Professional Documents
Culture Documents
Dr.Suhaemi,SpPD, Finasim
Types
Mitral Stenosis
Mitral Regurgitation
Mitral Valve Prolapse
Aortic Stenosis
Aortic regurgitation
Tricuspid valve
Tricuspid stenosis
Tricuspid regurgitation
Tricuspid Valve
Mitral Valve:
hockey stick
appearance
indicating
Rheumatic Valve
Disease
Valve area varied
between 1.4 to
1.6
Exercise Echo was
done
Subjective
symptoms
Prior history of
rheumatic fever
General malaise
Pain may or may
not be present
Objective
symptoms
Temperature
Murmurs
Dyspnea
Polyarthritis
Diagnosis
H/P
WBC and ESR
C-reactive protein
Cardiac enzymes
EKG
Chest x-ray
Echo
Cardiac cath
Cardiac output
Nursing Care
Vital signs
Rest and quiet environment
Give antibiotics, digitalis, and diuretics
Provide adequate nutrition
Monitor I/O
Explain treatment and home care
Mitral Stenosis
Mild asymptomatic
With progression dyspnea, orthopneas,
dry cough, hemoptysis, and pulmonary
edema may appear as hypertension and
congestion progresses
Right sided heart failure symptoms occur
later
S/S
Pulse may be normal to A-Fib
Apical diastolic murmur is heard
LA view
LV view
LA
Mitral
Management Principles
Stenosis
Severe MS
is usually symptomatic
Percutaneous mitral commissurotomy (PMC) is the treatment
modality of choice in the vast majority
PMC in optimal anatomy has acturial survival rate of 95%
after 7 years
PMC in skilled centers has a mortality of < 1%
Success of PMC depends on the pre-PMC valve anatomy
Mitral
Management Principles
Stenosis
Surgical treatment
- commissurotomy (only occasionally indicated,
usually PMC)
- valve replacement
Mitral Regurgitation
Pathophysiology
Echo performed
Aortic Stenosis
Aortic
Diagnosis
Stenosis
Clinical
Aortic
Management Principles
Stenosis
Asymptomatic
- no specific therapy
- endocarditis prophylaxis
- if appropriate, rheumatic fever prophylaxis
Mild and Mod AS ( AVA > 1.5 sq cm and 1.0 to 1.4 sq cm)
- Normal physical activity
- No specific therapy, restoration of NSR in case of AFib
- approx. progression is a decrease by 0.1 sq cm per year
- annual echo follow-up
Aortic
Management Principles
Stenosis
Nonsurgical (Balloon vavuloplasty)
- only a palliative treatment
- high risk elderly patients or as an emergent
procedure
Aortic Regurgitation
Guidelines for Indications for Surgery in Patients with Severe Aortic Regurgitation
Subjective symptoms
Fatigue
Weakness
General malaise
Dyspnea on exertion
Dizziness
Chest pain or discomfort
Weight gain
Prior history of rheumatic heart disease
Assessment, cont.
Objective symptoms
Orthopnea
Dyspnea, rales
Pink-tinged sputum
Murmurs
Palpitations
Cyanosis, capillary refill
Edema
Dysrhythmias
Restlessness
Diagnosis
Medical Treatment
Interventions
Mitral Valve
Commissurotomy
Mitral Valve Replacement
Balloon Valvuloplasty
Mechanical Valve
Mechanical Valve
Porcine Valve
Tissue Valve
Tissue Valve
Initial studies
Summary
Percutaneous Valvuloplasty
MV valvuloplasty efficacious in carefully selected patients
AV valvuloplasty
Only transient improvement and high restnosis rate in adult
population
Last resort or bridge to surgery in patients with severe calcified AS
PV valvuloplasty
mainly in pediatric population
Well-accdepted treatment for PS and good f/u results