1. Valve diseases doc. MUDr. Jaromír Chlumský

2. Mitral stenosis
Area 4-6 cm2 …1,5 cm2 dyspnea…….
1 cm2=operation

3. Mitral stenosis 50% revmatic fever (0.4 na 100 000)
Elevation of BP in LA ….pulmonary hypertension… vasoconstriction……tricuspid insuficiency

4. Dyspnea
Hemoptysis
Angina pectoris
Dysfagia
Ortner syndroma – kompresion of left n.recurens
Embolisation

5. Facies mitralis
Diastolic murmus OS

6. EKG
P mitrale
Hypertrophy of RV– systolic BP 100 torr, in 50% if BP 70 torr

7. Mitral configuration
Calcification of mitral valve
Kerley line type B

8. Trombus in LA

9. Catetrisation (over age of 40)
Gorlin equation

10. Progosis Asymptomatic pat. 80%/10 y Symptomatic pat. 40%/10 y
0,09 cm2 per year

11. Therapy
Anticoagulation
A-V node (betabloc.+digoxin)
Cardioversion

14. Surgery Valve area 0.6 cm2/m2 NYHA III/IV NYHA II + embolisation
Pulmonary hypertension 50 torr

15. Mitral regurgitation Primary –myxomatos valve, postrevmatic, prolaps
Secondary – ischemic, KMP
Acute – 1 day mortality 75%
Chronic

16. Prolaps 2-3% of population

17. Prolaps

18. SAM

19. Symptomatology
Dyspnea
Palpitation

20. Holosystolic murmus, III. sound

21. Dilatation of LA and LV

22. Echocardiography

23. Catetrisation (age over 40)
Regurgitation fraction over 55%
High vave V
Ventriculography

24. Therapy Severe insuficiency NYHA II-IV Normal EF
Endsystolic diametr LV 45 mm
Plastic operation – mortality 3%,
replacement 6%,
+ revascularisation 10-15%

25. Therapy ACE inhibitor Cardioversion Slow HR
Acute – nitroprusid, dobutamin, Contrapulsation

29. AS

30. AS - age

32. Aortic stenosis 4% in age of 85
Etiology: senil, postrevmatic, bikuspidal valve , risk factors for AS, congenital

33. Symptomatology
Dyspnea
syncopa
Stenokardia

34. Pulsus parvus et tardus
Diamond murmur+ early systolic clik

35. LV hypertrophy + ischemia

36. AS

38. AS

39. AS

42. Progresion of stenosis
Gadient 3-15 torr /year

43. Therapy Therapy of BP Therapy of hearth failure and angina pectoris
Statins no (SEAS)

44. Operation Gradient systolic 80 torr Mean pressure 50 torr
Valve area 0,4 cm2/m2
Symptoms
Prognosis: mortality 1%/ year in asymptomatic patients, herath failure – mortality in 2 years
Operation motrality 1-2%, + revascularistion 5-10%

46. Dobutamin echo and dysfunction of LV and ao stenosis

47. Mortality 1%/year

49. AI

50. Aortic insuficiency Failure of valve Failure of aortic ring Akute
Chronic

52. INTRINSIC VALVE DISEASE congenital bicuspid valve
rheumatic endocarditis
bacterial endocarditis (perforation / prolapse of cusp)
myxomatous valve associated with cystic medial necrosis
prosthetic valve: mechanical break, thrombosis, paravalvular leak
PRIMARY DISEASE OF ASCENDING AORTA
dilatation of the aortic annulus
syphilitic aortitis
ankylosing spondylitis (5-10%)
Reiter disease
rheumatoid arthritis
cystic medial necrosis: Marfan syndrome
laceration
decelerating trauma; hypertension

53. Patophysiology area 0,3-1 cm2
low diastolic pressure = low coronary flow
Tachykardia = decraese of regurgitation

54. Symptomatology
Dyspnea
Angina pectoris

55. diastolic murmur
Relativ ao stenosis
Austin Flint murmur
Corrigan puls
Musset symtom
Quincke pulsation

56. AI

57. AI

58. Catetrisation Regurgitant fraction 55% Enddiastolic pressure in LV
Transaortic gradient

59. Prognosis
Asymptomatic patient – SD 0,2%/year, hearth failure 1,3%/year
Asymptomatic +dysfunction of LV –symptoms in 25% /year

60. Therapy ACE inhibitors Betablocers no!!
Akute – nitroprusid, dopamin, contrapulsation

61. Surgery
Symptoms
Asymptomatic patient + EF 55%, EDD 55 mm, dilatation of aorta 55 mm

64. Valves Mechanic – aprox. 20 years, anticoagulation
Bioprothesis – no anticoagulation, years ( in age of % of pts)
Thrombosis or endocarditis 2-3 %/year

65. Trombosis

66. Kalcification of bioprothesis

67. Ross operation

74. Osler’s node

75. Janeway lesions