1. Valvular Heart Disease
Read Robbins
Web atlas: Valvular Heart Disease
Heart Sound Program (on all student computers-- same authors on web site:

2. Valvular Heart Disease
Stenosis - failure of a valve to open completely - impeding forward flow
Insufficiency - failure of a valve to close completely - allowing reversed flow(also called regurgitation)
Congenital or acquired

3. Aortic Stenosis Calcific aortic Stenosis (degeneration)
Congenital abnormality - bicuspid valve
Rheumatic HD ( rare <10%)
Never syphilis
Moderate LVH

4. Normal aortic valve – opened

5. Normal aortic valve –
shut

6. Chronic rheumatic aortic
stenosis (&probably
insufficiency)
Note fusion of leaflets

7. Chronic rheumatic AS - very fibrotic and fusion of leaflets

8. Calcific Aortic Stenosis
Most due to age related degeneration
Congenital bicuspid valve 1-2% of population
LVH
Angina and syncope

9. Valvular Degeneration caused by Calcification
Valves stressed by highly repetitive mechanisms
40 million cycles /year
Substantial tissue deformations at each cycle
High pressure gradients
All lead to thickening and in some individuals massive calcification
Tend to be advanced age (except for bicuspid valves)

10. Chronic calcific aortic
Stenosis- a degenerative
Process
Note: the cusps are not
fused
Globes of calcium
make it impossible for
the leaflets to close.

11. Bicuspid aortic
Valve- becomes
calcified

12. Bicuspid aortic
valve -now virtually
Non-moving due to the
massive dystrophic
calcification

13. Aortic Insufficiency ASVD & hypertension- degenerative aortic dilation
Collegen disorders (Marfan’s, E-D etc)
Infectious Endocarditis (acute)
Rheumatic HD (rare) - usually stenosis also
Syphilis (rare today)
Leads to: Massive LVH, CHF

14. AI- bacterial endocarditis with destruction of leaflet

15. AI- destruction of valve leaflets due to bacterial
endocarditis

16. Mitral Stenosis Chronic rheumatic endocarditis - almost always
Congenital abnormalities
Lead to:
CPC of lung
Atrial fibrillation
mural thrombosis

17. Normal mitral valve
Chronic rheumatic endocarditis

18. Chronic rheumatic endocarditis – mitral stenosis

19. Chronic rheumatic stenosis

20. Mitral Insufficiency Mitral valve prolapse
Papillary muscle dysfunction (MI)
Rheumatic HD - post inflammatory scaring (usually MS also)
Infective endocarditis
Leads to LVH
Mitral annular calcification

21. Abnormalities of the Mitral Valve
Valve Leaflets
Chordae Tendineae
Papillary Muscles
Mitral Annulus

22. Abnormalities of the Valve Leaflets
Rheumatic Heart Disease
shortening, rigidity, deformity and retraction of the leaflets
Infective Endocarditis
Perforation and retraction(healing)

23. Abnormalities of the Mitral Annulus
Dilation
normally the mitral annulus constricts during systole. A dilated left ventricle will result in dilation of the mitral annulus and result in mitral regurgitation.

24. Abnormalities of the Mitral Annulus
Calcification of annulus
one of the most common cardiac abnormalities found at autopsy.
Usually of little consequence but may immobilize the basal portions of the MV leaflets preventing their normal excursion.

25. Abnormalities of the Chordae Tendineae
Rupture
primary
infective endocarditis
trauma
rheumatic fever
Lenghtening of the chordal structures may occur with MV prolapse allowing excessive billowing of the MV leaflets

26. Mitral Valve Prolapse Enlarged leaflet balloons into left atrium
Midsystolic clicks heard
Valve may become incompetent
Late systolic murmur
3% of population
6:4 female:male ratio
Most no untoward effects

27. Mitral valve prolapse

28. Myxomatous degeneration in a patient
With mitral valve prolapse

29. Mitral Valve Prolapse Complications
Most have no untoward effects - 3% have complications
Infectious endocarditis
Mitral insufficiency
Arrhythmias
Stroke or other systemic infarct
Sudden death (very rare)

30. Mitral valve prolapse with rupture of chordae tendinae

31. Damaged papillary
muscle causing
mitral regurgitation
Complete rupture from MI
Muscle dysfuction
due to MI

32. Complications of Artificial Valves
Paravalvular leak
Thromboembolism
Infective endocarditis
Structural deterioration
Occlusion by tissue overgrowth

34. Summary Mitral Stenosis : Rheumatic Heart Disease
Mitral insufficiency: myxomatous degeneration (mitral valve prolapse), damaged papillary muscle due to infarct
Aortic stenosis: calcification of normal and congenitally bicuspid aortic valves
Aortic insufficiency: dilation of the ascending aorta, related to hypertension and aging