Valvular Heart Disease

Description

• Mitral stenosis:
  • Obstruction of diastolic blood flow into the left ventricle (LV)
• Mitral regurgitation:
  • Inadequate closure of the leaflets allows retrograde blood flow into the left atrium (LA)
  • Acute: Pressure overload in LA and pulmonary veins causing acute pulmonary edema
  • Chronic: LV volume overload with dilatation and hypertrophy with LA enlargement
• Aortic stenosis:
  • Obstruction of LV outflow with increased systolic gradient
  • Progressive increase in LV systolic pressure and concentric hypertrophy
• Aortic regurgitation:
  • Acute LV pressure and volume overload leading to left-heart failure and pulmonary edema
  • Chronic volume overload with LV dilation and hypertrophy

• Degenerative valvular disease is most common (aortic stenosis and mitral regurgitation)
• Aortic valve replacement is the most common surgical procedure

Etiology

• Mitral stenosis:
  • Rheumatic fever
  • Cardiac tumors
  • Rheumatologic disorders (lupus, rheumatoid arthritis)
  • Myxoma
  • Congenital defects: Parachute valve
• Mitral regurgitation (acute):
  • Ruptured papillary muscle (infarction, trauma)
  • Papillary muscle dysfunction (ischemia)
  • Ruptured chordae tendineae (trauma, endocarditis, myxomatous)
  • Valve perforation (endocarditis)
  • Weight-loss medications (fenfluramine, dexfenfluramine)
• Aortic stenosis:
  • Congenital aortic stenosis: Male > female (4:1)
  • Congenital bicuspid valve (1–2%)
  • Rheumatic aortic stenosis
  • Calcific aortic stenosis
• Aortic regurgitation:
  • Infective endocarditis
  • Rupture of sinus of Valsalva
  • Acute aortic dissection
  • Chest trauma
  • Following valve surgery
  • Bicuspid aortic valve
  • Rheumatic fever
  • Weight-loss medications (fenfluramine, dexfenfluramine)
  • Collagen vascular or connective-tissue diseases
  • Systematic lupus erythematosus
  • Marfan syndrome
  • Pseudoxanthoma elasticum
  • Ankylosing spondylitis
  • Ehlers–Danlos syndrome
  • Polymyalgia rheumatica