can be treated either pharmocologically or surgically
Drugs that inhibit prostaglandin synthesis, such as indomethacin, may be used to induce closure

6. Arterial Septal Defects
A hole in the atrial septum persists as a result of improper septal formation
Partioning of atria usually occurs during 5th and 6th week of development and occurs in two stages
Defects may be small, asymptomatic or large, symptomatic.
Most are small and discovered inadvertently during routine physicals
Young children with arterial septal defects may be symptomatic, but experience symptoms later in life
Spontaneous closure can happen, surgery postponed until school

7. Ventricular Septal Defects
Opening in ventricular septum that results from an imperfect separation of ventricles during early fetal development.
Most common form 20-30%.
Can be only defect or one of multiple cardiac anomalies.
Left and right ventricles exchange blood through the opening in the septum.
The severity of symptoms range from an asymptomatic murmur to CHF.
Treatment is dependant on severity of defect, surgical intervention is necessary in infants who do not respond to medical management

8. Prevention
Use of Rubella Vaccine, especially during childbearing age if not been vaccinated.
Not given during pregnancy due to potential risks to fetus
No medications ae to be used during pregnancy without consultation of physician
Appropriate radiologic equipment
Cessation of tobacco, alcohol, drugs
Genetic counseling

9. Clinical Considerations
Signs & Symptoms
Easy fatigue
Exertional dyspnea, fainting
Cyanosis of lips and nail beds
Poor growth and development
Chest deformity
Heart murmur
CHF

10. Dental Hygiene Considerations
Prevention of Infective Endocarditis
Certain specific serious congenital heart conditions including unrepaired or incompletely repaired cyanotic congenital heart disease are advised to have pre med and antibiotics
Maintenance of high level of oral health.

11. Mitral Valve Prolapse Occurs in 2,4%-7% of general population
More in men than women and may have familial basis
Cause is usually unknown
Linked to Marfan syndrome, osteogenesis imperfecta, connective tissue disorders and with cardiac motologic, neuroendocrine, metabolic and psycologic disorders.

12. Description Located between left atrium & left ventricle.
When mitral valve leaflets are damaged, the closure is imperfect and oxygenated blood can backflow or regurgitate.
Mitral valve is prolapsed into the atrium during systole.

13. Symptoms
Most are asymptomatic, it is discovered during routine physical examination
Small percentage have symptoms
Pain mimicking angina
Dyspnea
Fatigue
Palpitations
Light headedness
More severe involvement presents an increase of palpitations and progressive mitral regurgitation along with a systolic click and murmur.

14. Treatment Focuses on relief of symptoms and prevention of complication
B-adrenergic-blocking drdugs
Cessation of stimulants
Caffiene
Alcohol
Cigarettes

15. Pre-Medication
Prior thinking recommended antibiotic premedication for dental procedures for MVP
Current recommendations of AHA are that they are no longer recommended regardless of whether or not they have any associated symptoms.

16. Dental Hygiene Considerations
Keep up to date records on patients medications
Encourage meticulous homecare regimen