心脏瓣膜病(32p).pptVIP

Valvular Heart Disease Kenneth S. Korr M.D. Associate Professor of Medicine, Brown Medical School Director, Division of Cardiology The Miriam Hospital Normal Valve Function Maintain forward flow and prevent reversal of flow. Valves open and close in response to pressure differences (gradients) between cardiac chambers. Abnormal Valve Function Valve Stenosis Obstruction to valve flow during that phase of the cardiac cycle when the valve is normally open. Hemodynamic hallmark -“pressure gradient” ~ flow// VA Valve Regurgitation, Insufficiency, Incompetence Inadequate valve closure---? back leakage A single valve can be both stenotic and regurgitant; but both lesions cannot be severe!! Combinations of valve lesions can coexist Single disease process Different disease processes One valve lesion may cause another Certain combinations are particularly burdensome (AS MR) Mitral Valve Competence: Integrated function of several anatomic elements Posterior LA wall Anterior Posterior valve leaflets Chordae tendineae Papillary muscles Left ventricular wall where the papillary muscles attach Mitral Valve Disease: Etiology Mitral Stenosis Rheumatic - 99.9%!!! Congenital Prosthetic valve stenosis Mitral Annular Calcification Left Atrial Myxoma Acute Mitral Regurgitation Infective endocarditis Ischemic Heart disease Papillary ms rupture Mitral valve prolapse Chordal rupture Chest trauma Chronic Mitral Regurgitation Ischemic Heart disease Papillary ms dysfunction Inferior posterior MI Mitral Valve prolapse Infective endocarditis Rheumatic Prosthetic Mitral annular calcification Cardiomyopathy LV dilatation IHSS Mitral Regurgitation-Pathophysiology MR: Leakage of blood into LA during systole 10 Abnormality -Loss of forward SV into LA Compensatory Mechanisms Increase in SV ( EF) Forward SV + regurgitant volume LV (LA) dilatation Left Ventricular Volume Overload (LVVO) Chronic Mitral Regurgitation - LVVO LVVO LV dilatation Eccentric hypertrophy Increased LA pressure Pulm