Valvular Heart Diseases

Valvular Heart Disease
MITRAL STENOSIS
Pathophysiology
? rheumatic fever.
? calcific degeneration,
? malignant carci¬noid disease,
? congenital mitral stenosis.
? SLE .
The increased pressure gradient across the mitral valve ?increases left atrial pressure with resultant ?left atrial dilation, ?onset of atrial fibrillation, and often ?formation of left atrial thrombi, which may embolize. Elevation in left atrial pressure, producing ?pulmonary venous con¬gestion ?irreversible pulmonary arteriosclero¬sis and ?pulmonary hypertension and ?right ventricular failure.
presentation
Patients with mitral stenosis may develop symptoms of
• exertional dyspnea.
• dyspnea at rest or orthop¬nea.
• easy fatigability and cardiac cachexia.
• hoarseness
• dysphasia.
• peripheral edema, hepatic congestion, cirrhosis, and anasarca.
• Atrial thrombi.
• Angina.


Diagnosis
On cardiac examination, the pulse may be irregular. The first heart sound may be accentuated in early mitral stenosis. The second heart sound may be accentuated by pulmonary hy¬pertension, and an opening mitral snap may be audible in diastole. A mid-diastolic rumble may be audible .
The chest radiograph
• left atrial enlarge¬ment with prominence of the left atrial appendage.
• Enlargement of the left atrium is typically seen on the posteroanterior film as a double con¬tour visible behind the right atrial shadow.
• Cephalization of pulmo¬nary blood flow, and occasionally the presence of Kerley B¬ lines, or even pulmonary edema .
• Right atrial and right ventricular enlargement. The overall cardiac size may be normal, but enlargement of the left atrium and the pulmonary artery may obliterate the normal concavity between the aorta and the left ventricle, producing a "straight" left border of the heart.
The electrocardiogram
• prominent p-wave,
• termed p mitrale.
• Atrial fibrilla¬tion,
• right ventricular hypertrophy, and right-axis deviation
Two-dimensional echocardiography
• mitral leaflet thickening and calcification,
• leaflet immobility, and thickening of the subvalvular mitral apparatus.
• mi¬tral valve gradient.
• mitral valve orifice area.
Left- and right-sided heart catheterization The gold standard for ?quantifying the severity of mitral stenosis ?patients older than 35 years or the ?presence of risk factors for coro¬nary artery disease in patients likely to need an operation