MITRAL

STENOSIS
WHAT IS MITRAL VALVE
STENOSIS?

THE MITRAL VALVE DOES

NOT OPEN COMPLETELY AS
A RESULT THERE IS
IMPROPER FILLING OF
BLOOD INTO LV FROM LA
DURING DIASTOLE
..
MITRAL VALVE AREA
 NORMAL -- 4-6 cmsq
 MILD -->1.5 cmsq
 MODERATE – 1.0 to 1.5 cmsq
 SEVERE -- <1.0 cmsq
ETIOLOGY
 RHEUMATIC FEVER – MOST COMMON (~97%)
 MITRAL ANNULAR CALCIFICATION – AGE RELEATED
 INFECTIVE ENDOCARDITIS
 CONGENITAL MITRAL STENOSIS – VERY RARE
 COR TRIATRIATUM
 LEFT ATRIAL MYXOMA – NOT TRUE MS
 MUCOPOLYSACCHARIDOSIS
PATHOLOGY
CUPS/LEAFLETS – THICKENED
FUSSION OF COMMISURES AND CHORDAE
TENDINAE
ENDOMYOCARDIAL FIBROSIS/ VALVULAR
FIBROSIS
REDUCED MITRAL VALVE AREA
VALVULAR CALCIFICATION IN ADVANCED STAGE
PATHOPHYSIOLOGY
 INCREASE LEFT ATRIAL PRESSURE (NORMAL IS 4-8 mm of Hg)
 PULMUNARY VENOUS HYPERTENTION
 INCREASEPULMUNARY CAPILLARY PRESSURE DUE TO
CAPILLARY CONGESTION
 PULMUNARY ARTERIAL HYPERTENTION
 RIGHT VENTRICULAR HYPERTROPHY
 RIGHT ATRIAL ENLARGEMENT
 RIGHT HEART FALIURE
 INCREASE JUGULAR VEIN PRESSURE
LEFT RECURRENT LARENGEAL NERVE GETS
COMPRESSED DUE TO LA HYPERTROPHY LEADING
TO HOARSENESS O VOICE  OTNER SYNDROME
EOSOPHAGUS IS COMPRESSED  DYSPHAGIA
CONGESTION IN PULMUNARY CAPILLARIES
CONGESTION ON ARTERIES THEN LUNGS -
DYSPENEA
ALSO DYSPENEA ON EXERTION
ORTHOPENEA
HEMOPTYSIS
ATRIAL FIBRILLATION
PALPITATION  DUE TO RAPID
VENTRICAL RATE
CHEST PAIN
EDEMA FEET
AUSCULTATION
 LOUD S1
 MAY HAVE OPENING SNAP
 MID
DIASTOLIC MURMUR- WHICH INCREASES ON PRE
SYSTOLIC ACCENTUATION
 P2 IS LOUD  DUE TO PULMUNARY ARTERY HYPERTENTION
 LEFT
PARASTERNAL HEAVE  DUE TO RIGHT VENTRICULAR
HYPERTENTION
 MAYHEAR GRAHAM`S STEEL MURMUR  DUE TO
PULMUNARY REGURGITATION
DIAGNOSIS
 ECHOCARDIGRAM – BEST INITIAL
INVESTIGATION
 TTE OR TEE (BETTER)
 ECG

 LEFT ATRIAL ENLARGMENT  P

MITRAL
 RIGHT ATRIAL ENLARGEMENT  P
PULMUNALE
 CHEST X-RAY
 STRAIGHTENING OF LEFT BORDER
 DOUBLE DENSITY LEFT ATRIUM
 DIGOXIN  FOR ATRIAL FIBRILLATION, DECREASES
VENTRICLE RATE BY INCREASING REFRACTORY PERIOD OF
AV NODE.
SURGERY
 BALOON VALVULOPLASTY – WHEN NOT CALCIFIED VALVE
REPLACEMENT:--
 TISSUE VALVE-7-8 YEARS , NO NEED OF ORAL
ANTICOAGULANT . USED FOR PREGNANT 0 AND
UNMARRIED FEMALE, ELDER PEOPLE
 METTALIC VALVE -- ~15 YEARS, NEEDS ORAL
ANTICOAGULANT, USED IN YOUNG MALES
THANK YOU!!
 BY :-- PRIYANKA BHOWMIK