is the failure of valve to close

Valvular Heart Disease

VALVULAR HEART DISEASE

In a pump, a defective valve produces one or both of the following defects:

1) Stenosis

“It is failure of a valve to open

completely resulting in obstruction to the forward flow of the blood.”

2) Insufficiency/regurgitation/incompetence

“It

is the failure of valve to close

completely resulting in back flow of blood.

Stenosis or insufficiency may occur in following forms:

a) Pure, stenosis or regurgitation b) Mixed,

Stenosis and regurgitation coexist in same valve, usually 1 defect predominates.

c) Isolated, in 1 valve only (MV) d) Combined,

More than 1 valve dysfunctional

Causes of VHD

(A) Acquired valvular heart disease:

Inflammatory diseases:

1. Non-infective inflammation: RHD, RA, SLE, Ankylosing spondylitis

2. Infective disorders: valvulitis, endocarditis, syphilis

Non-inflammatory diseases:

1. Degenerative diseases: Senile valve damage, Myxomatous degeneration 2. Post surgical valve damage

3. Infiltrative diseases: Amyloidosis,

leukaemia

(B) Congenital disorders:

1. Absence of valve 2. Atresia of valve

3. Abnormality of leaf or cusp

4. Incomplete differentiation of valve

5. Inborn error of collagen metabolism

Most frequent causes:

Aortic Stenosis

Calcification of congenitally deformed valve

Aortic Insufficiency

Dilation of ascending aorta

(e.g., hypertension and aging) Mitral Stenosis

Rheumatic heart disease Mitral Insufficiency

Mitral valve prolapse (myxomatous

degeneration)

Mitral Stenosis

The mitral valve apparatus consists of:

 The anterior and the posterior leaflets

 The mitral annulus

 The chordae tendineae

 Papillary muscles

 Underlying myocardium

The mitral orifice in normal adults: 5 cm² In significant mitral stenosis: 1 cm²

Mitral Valve

Mitral Stenosis Etiology

 RHD (Most common cause), Occurs in 40%

of all patients with RHD

 Bacterial endocarditis

 Endocardial fibroelastosis

 Congenital parachute mitral valve

Both chordae tendineae are attached to one papillary muscle

Parachute Mitral Valve

Morphology

 Valve leaflets are thickened by fibrous tissue or calcific deposits.

 Fibrous adhesion of mitral commissures.

 Fusion & shortening of chordae tendineae.



Purse-string puckering, button-hole or Purse-string puckering, button-hole or fish-mouth mitral orifice.

fish-mouth mitral orifice.

Fish Mouth Orifice Button hole Orifice

Effects:

Effects:

Dilatation, hypertrophy & pressure of the Dilatation, hypertrophy & pressure of the ↑↑ left atrium

left atrium →→Pul hypertensionPul hypertension →→Exertional Exertional dyspnoea.

dyspnoea.

Pulmonary hypertensionPulmonary hypertension may cause:

 Hypertrophy & dilatation of right ventricle

 Dilatation of right atrium

Mitral Regurgitation

Mitral Regurgitation Etiology

 All causes of MS

 RHD most common cause

 Mitral valve calcification in elderly

 Myxomatous degeneration of Mitral valve (MV prolapse)

 Damage to the cusps, chordae, papillary muscles, or annulus

 Dilatation of mitral ring by:

MI, myocarditis, LVF in hypertension

Morphology

 RHD

Leaflets are rigid, deformed &

retracted

Commissures are fused

Chordae tendineae are short & fused

Myxomatous degeneration

Prolapse of leaflets into the left atrium

Calcific mitral valve annulus

Irregular, stony hard, bead like thickening in the region of annulus

Calcific mitral valve annulus

Mitral valve prolapse

Effects:

Dilatation, hypertrophy & pressure of the ↑ left ventricle (LV can’t empty completely) → Marked dilatation & pressure of the left ↑

atrium → Pul hypertension →Right heart failure

Pulmonary hypertension may cause:

 Chronic passive congestion of the lungs

 Hypertrophy & dilatation of right ventricle

 Dilatation of right atrium

Aortic Stenosis

Aortic Stenosis

Aortic Stenosis

Aortic stenosis comprises about 25% of all

patients with chronic valvular heart disease. About 80% patients are males.

Etiology:

1. Calcification in patients 65 years˃

2. Calcification of a congenitally bicuspid aortic valve

3. Rheumatic heart disease frequently associated with rheumatic mitral valve disease

Morphology:

The aortic cusps show characteristic fibrous thickening and calcific nodularity of the closing

edges.

Effects:



Obstruction to the outflow resulting in concentric hypertrophy of the left

ventricle. When cardiac failure

supervenes, there is dilatation as well as hypertrophy of the left ventricle

(eccentric hypertrophy).



Three cardinal symptoms of aortic stenosis are:



Exertional dyspnea



Angina pectoris due to hypertrophy



Syncope

Aortic Insufficiency

Aortic insufficiency

3/4^th of all the patients are males

 Chronic RHD (75%)

 Syphilitic valvulitis

 Infective endocarditis

 Myxomatous degeneration of aortic valve

 Damage to the cusps

 Congenitally bicuspid aortic valve

Morphology

 The aortic valve cusps are thickened, deformed and shortened and fail to

close.

 Distension and distortion of the ring.

Effects:

 ↑ Left ventricular end diastolic volume → Hypertrophy and dilatation of the left

Ventricle ^→ left atrial pressure increases → Pulmonary hypertension →Right heart failure

 The characteristic physical findings are:

Awareness of the beatings of the heart

Poundings in the head with each heart beat

Low diastolic and high pulse pressure

Rapidly rising and collapsing water hammer pulse

Booming ”pistol shot” sound over the femoral artery