Valvular Heart Disease

VALVULAR HEART DISEASE DR.LIU LIXIN Department of cardiology

Rheumatic Fever 

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Definition: autoimmune disease caused by streptococcal infection, cross-react between streptococcal antigens and structural glycoprotein of heart, joints, central nerves system and connective tissue. Pathology: exudation, proliferation (Aschoff nodes), scarring

Rheumatic Fever 

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Clinical Manifestations: fever, rheumatic carditis, arthritis, chorea, deformity of skin Laboratory finding: ASO>500U, ASK>80U, ESR↑,Alb↓,γ+a2↑ CRP(+), CPK-MB↑, GOT↑,TnT TnI↑, C3↑, IgA↑

Rheumatic Fever  

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Diagnosis: Jones standards, 1992 AHA Treatment: 1) rest 2) antibiotics :Penicillin 3) anti- inflammation: Aspirin Corticosteroids 4) others Prevention

Overview of Valves

Mitral Stenosis 

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Etiology: predominant cause: rheumatic fever rare cause Pathology: thickening, shortening, adhering, calcium depositing, and scarring four forms of fusion: (1) commissural, (2) cuspal, (3)chordal, (4)combined two types of shape: fish-mouth shaped, funnel-shaped

Mitral Stenosis 

Pathophysiology: normal cross-sectional area:4-6 cm2 mild MS: <2 cm2, LAP↑→LAH ---compensated period moderate MS: <1.5 cm2, PVP↑, PCWP↑, →interstitial edema severe MS: <1.0 cm2,PAP↑→RVoverload →RV failure →TR →PR

Mitral Stenosis 

Clinical Manifestations (MVA<1.5cm2) 1. Symptom: dyspnea, hemoptysis, cough, hoarseness (ortner’s syndrome) 2. Signs: -Mitral faces -Diastolic thrill at apex -S1↑(flexible), OS(Opening snap), Diastolic rumbling murmur at apex, -P2↑, splitting, Graham-Steel murmur(PR),TR

Mitral Stenosis 

Laboratory Examination - ECG: 1) left atrial enlargement: P wave (II,V1) 2) Af; 3) right ventricular hypertrophy - X-film: change in cardiac silhouette, Kerley B lines - Echocardiography: M-mode, Twodimensional, Doppler

正常二 尖瓣形 态

风湿性 二尖瓣 狭窄

Rheumatic mitral stenosis

风湿 性二尖 瓣狭 窄 Rheumatic mitral stenosis

风湿性 二尖瓣 狭窄 Rheumatic mitral stenosis

风湿性 二尖瓣 狭窄 Rheumatic mitral stenosis

风湿性 二尖瓣 狭窄 Rheumatic mitral stenosis

Mitral Stenosis 

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Diagnosis & Differential diagnosis - Diastolic rumbling murmur at apex + X-film + ECG + Echo - relative MS; Austin-Flint murmur; left atrial myxoma ; Graham steell murmur Complication: Atrial fibrillation; acute pulmonary edema; congestive heart failure; thromboembolism; infective endocarditis; pulmonary

Mitral Stenosis 

Management: - Medical treatment: Antibiotics, Diuretics and Digitalis, Antiarrhythmic drugs, Anticoagulant - Percutaneous balloon mitral valvuloplasty ( PBMV) - Surgical treatment: Closed mitral valvotomy Open valvotomy Mitral valve replacement

Balloon Mitral Commissurotomy

Mitral Regurgitation 

Etiology and Pathology - Abnormalities of valve leaflets: Rheumatic, infective - Abnormalities of the mitral annulus: dilatation, calcification - Abnormalities of the chordae tendineae: congenitally, infective, trauma, Rheumatic - Involvement of papillary muscle: CAD

Mitral Regurgitation 

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Pathophysiology In systolic period, blood flow from LV → LA, LA filling pressure↑; in diastolic period, LV accepts more blood →LV dilation, hypertrophy →LVEDP↑ →LAP↑→PCWP↑→PAP↑→RHF; CO↓ Chronic Acute

Mitral Regurgitation 

Clinical Manifestations (1) Symptoms: asymptomatic( gradually,>20 years), palpitation, fatigue, dyspnea, pulmonary edema (2) Signs: - apical pulse→left,lower - apical beat heavy - cardiac dullness enlarged→left - pansystolic murmur at apex, radiate to left axilla, subscapular - S1↓,P2↑

Mitral Regurgitation 

Laboratory Examination: - ECG: LA enlargement, Af, LV hypertrophy - X- Film: chronic– cardiomegaly (LV, LA) acute– interstitial edema (Kerley B) - Echocardiography: two-dimensional, Doppler , color flow mapping - Angiocardiography & Magnetic resonance imaging

二尖 瓣脱垂 伴关闭 不全

二尖瓣 关闭不 全

Mitral Regurgitation 

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Diagnosis: systolic murmur at apex + LA↑, LV↑+ Echo Differential Diagnosis: relative MR, ventricular septal defect, tricuspid regurgitation, aortic stenosis Management: - Medical treatment - Surgical treatment

Aortic Stenosis 

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Etiology & Pathology: - Rheumatic AS, Congenital AS, Degenerative calcific AS Pathophysiology: - Obstruction to LVOT→ LVH→ LAH→ PVP↑→ Pulmonary edema; - LVEF↓→ischemia of peripheral 、 brain 、 heart

Aortic Stenosis 

Clinical Manifestations: - Symptoms: heart failure (fatigue, dyspnea), angina pectoris, syncope, sudden death - Signs: Apical impulse↑,to left Systolic thrill in AV area,pulse↓ Cardiac dullness→left Ejection sound & SM in AV area, radiate to neck A2↓ splitting paradoxically

Aortic Stenosis 

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Laboratory Examination: ECG; X- film; Echocardiography; Angiography Diagnosis & Differential Diagnosis: - murmur + Echo - MI, TI, VSD - other murmurs of LVOT obstruction

风湿性 主动 脉瓣狭 窄伴 返 流 Rheumatic aortic stenosis and regurgitation

风湿性 主动 脉瓣狭 窄伴 返 流 Rheumatic aortic stenosis and regurgitation

风湿性 主动 脉瓣狭 窄伴 返 流 Rheumatic aortic stenosis and regurgitation

风湿性 主动 脉瓣狭 窄伴 返 流 Rheumatic aortic stenosis and regurgitation

Aortic Stenosis 

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Complications: Sudden death, heart failure, arrhythmia, infective endocarditis, systemic embolism Management: - Medical treatment - Surgical treatment

Aortic Regurgitation 

Etiology & Pathology - Valvular Disease: rheumatic, congenital, infective prolapse, ankylosing spondylitis, degenerative - Aortic Root Disease: syphilitic aoritis, Marfan syndrome, ankylosing spondylitis, degenerative - Acute AR: infective, trauma, aortic

Aortic Regurgitation 

Pathophysiology: - LV receives both blood from LA & AO →volume overload →LV dilation → pulmonary edema →relative MI,MS; - Diastolic pressure↓,pulse pressure↑

Aortic Regurgitation 

Clinical Manifestations: - Symptom: palpitation, angina - Sign: apical impulse→ left, inferior cardiac dullness →left, inferior Boot-shaped shadow—cardiac waist↓ DM in AV2 area →apex S1↓,A2↓ relative MI—SM at apex relative MS—Austin Flint

Aortic Regurgitation 

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Sign: Peripheral vascular sign: - pulse pressure↑, carotid pulsation↑ - Musset sign, water hammer pulse, Traube sign, Duroziez murmur, Muller sign, Quincke sign, Laboratory Examination: ECG, X-Film, Echo, etc

Aortic Regurgitation 

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Diagnosis & Differential Diagnosis: AI + peripheral vascular signs + Echo Complication: infective endocarditis ventricular arrthymia heart failure

Aortic Regurgitation 

Management: Medical treatment Surgical treatment