Post on 08-Apr-2018
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Cause of MS
Rheumatic Carditis. Woman : Man
2:1.
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Transmitralflow
Diastolicfillingperiod
Left AtrialPressure and
Development of symptoms
� MV area > 1.5 cm2 : symptoms at rest (-).
8/7/2019 Dr Abubakar
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D yspnea
Exercise
Infection
Atrialfibrillation with rapid ventricular
response
Pregnancy
EmotionalStress
8/7/2019 Dr Abubakar
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Mitral stenosis is a continuous,progressive, lifelong disease, usually consisting of a slow, stable course in theearly years followed by a progressive
acceleration later in life.
In developed countries, there is a long
latent period of 20 to 40 years from theoccurrence of rheumatic fever to the onsetof symptoms. Once symptoms develop,there is another period of almost a decade
before symptoms become disabling.
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Mortality inuntreated MS
Progressivepulmonary & SystemicCongestion60 ± 70 %
SystemicEmbolism 20
± 30 %
Pulmonary Embolism 10 %
Infection 1 ± 5 %
8/7/2019 Dr Abubakar
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MILD MODERATE SEVERE
Area (cm2) > 1,5 1,0 ± 1,5 < 1,0
Mean gradient (mmHg) < 5 5 ± 10 > 10
Pulmonary Artery Systolic
Pressure (mmHg)
< 30 30 ± 50 > 50
MitralMitral StenosisStenosis severity caused based on hemodynamicseverity caused based on hemodynamicand natural history dataand natural history data
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No medicaltherapy
No Specificmedical therapy
BB or CCB
Digitalis not benefit
Relieve the fixedobstruction
MS + MR
Mild MS +
Asymptomatic patient +Normal SR
High HR
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30 ² 40 %MS + AF
Shortens diastolicfilling period
Elevation of L A pressure
10 yr survival rate :25%
Risk of arterialembolization
(stroke)
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Anticoagualationat MS
With AF
LA thro us
SevereMS + LA >55or + SEC
Priore olicevents
8/7/2019 Dr Abubakar
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Marfan syndrome
Idiopathic dilatation of aortae Bicuspid valves
Infective Endocarditis Systemic hypertension
Rheumatic diseaseCalcific degeneration
Myomatous degeneration
Dissection of the ascending
aortae
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AorticRegurgitation
Asymptomatic
Normal LVsystolic function
Progression toasymptomatic
and/or LVdysfunction
< 6%/year
Progression toasymptomaticLV dysfunction
< 3,5%/year
Sudden death
< 0,2%/year
LV dysfunction
Progression tocardiac symptoms
>25%/year
Symptomatic
Mortality rate
> 10%/year
8/7/2019 Dr Abubakar
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A. To confirm the diagnosis of AR if there is anequivocal diagnosis based on physicalexamination
B. To assess the cause of AR and to assess valvemorphology
C. To provide a semiquantitative estimate of theseverity of AR
D. To assess L V dimension, mass, and systolicfunction
E. To assess aortic root size.
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CARDIAC CATHETERIZATION
Indication
Assessment of severity of
regurgitation
Aortic root sizewhen noninvasive
tests areinconclusive or
discordant
Before AVR inpatients at risk
for CAD
Assessment of LV function
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MEDICAL THERAPY
Vasodilator (sodium nitroprusside, hydralazine, nifedipine,
felodipine, ACE inhibitors)
A. Chronic therapy in patients with severe AR who have
symptoms or LV dysfunction when surgery is not recommendedbecause of additional cardiac or noncardiac factors.
B. Short-term therapy to improve the hemodynamic profile of
patients with severe heart failure symptoms and severe LV
dysfunction before proceeding with AVR.
C. Long-term therapy in asymptomatic patients with severe AR
who have LV dilatation but normal systolic function.
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Calcificationof a normal
trileaflet
Congenitalbicuspid
valve
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ASProlonged
latentperiod
Morbidity &mortality
are very low
AS Moderate
Jet velocity >3,0/s
Jet velocity of 0,3 m/s
Mean pressure gradientof 7 mmHg per year
valve area of 0,1 cm2
year
regular clinical follow-up is
mandatory in all patients
with asymptomatic mild to
moderate AS.
regular clinical follow-up is
mandatory in all patients
with asymptomatic mild to
moderate AS.