Must Know About Mitral and Aortic Valvic Problem

Feranti Meuthia
Nadya Luthfah
Achmad Lefi

Rheumatic disease is the most common cause of valve disease worldwide,

especially in the young, with an estimated prevalence of 15.6 to 19.6 million. Each

valve lesion imparts a unique hemodynamic load on the left ventricle, wherein aortic

stenosis creates a pure pressure overload, mitral regurgitation presents a pure volume

overload, aortic regurgitation causes combined pressure and volume overload, and

mitral stenosis leads to volume underload and potentially increased afterload. Many

adverse outcomes in adults with valvular heart disease are due to sequelae of the disease

process, including atrial fibrillation, embolic events, left ventricular dysfunction,

pulmonary hypertension, and endocarditis. The most important diagnostic test for mitral

valve and aortic valve disease is echocardiography. It provides the ability to determine

the cause of regurgitation or stenosis, to assess the severity of condition, and its effect

on LV size, LA size, LV function, RV function, pulmonary atrery pressure, and

hemodynamics. Medical therapy in adults with valvular heart disease focuses on

prevention and treatment of complications because there are no specific therapies to

prevent progression of the valve disease itself. Periodic evaluation of disease severity

and the LV response to chronic volume and/or pressure overload allows optimal timing

of surgical and percutaneous interventions.

Mitral regurgitation (MR) is a common valvular disorder that can arise from

abnormalities of any part of the mitral valve apparatus. The most common symptoms,

when present, are exertional dyspnea and fatigue due to the combination of a decreased
forward (ie, effective) cardiac output, an increase in left atrial pressure due to backflow

across the mitral valve, and pulmonary artery hypertension. Another common clinical

presentation is intermittent or persistent atrial fibrillation. MitraClip procedure may be

considered in patients with symptomatic severe primary MR who fulfill the echo criteria

of eligibility, are judged inoperable or at high surgical risk by a ‘heart team’, and have a

life expectancy greater than 1 year. Mitral stenosis (MS), resulting from thickening and

immobility of the mitral valve leaflet, causes an obstruction in blood flow from the left

atrium to left ventricle. As a result, there is an increase in pressure within the left

atrium, pulmonary vasculature, and right side of the heart, while the left ventricle is

unaffected in isolated MS. The most common and often only symptom of MS is

dyspnea. Atrial fibrillation (AF) is also common in patients with MS due to the

elevation of left atrial pressure and consequent left atrial enlargement. Percutaneous

mitral commisurotomy is indicated in symptomatic mitral stenosis patients with

favourable characteristics, or patients with contraindication or high risk for surgery.

The aortic valve lies between the left ventricle and the aorta, the big blood vessel

that carries blood to all the tissues of the body. The aortic valve has 3 flexible leaflets

called cusps. The valve’s purpose is to prevent the backflow (regurgitation) of blood

pumped from the heart. Many patients with chronic severe Aortic Regurgitation (AR)

may remain clinically compensated for years with normal LV function and no

symptoms. Symptomatic patients should undergo surgery unless there are excessive

comorbidities or other contraindications. Aortic stenosis (AS) is caused by narrowing of

the orifice of the aortic valve and leads to obstruction of left ventricular outflow. Aortic

stenosis is perhaps the most common of all valvular heart diseases in the developed

nations of the world. Once symptoms of aortic stenosis develop, life expectancy is
shortened to about 3 years unless the mechanical obstruction to left ventricular outflow

is relieved by aortic valve replacement (AVR). Patients with aortic stenosis which are

not suitable for AVR after surgical consultation clearly benefit from Transcatheter

Aortic valve Intervention (TAVI), compared with conservative treatment.