Valvular diseases
Lubomír Křivan M.D.
Auscultation to the valves
CZ - 300 operations / 1.000.000
• Primary valvular disease
▪ Rheumatic fever – sterile inflamation
▪ Infectious endocarditis
▪ SLE
▪ CAD ( dysfunction, rupture pap. muscle)
▪ Degenerative valvular dysfunction
• Secondary valvular diseases
▪ Remodelation of the heart (CAD, DCMP…)
Endocarditis in SLE (Liebmann – Sacks)
Type of valvular damage
1. STENOSIS
2. REGURGITATION
3. COMBINATION
Diagnosis
• History + physical exam.
• ECHO ( TTE + TEE )
• Heart invasive cathetrisation
Therapy
• symptomatic regimen treatment
• pharmacotherapy
• surgery
Mitral stenosis
• dyspnea NYHA I.-IV. ( cough )
• facies mitralis + lip cyanosis
• opening snap + diastolic murmur
• HF of right ventricle
• X ray
• ECHO – dilatation of LA
Mi stenosis
Mi stenosis
Mi stenosis
Mitral stenosis
• MV area < 0,5- 1,0/m2 (normal 4-6 )
• Med. pressure gradient > 8 mmHg.
• NYHA II - III
• recurrent systemic embolisations
• pulmonary hypertension
Treatment of mitral stenosis
• baloon valvuloplasty
• mitral comisurotomy
• MVR – mitral valve replacement
X ray of the valve
X ray of the valve
Mi stenosis – bad timing
Mitral regurgitation
• 2 nd most common valv. disease
• Acute – papillary muscle / tendon rupture
• Chronic
– Primary - degeneration
– Secondary – dilatation of LV
• Dyspnea, systolic murmur
• ECG - Atrial fibrillation
• ECHO + X ray – dilatation of the LA,LV
Mitral regurgitation
• endsystolic diameter of LV > 45mm
• enlargement of LA > 50mm
• regurgitation fraction > 50% SV
• LVEF ≤ 60%
Treatment of mitral regurgitation
• Vasodilatation, diuretics, ACEI
• MVP
• Edge to edge percutaneous (Mitraclip)
• MVR
Aortic stenosis
Most common valvular disease
• Chest pain
• Dyspnea
• Syncope (after excercise)
• systolic murmur
• ECG hypertrophy
• X ray „aortic shape“
Aortic stenosis
Ao stenoza
Ao stenozqa
Ao stzenozqa
Aortic stenosis
• symptoms
• AVA < 0,5cm2/m2
• Mean systolic gradient > 40 mmHg
• worsening of LV function
Therapy: AVR
Bioprothesis of Ao valve
Kuličková chlopeň
TAVI
Aortic valve
Aortal regurgitation
• Dyspnea + chest pain
• diastolic murmur
• systolic-diastolic difference
• ECG LV overload
• X ray + ECHO - dilatation, LVH
Aortic regurgitation
Aortic regurgitation
• Endsystolic diameter > 50mm
• regurgitation fraction > 50% SV
• S-D amplitude > 100 mmHg
• Increased enddiast. P. in LV
• symptoms ( dyspnea, syncope, chest pain )
Therapy - AVR
Rare inquired valv. diseases
• Tricuspidal and pulmonary stenosis
• Tricuspidal and pulmonary regurgitation
( mostly secondary )
After valve replacement !
• Anticoagulation: Vitamin K inhibitors
• INR Mi valve 3,0
• INR Ao valve 2,5
• Direct thrombin inhibitors - Rivaroxaban, Dabigatran …not
recommended !!
Prophylaxis of infective endocarditis
• ATB prophylaxis: Respiratory tract + oral cavity
– Mechanical prosthetic valve
– Prior infective endocarditis
– Congenital heart disease (cyanotic shunts, deffects, art. materials)
• AMOXICILIN 2g p.o. 30min before procedure (Clindamycin,
Vancomycin)
IE of Mi valve
IE of Aortic valve
Septic hematomas in IE
IE with emboli and
gangraena