Valvular diseases Lubomír Křivan M.D. D:\FN%20Brno_modra_obdelnik.jpg aortic-valve-disease-1 Auscultation of the valves Operation of valvular disease – 30% of cardiosurgery procedures •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…) chordae_tendineae-866 Endocarditis in SLE (Liebmann – Sacks) Type of valvular damage 1. STENOSIS 2. REGURGITATION 3. COMBINATION HD004%20chamber%20pressures%20mitral%20stenosis HD005%20chamber%20pressures%20aortic%20regurg Diagnosis •History + physical exam. •ECHO ( TTE + TEE ) •Heart invasive cathetrisation • Echo%20Figure%203 Therapy •symptomatic regimen treatment •pharmacotherapy •Surgery - IMPORTANT TIMING • •Too early – increased risk of dying due to long term complications •Too late – risk of ireversible changes (remodellation, PH..) 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 pic00026 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 ANd9GcT2MgPZOOucv8rx7cz_SVFREYoHM_IoS9LwhXMO0_dGhqZ1G1nl fig6 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 mitralregurgitationnormal Mitral regurgitation •endsystolic diameter of LV > 45mm •enlargement of LA > 50mm •regurgitation fraction > 50% SV •LVEF ≤ 60% • Clinical-Cardiology-03 Treatment of mitral regurgitation •Vasodilatation, diuretics, ACEI •MVP •Edge to edge percutaneous (Mitraclip) •MVR 15035 annuloplasty-valve-repair Související obrázek Aortic stenosis •Most common valvular disease • •Chest pain •Dyspnea •Syncope (after excercise) •systolic murmur •ECG hypertrophy •X ray „aortic shape“ Aortic stenosis Ao stenoza Aortic stenosis •symptoms •AVA < 0,5cm2/m2 •Mean systolic gradient > 40 mmHg •worsening of LV function Therapy: AVR Bioprothesis of Ao valve ELS Sapien_00022touched up0 TAVI Výsledek obrázku pro TAVI Aortic valve Aortic regurgitation •Dyspnea + chest pain •diastolic murmur •systolic-diastolic difference •ECG LV overload •X ray + ECHO - dilatation, LVH AorticRegurgitationNormal HD005%20aortic%20regurgitation Aortic regurgitation [USEMAP] 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 C:\Users\24243\Desktop\HUMAN_HEART_VALVE-_AORTIC_VALVE_REPLACEMENT.png Rare inquired valv. diseases •Tricuspidal and pulmonary stenosis •Tricuspidal and pulmonary regurgitation ( mostly secondary ) _original Id460 After valve replacement ! •Anticoagulation: Vitamin K inhibitors •INR Mi valve 3,0 •INR Ao valve 2,5 • •Direct thrombin inhibitors - Rivaroxaban, Dabigatran …not recommended !! WarfarinRat 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) • Septic hematomas in IE septické embolisace u IE septické embolisace u IE 2 • suchá ganfréna u IE 2 suchá gangréna u IE IE with emboli and gangraena