1. Valvular Heart DISEASE

3. What is Valvular Heart Disease?

4. What Are the Types of Valve Disease?
There are several types of valvular heart disease, include:
1)Valvular stenosis: When a valve opening is smaller than normal
2)Valvular Insufficiency/REGURGITATION: occurs when a valve does not close tightly, thus allowing blood to leak backwards.
Both valvular diseases can involve all four valves.

5. Types Mitral Stenosis Mitral Regurgitation Aortic Stenosis
Aortic regurgitation
Tricuspid valve is affected infrequently
Tricuspid stenosis – causes Rt HF
Tricuspid regurgitation
Pulmonary valve disease

6. What Causes Valvular Disease?
Congenital : mostly affect the aortic or pulmonic valve ,
Acquired :.
Other Acquired causes?
Rheumatic fever
Infective endocarditis
Coronary artery disease
Heart attack
Cardiomyopathy (heart muscle disease)
Syphilis .
Hypertension .
Aortic aneurysms .
Connective tissue diseases

7. Rheumatic Heart Disease
Inflammatory process that may affect the myocardium, pericardium and or endocardium
Usually results in distortion and scarring of the valves
Caused by a type 2 inflammatory reaction secondary to sore throat caused by a bacteria called S.pyogenes

8. Rheumatic Heart Disease, cont.
Prior history of rheumatic fever
General malaise
Pain – may or may not be present
Murmurs
Dyspnea
polyarthritis

9. Infective endocarditis
Infection of heart valves
Commonly bacterial
Results in damage to valve structure giving rise to senosis or regurgitation

10. Mitral Stenosis Usually results from rheumatic carditis
Is a thickening by fibrosis or calcification
Can be caused by tumors, calcium and thrombus
Valve leaflets fuse
These narrows the opening and prevents normal blood flow from the LA to the LV
LA pressure increases, left atrium dilates, PAP increases, and the RV hypertrophies
Pulmonary congestion and right sided heart failure occurs
Followed by decreased preload and CO decreases

12. Mitral Stenosis, cont. Mild – asymptomatic
With progression – dyspnea, orthopneas, dry cough, hemoptysis, and pulmonary edema may appear
Right sided heart failure symptoms occur later
Signs
Atrial fibrillation
Apical diastolic murmur is heard

13. aortic stenosis
characterized by an abnormal narrowing of the aortic valve opening.

14. Causes of Aortic Valve Stenosis
1)Most commonly, aortic stenosis is due to age-related progressive calcification
3)Rheumatic aortic stenosis(10%)

16. Clinical presentation
Congestive heart failure
Syncope
Angina

17. Aortic Regurgitation
is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle.
Causes:
Infective endocarditic
Rheumatic disease
Trauma
Aortic dilatation like in Marfan’s Syndrome, syphilis

18. Mitral Stenosis Usually results from rheumatic carditis
Is a thickening by fibrosis or calcification
Can be caused by tumors, calcium and thrombus
Valve leaflets fuse
These narrows the opening and prevents normal blood flow from the LA to the LV
LA pressure increases, left atrium dilates, PAP increases, and the RV hypertrophies
Pulmonary congestion and right sided heart failure occurs
Followed by decreased preload and CO decreases

20. Mitral Stenosis, cont. Mild – asymptomatic
With progression – dyspnea, orthopneas, dry cough, hemoptysis, and pulmonary edema may appear
Right sided heart failure symptoms occur later
Signs
Atrial fibrillation
Apical diastolic murmur is heard

21. Mitral regurgitation :
-occurs when the mitral valve does not close properly while the heart pumps out blood .
-Most common cause is mitral valve prolapse (MVP) .
-Pathophysiology ; blood leaks back into LA> dilatation of LA >reduction in LV systolic function>later LV dilatation.
-symptoms are (palpitation- dyspnea- edema- fatigue- ascitis)

22. diagnostic tests Echocardiography . Transesophageal echocardiography .
Cardiac catheterization .(also called an angiogram)
MRI

25. Treatment of valvular heart disease
Drugs to facilitate myocardial functioning
Surgical-valve replacement/valve repair

26. Medial Treatment
Nonsurgical management focuses on drug therapy and rest
Diuretic, beta blockers, digoxin, O2, vasodilators, prophylactic antibiotic therapy
Manage atrial fibrillation , if develops, with conversion if possible, and use of anticoagulation

27. Surgical Management of Valve Disease
Mitral Valve
Mitral Valve Replacement
Balloon Valvuloplasty
Aortic Valve Replacement

28. Baloon valvuloplasty

29. Mechanical Valve

30. Mechanical Valve

31. Tissue Valve

32. Advantages of surgical repair
Reducing progression into heart faliure
better functional outcome
Disadvantages
Valve failure
Some valves warrant life long anticoagulatioln

33. Thank you….