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Spectrum of VHD
Aortic Valve
Mitral Valve
Tricuspid Valve
Pulmonic Valve
Spectrum of VHD
Regurg
Acute
Aortic Valve Chronic
Stenosis Acute
Chronic
Regurg
Acute
Mitral Valve Chronic
Stenosis Acute
Chronic
Regurg
Acute
Tricuspid Valve
Chronic
Stenosis Acute
Chronic
Regurg
Acute
Pulmonic Valve
Chronic
Stenosis Acute
Chronic
Cardiac Physiology
Systole
AV/PV opens
S1-S2 MV/TV closes
Diastole
AV/PV closes
S2-S1 MV/TV opens
Systole
S1-S2
Diastole
S2-S1
These concepts are set in stone, it cant occur any other way,
It would be anatomically impossible
STENOSIS MITRALIS
Mitral Stenosis
Etiology
Symptoms
Physical Exam
Severity
Natural history
Timing of Surgery
Mitral Stenosis:
Pathophysiology
Symptoms
Fatigue
Palpitations
Cough
Left sided failure
Orthopnea
PND
Palpitation
Afib
Systemic embolism
Pulmonary infection
Hemoptysis
Right sided failure
Hepatic Congestion
Edema
Worsened by conditions
that cardiac output.
Exertion,fever, anemia,
tachycardia, Afib,
intercourse, pregnancy,
thyrotoxicosis
S1
S2 OS
S1
Murmur
Systolic Murmurs
Aortic stenosis
Mitral insufficiency
Mitral valve prolapse
Tricuspid insufficiency
Diastolic Murmurs
Aortic insufficiency
Mitral stenosis
S1
S2
S1
Complications
Atrial dysrrhythmias
Systemic embolization (10-25%)
Risk of embolization is related to, age,
presence of atrial fibrillation, previous
embolic events
Congestive heart failure
Pulmonary infarcts (result of severe CHF)
Hemoptysis
Massive: 20 to ruptured bronchial veins
(pulm HTN)
Streaking/pink froth: pulmonary edema, or
infection
LAE
RVH
Premature contractions
Atrial flutter and/or fibrillation
Mitral Stenosis
There is atrial fibrillation. No P waves are visible. The
rhythm is irregularly irregular (random).
There is the suggestion of right ventricular hypertrophy.
Right axis deviation and deep S waves in the lateral leads.
Another important feature of right ventricular hypertrophy
not shown here is a dominant R wave in lead V1.
The combination of Atrial Fibrillation and Right Axis Deviation on
the ECG suggests the possibility of mitral stenosis.
Mitral Stenosis:Therapy
Medical
Balloon valvuloplasty
Mitral Stenosis:Therapy
Surgical
Mitral commissurotomy
Mitral Valve Replacement
Mechanical
Bioprosthetic
ACC/AHA Class I
Mitral Regurgitation
Etiologies
Rheumatic
MVP
Endocarditis
Mitral Regurgitation
Symptoms
Mitral Regurgitation
Physical Exam
Mitral Regurgitation
Diagnosis
Mitral Regurgitation
- SBE
Prophylaxis
Aortic Valve
Aortic Stenosis
Aortic Regurgitation
Aortic Stenosis
Etiologies
Congenital
Bicuspid
Rheumatic
Degenerative
0-30 yrs
30-50 yrs
30-60 yrs
>60 yrs
Aortic Stenosis
Etiology
Aortic Stenosis
Physical Exam
Symptomp
fatigue
dizziness with exertion
shortness of breath
irregular heartbeats or palpitations
chest pain
Aortic Stenosis
Symptoms
Angina
Syncope
Congestive Heart Failure (CHF)
Aortic Stenosis
Aortic Stenosis
Aortic Stenosis
Diagnosis
Aortic Stenosis
Treatment of Symptomatic Aortic Stenosis or
Decreased LV Function
Medical Therapy treats the symptoms not the cause
Aortic Valve Replacement
Bioprosthetic vs Mechanical AVR
Treatment
balloon dilation valvotomy - surgical release of adhesions that are preventing the
valve leaflets from opening properly.
aortic valve replacement - the aortic valve is replaced with a new
mechanism. Replacement valve mechanisms fall into two
categories: tissue (biological) valves, which include animal valves,
and mechanical valves, which can be metal, plastic, or another
artificial mechanism. Children who have undergone a valve
replacement will need to follow antibiotic prophylaxis throughout
their lifetime.
aortic homograft - a section of aorta from a tissue donor with its
valve intact is used to replace the aortic valve and a section of the
ascending aorta.
pulmonary homograft (Ross procedure) - a section of the child's
own pulmonary artery with the valve intact is used to replace the
aortic valve and a section of the aorta. A section of pulmonary
artery from a tissue donor with its valve intact is used to replace
the transferred pulmonary artery
Aortic Valve
Aortic Stenosis
Aortic Regurgitation
Aortic Regurgitation
Etiologies
Aortic Regurgitation
Aortic Regurgitation
Physical Exam
Diastolic Murmur
Hyperdynamic LV apical impulse
Bounding Pulses
S4, S3 Gallop-advanced AI
Aortic Regurgitation
Diagnosis
Aortic Regurgitation
Treatment of Asymptomatic Aortic Regurg
Medical Therapy treats the symptoms not the cause
Tricuspidalis
Regurgitasi trikuspidalis:
Manifestasi klinis
Diagnostik
Stenosis trikuspidalis
Jarang ditemui
Sering bersamaan dengan penyakit
katup lain
Disebabkan RHD
Tricuspid valve
Stenosis
: Low-to medium-pitch diastolic
rumble with inspiratory accentuation
Penyebab
PULMONAL VALVE
Stenosis pulmonalis
Regurgitasi pulmonalis
Pulmonary Stenosis
Pulmonary Regurgitation
DIAGNOSTIK
Manifestasi klinis
Ringan berat
Ro thorax
EKG
Echocardiografi
Cath jantung
Treatment