Valvular heart disease

• What is morbidity and mortality?

  Morbidity - Disease

  Mortality - Death
• Patient with valvular disease

  Patients can be asymptomatic, symptomatic and sometimes, manifestations appear late that they become untreated and progress into heart failure.
• What are the types of valves?

  Semilunar - Pulmonary and aortic valves (cusp formation are alike)

  Atrioventricular valve - Tricuspid and mitral valves
• How does the valve sit?

  • The pulmonary valve is the most anterior.
  • The aortic valve sits behind the pulmonary valve.
  • Mitral valve sits laterally to aortic valve
• What is the enlargement between the aortic root area between the aortic valve annulus and the sinotubular ridge?

  Sinus of Valsalva
• The three cusps?

  The right, left, and non-coronary cusps are adjacent to the orifices and to the coronary vessels.
• What is the mitral valve?

  AKA parachute valve.

  The valve ring (annulus) - Sits between the atria and the ventricle. The valve ring is an incomplete circle. There's a gap that allows it to move when the heart is contracting.
• Leaflet of mitral valve

  P1 (anterior or medial scallop), p2 (middle scallop), p3 ( Posterior or lateral scallop)

  A1, A2, A3

  Anterior mitral valve leaflet (AMVL)
• Chordae tendineae

  The chords go up and attach to both leaflets, the anterior and posterior, and then come down and attach to the papillary muscle.

  Chords are there to ensure valves shut efficiently as valves has to withstand lots of pressure.
• What does coacting mean?

  Closing
• What can we use to check mitral valve mobility and functionality?

  M mode and E wave (which represents passive filling)
• What happens when the pressure in the left ventricle is lower than the pressure in the left atrium?

  Valve drops open
• What is end-diastolic volume?

  Volume of blood in the ventricle at the end of diastole.
• What is the largest hole and orifice within the heart?

  The mitral valve. Mitral valve has the largest orifice between left atrium and right ventricle
• What are the three leaflets of the tricuspid valve?

  Anterior, posterior, septal leaflet.

  The septal is the smallest
• Pulmonary valve morphology?

  It has the same morphology as the aortic valve but is not austere to the coronary vessels.
• What opens and closes the valves?

  Pressure
• When does the mitral valve open?

  When the pressure in the left ventricle is lower than the pressure in the left atrium.
• When does the tricuspid valve open?

  Pressure in the right ventricle has to be lower than the right atrium for tricuspid valve to open.
• When does the semilunar valve open?

  When pressure in ventricle exceeds pressure on other side of the valve
• What are the types of valvular heart disease?

  • Regurgitation (incompetence) - Leaky valves that allows for backflow of blood
  • Atresia/malformation - People born with malformed valve (congenital)
  • Stenosis - thickened, stiffened, narrowed or fused (obstruction to flow)
• What is the aetiology?

  • Congenital
  • Acquired - Degenerative (old age), infective endocarditis, rheumatic fever, secondary causes (MI, DCM, PPM)
• Congenital aetiology?

  • Ebsteins - Tricuspid valve is displaced toward the apex (right atrium has been ventricularised)
  • Tetralogy of Fallot - Combination of pulmonary stenosis, overriding aorta, right ventricular hypertrophy and ventricular septal defect.
  • Aortic stenosis
  • Pulmonary stenosis
  • Tricuspid atresia - Tricuspid valve hasn't formed properly, lead to hypoplastic right ventricle
• Rheumatic fever?

  • Starts off with throat infection (streptococcal)
  • Starts attacking valves
  • Destroys valves and makes them thickened
  • Associated with mitral stenosis
• What is affected when someone has severe aortic stenosis?

  The after load
• What is a haemodynamic waveform?

  A pressure waveform that is simultaneously recorded from the ventricle
• BART

  Blue away, red towards
• Manifestation of aortic regurgitation

  • Exertional fatigue
  • Shortness of breath (cardiac output has gone down)
  • Dyspnoea
  • Exertional dyspnoea
• Mitral valve stenosis

  • Valve is thin and immobile
  • Heavily calcified
  • Posterior leaflet is hardly moving
• Mitral stenosis risk

  Patient is at risk of high atrial pressure

  Stroke

  Thrombus formation (so blood thinner is needed)
• What murmur is mitral stenosis?

  It's a diastolic murmur its occurring between S2 and S1.
• Mitral regurgitation

  Some blood is coming back toward the left atrium. Some will go out.

  Can cause pulmonary oedema, dilated LA
• What type of murmur is mitral regurgitation?

  Hollow systolic or pan systolic murmur occurring between S1 and S2
• Symptoms of MR

  Orthopnoea

  Exercise-related fatigue

  Risk of stroke as a result of thrombus formation
• What is mitral valve prolapse (secondary cause)?

  Leaflet moving above the annulus. So it's lifting during systole and putting blood back in LA because the leaflet is not coarcting
• Pulmonary stenosis

  • Most cases are congenital
  • Turbulent flow due to stenosis
  • Blood sample can be taken (Doppler)
• Symptoms of Pulmonary stenosis?

  • Shortness of breath
  • Poor growth
  • Increased amplitude
  • Right ventricular hypertrophy
• Pulmonary regurgitation?

  • Doppler can be used to see regurgitant flow
• Tricuspid stenosis

  • Dilated right atrium
  • Lots of red blood cells in there
  • Tall peak P wave
• Clinical manifestation (Symptoms)

  • Shortness of breath
  • Fatigue
  • Reduced exercise capacity
  • Syncope
  • Chest pain and arrhythmias
  • Thromboembolism