Valvular heart disease

 Valvular heart disease is when any valve in the heart has

damage or is diseased. There are several causes of valve
disease.
 The normal heart has four chambers (right and left atria,
and right and left ventricles) and four valves
 The mitral valve, also called the bicuspid valve, allows
blood to flow from the left atrium to the left ventricle.
 The tricuspid valve allows blood to flow from the right
atrium to the right ventricle.
 The aortic valve allows blood to flow from the
left ventricle to the aorta.
 The pulmonary valve allows blood to flow
from the right ventricle to the pulmonary artery.
 Mitral valve stenosis

 Mitral valve stenosis — sometimes called mitral

stenosis — is a narrowing of the valve between the two
left heart chambers. The narrowed valve reduces or
blocks blood flow into the heart's main pumping
chamber. The heart's main pumping chamber is the
lower left heart chamber, also called the left ventricle .
 Causes of mitral valve stenosis include:
 Rheumatic fever. This complication of strep throat is
the most common cause of mitral valve stenosis. When
rheumatic fever damages the mitral valve, the
condition is called rheumatic mitral valve disease.
 Calcium deposits. As you age, calcium deposits can
build up around the mitral valve. This can cause
narrowing of the structures that support the mitral
valve flaps.
 Radiation therapy. This is a treatment for certain types
of cancer. Radiation to the chest area can sometimes
cause the mitral valve to thicken and harden..
 Heart problem present at birth, also called a
congenital heart defect. Rarely, some babies are born
with a narrowed mitral valve that causes problems over
time.
 Other health conditions. Lupus and other autoimmune
conditions may rarely cause mitral valve stenosis.
 SIGN AND SYMPTOMS
 Shortness of breath, especially with activity or when
you lie down
 Fatigue, especially during increased activity

 Swollen feet or legs

 Sensations of a fast, fluttering or pounding heartbeat

 Dizziness or fainting

 Irregular heart sound, also called a heart murmur

 Fluid buildup in the lungs

 Irregular heart rhythms

 Chest discomfort or chest pain

 Coughing up blood
 DIAGNOSTIC EVALUATION
 Echocardiogram. An echocardiogram can confirm mitral
stenosis. Sound waves create images of the beating heart.
The test can identify areas of poor blood flow and heart
valve problems. It also can help determine the severity of
mitral valve stenosis.
 Chest X-ray. A chest X-ray shows the condition of the
heart and lungs. It can tell whether the heart is enlarged,
which can be a sign of certain types of heart valve disease.
 Exercise stress tests. These tests often involve walking
on a treadmill or riding a stationary bike while the heart
is monitored. Exercise tests help show how the heart
responds to physical activity and whether valve disease
symptoms occur during exercise.
 CARDIAC CT :- This test combines several X-ray
images to provide a more detailed cross-sectional view
of the heart and the heart valves. A cardiac CT is
commonly done to evaluate mitral stenosis that isn't
caused by rheumatic fever.
 MEDICAL MANAGEMENT

 Diuretics to reduce fluid buildup in the lungs or other

areas of the body.
 Blood thinners, called anticoagulants, to help prevent
blood clots if you have a certain irregular heart rhythm
called atrial fibrillation.
 Beta blockers, calcium channel blockers.
 Heart rhythm drugs to treat atrial fibrillation or other
irregular heart rhythms. These types of drugs are called
anti-arrhythmics.
 Antibiotics to prevent a return of rheumatic fever if
that's what damaged the mitral valve.
 SURGICAL MANGEMENT
 Balloon valvuloplasty. This procedure is done to repair
a mitral valve with a narrowed opening. It uses a hollow,
flexible tube called a catheter and a tiny balloon. The
provider inserts the balloon-tipped catheter into an artery,
usually in the groin. It's guided to the mitral valve. The
balloon is inflated, widening the mitral valve opening.
The balloon is deflated. Then the catheter and balloon
are removed.
 Mitral valve replacement. If the mitral valve can't be
repaired, surgery may be done to replace the damaged
valve. The damage valve is replaced with a mechanical
one or a valve made from cow, pig or human heart
tissue. A valve made from animal or human tissue is
called a biological tissue valve.
 Mitral valve regurgitation

 Mitral valve regurgitation is the most common type of

heart valve disease. In this condition, the valve
between the left heart chambers doesn't close fully.
Blood leaks backward across the valve. If the leakage
is severe, not enough blood moves through the heart
or to the rest of the body. Mitral valve regurgitation
can make you feel very tired or short of breath.
 CAUSE AND RISK FACTOR
 Rheumatic fever. Rheumatic fever is a complication of
untreated strep throat. Rheumatic fever can damage the
mitral valve, leading to mitral valve regurgitation early
or later in life.
 Inflammation of the inner lining of the heart's
chambers and valves, called endocarditis. This
condition is usually caused by an infection. Germs get
into the bloodstream and attach to damaged areas in the
heart.
 Heart attack. A heart attack can damage the area of the
heart muscle that supports the mitral valve. If there is a
lot of heart attack damage, sudden and severe mitral valve
regurgitation can occur. A leaky mitral valve caused by a
heart attack is called ischemic mitral regurgitation.
 Heart problem present at birth, also called a
congenital heart defect. Some people are born with heart
structure problems, including damaged heart valves.
 Radiation therapy. Rarely, radiation therapy for cancer
that is focused on the chest area can lead to mitral valve
regurgitation.
 SIGN AND SYMPTOMS
 Irregular heartbeat, called an arrhythmia.

 Shortness of breath, especially when lying down.

 Feelings of a rapid, pounding or fluttering heartbeat,

called palpitations.
 Swollen feet or ankles.
 DIAGNOSTIC EVALUATION
 Echocardiogram. Sound waves are used to create pictures
of the beating heart. An echocardiogram shows the structure
of the mitral valve and blood flow in the heart.
 Electrocardiogram (ECG). This test shows how the heart
is beating. Sticky patches called sensors are attached to the
chest and sometimes the arms and legs
 Chest X-ray. A chest X-ray shows the condition of the heart
and lungs. This quick test can help diagnose an enlarged
heart or fluid in the lungs.
 Exercise tests or stress tests. These tests often involve
walking on a treadmill or riding a stationary bike while
the heart is checked. Exercise tests show how the heart
reacts to physical activity.
 MEDICAL MANAGEMENT
 Water pills, also called diuretics:- This medicine
reduces or prevents fluid buildup in the lungs and other
parts of the body.
 Blood thinners, also called anticoagulants:

 Antihypertensive drug :-.

 MITRAL VALVE
REPLACEMENT
 During mitral valve replacement, the surgeon
removes the mitral valve. It's replaced with a
mechanical valve or a valve made from cow, pig or
human heart tissue. A tissue valve also is called a
biological tissue valve.
 Tricuspid valve stenosis
 Tricuspid valve stenosis, also known as tricuspid
stenosis, is narrowing in the heart’s tricuspid valve. The
tricuspid valve sits between the right atrium (upper
chamber of the heart) and right ventricle (lower chamber
of the heart) and prevents blood flow from returning into
the right atrium from the right ventricle.
 If left untreated, the right atrium can enlarge and affect
the blood flow in the chambers and veins in the heart.
 CAUSES AND RISK FACTOR

 Congenital heart disease — if your child has Ebstein’s

anomaly, he or she is at greater risk of developing tricuspid
stenosis.
 Rheumatic fever — if you had rheumatic fever as a child,
you are at higher risk of developing tricuspid stenosis.
 Other heart conditions — history of heart disease,
including a heart attack, heart failure or pulmonary
hypertension, could put you at higher risk for developing
valve disease later.
 Symptoms of tricuspid valve stenosis

 The most common symptoms of tricuspid valve

stenosis are fluttering discomfort in the neck and an
irregular heartbeat.
 Other symptoms of tricuspid stenosis include:

 Cold skin

 Fatigue

 Shortness of breath with activity

 Enlarged liver
 Diagnosis of tricuspid valve stenosis

 Tricuspid stenosis can be diagnosed in a physical exam with

your doctor. With a stethoscope, your doctor may be able to hear
a specific heart murmur associated with tricuspid stenosis.

 Echocardiogram — the most common test used to confirm and

access the diagnosis of tricuspid stenosis.

 Electrocardiogram — can detect heart rhythm abnormalities,

which are a sign of tricuspid valve stenosis.

 Chest x-ray — will take pictures of the heart to determine if

there are heart abnormalities.
 SURGICAL TREATMENT
 Surgical treatments for tricuspid stenosis include:

 Balloon valvuloplasty — during a balloon

valvuloplasty, a catheter with a deflated balloon on the
end is inserted into the damaged tricuspid valve and
once in position, the balloon is inflated to widen the
valve.
 Tricuspid valve replacement — in severe cases, the
tricuspid valve can be replaced with a tissue or
mechanical valve.
 TRICUSPID REGURGITATION,

 Tricuspid regurgitation, or tricuspid valve regurgitation, is

a type of heart valve disease that occurs when the
valve’s flaps (cusps or leaflets) do not close properly. The
tricuspid valve controls the flow of blood from your
heart’s right atrium (top chamber) to the right ventricle
(bottom chamber). Blood can leak backward into the
atrium from the leaky tricuspid valve, causing your heart
to pump harder to move blood through the valve.
 CAUSES
 The most common cause of tricuspid regurgitation is
enlargement of the right ventricle. Pressure from heart
conditions, such as Heart failure, P
ulmonary Hypertension and Cardiomyopathy, cause
the ventricle to expand. The result is a misshapen
tricuspid valve that is leaky and cannot close properly.
 SIGN AND SYMPTOMS
 Fatigue: You may feel unusually tired, especially
during physical activity.
 Swelling: You may have noticeable swelling in your
abdomen, legs or neck veins.
 Abnormal heart rhythms: Cardiac arrhythmia may
feel like your heart is beating too slowly, too quickly or
irregularly.
 Shortness of breath: You may have trouble breathing
deeply, especially during exercise.
 DIAGNOSTIC EVALUATION
 Echocardiogram. This is the main test used to diagnose
tricuspid valve regurgitation. An echocardiogram uses
sound waves to create detailed images of the beating
heart. The test can show the structure of the heart and
heart valves, including the tricuspid valve, and the flow
of blood through the heart areas.
 CARDIAC MRI:- Magnetic fields and radio waves are
used to create detailed images of your heart.
 Electrocardiogram (ECG or EKG). This quick and
painless test measures the electrical activity of the heart.
 Chest X-ray. A chest X-ray shows the condition of the
heart and lungs.
 Exercise stress test. This type of test is done to show
how the heart works during physical activity.
 MEDICAL MANAGEMENT
 Drugs to remove extra fluids from the body (diuretics)

 Drugs to control irregular heartbeats (anti-arrhythmics)

 SURGICAL PROCEDURE
 Tricuspid valve replacement. If the tricuspid valve
can't be repaired, the surgeon may remove the
damaged or diseased valve and replace it with a
mechanical valve or a valve made from cow, pig or
human heart tissue (biological tissue valve).
 PULMONARY VALVE STENOSIS

 Pulmonary valve stenosis is a narrowing of the valve

between the lower right heart chamber and the lung
arteries. In a narrowed heart valve, the valve flaps
may become thick or stiff. This reduces blood flow
through the valve.
 CAUSES AND RISK FACTOR
 German measles, also called rubella. Having German
measles during pregnancy increases the risk of pulmonary
valve stenosis in the baby.

 Noonan syndrome. This condition is caused by altered DNA.

It can lead to many problems with the heart's structure and
function.

 Rheumatic fever. This complication of strep throat can cause

permanent damage to the heart and heart valves. It increases
the risk of developing pulmonary valve stenosis later in life.
 Carcinoid syndrome. This condition occurs when a
rare cancerous tumor releases certain chemicals into
the bloodstream. It causes shortness of breath,
flushing and other symptoms. Some people with this
syndrome develop carcinoid heart disease, which
damages heart valves.
 SIGN AND SYMPTOMS
 Pulmonary valve stenosis symptoms may include:

 A whooshing sound called a heart murmur that can

be heard with a stethoscope.
 Fatigue.

 Shortness of breath, especially during activity.

 Chest pain.

 Fainting.
 DIAGNOSTIC EVALUATION
 Electrocardiogram (ECG or EKG). This quick and
painless test records the electrical signals in the heart.
 Echocardiogram. An echocardiogram uses sound
waves to produce images of the heart. This common test
shows how the heart beats and pumps blood.
 Other imaging tests. Magnetic resonance imaging
(MRI) and computed tomography (CT) scans are
sometimes used to confirm the diagnosis of pulmonary
valve stenosis.
 SURGICAL MANAGEMENT
 Balloon valvuloplasty. The provider inserts a flexible tube
with a balloon on the tip into an artery, usually in the
groin. X-rays help guide the tube, called a catheter, to the
narrowed valve in the heart. The balloon inflates, making
the valve opening larger. The balloon is deflated. The
catheter and balloon are removed.
 Pulmonary valve replacement. If balloon valvuloplasty
isn't an option, open-heart surgery or a catheter procedure
may be done to replace the pulmonary valve
 PULMONARY VALVE REGURGITATION

 Pulmonary regurgitation (PR, also called

pulmonic regurgitation) is a leaky pulmonary
valve. This valve helps control the flow of blood
passing from the right ventricle to the lungs. A
leaky pulmonary valve allows blood to flow back
into the heart chamber before it gets to the lungs
for oxygen.
 CAUSES AND RISK FACTOR
 Rheumatic heart disease. Untreated bacterial infections can cause
rheumatic fever, which can damage your heart’s valves and cause
rheumatic heart disease. This is more common in developing
countries.

 Pulmonary hypertension. This is high blood pressure in the blood

vessels of your lungs. The high pressure on these vessels can
extend all the way to where the pulmonary artery exits your heart.
That high pressure stretches both the artery and the valve, causing
the valve to leak.

 Genetic disorders. Pulmonic regurgitation commonly happens in

people with inherited conditions like Marfan syndrome.
 SIGN AND SYMPTOMS

 Feeling tired

 Fainting with exercise or other activity

 Abnormal heart rhythms

 A heart murmur (an extra heart sound when a doctor listens to

the heart with a stethoscope)
 DIAGNOSTIC EVALUATION
 Pulse oximetry - a painless way to monitor the amount of
oxygen in the blood
 Chest X-ray

 Echocardiogram (also called "echo" or cardiac ultrasound) -

sound waves used to see the heart
 Electrocardiogram (ECG) - measures the electrical activity of
the heart
 Cardiac MRI - a three-dimensional picture of the heart arteries
and veins
 TREATMENT
 PULMONARY VALVE REPLACEMENT
 Aortic valve stenosis
 Aortic valve stenosis — or aortic stenosis — is a
type of heart valve disease (valvular heart disease).
The valve between the lower left heart chamber and
the body's main artery (aorta) is narrowed and
doesn't open fully. This reduces or blocks blood
flow from the heart to the aorta and to the rest of
the body.
 CAUSES AND RISK FACTORS
 Congenital heart defect. Some children are born with an aortic valve
that has only two cusps (bicuspid aortic valve) instead of three (tricuspid
aortic valve). Rarely, an aortic valve may have one (unicuspid) or four
(quadricuspid) cusps.

 Calcium buildup on the valve (aortic valve calcification). Calcium is a

mineral found in the blood. As blood repeatedly flows over the aortic
valve, calcium deposits can build up on the heart valves.

 Rheumatic fever. This complication of untreated strep throat can

damage the heart valves. It may cause scar tissue to form on the aortic
valve. Scar tissue can narrow the aortic valve opening or create a rough
surface on which calcium deposits can collect.
 SIGN AND SYMPTOMS
 An irregular heart sound (heart murmur) heard through a stethoscope

 Chest pain (angina) or tightness with activity

 Feeling faint or dizzy or fainting with activity

 Shortness of breath, especially with activity

 Fatigue, especially during times of increased activity

 Rapid, fluttering heartbeat (palpitations)

 Not eating enough (mainly in children with aortic valve stenosis)

 Not gaining enough weight (mainly in children with aortic valve

stenosis)
 DIAGNOSTIC EVALUATION

 Echocardiogram. An echocardiogram uses sound waves to create

pictures of the beating heart. It shows how blood flows through the
heart and heart valves. It can help identify a weakened heart
muscle and determine the severity of aortic valve stenosis.

 Electrocardiogram (ECG or EKG). This painless test measures

the electrical activity of the heart

 Chest X-ray. A chest X-ray shows the condition of the heart and
lungs. It can help determine whether the heart is enlarged, which
can occur in aortic valve stenosis
 Exercise tests or stress tests. These tests often
involve walking on a treadmill or riding a stationary
bike while the heart is monitored.
 CT SCAN

 MRI
 SURGICAL MANAGEMENT

 Balloon valvuloplasty.:- In this procedure, a long, thin tube

(catheter) with a balloon on the tip is inserted into an artery in the
arm or groin. It's guided to the aortic valve. Once in place, the
balloon is inflated, which widens the valve opening. The balloon
is then deflated, and the catheter and balloon are removed.

 Aortic valve replacement. Aortic valve replacement is often

needed to treat aortic valve stenosis. In aortic valve replacement,
the surgeon removes the damaged valve and replaces it with a
mechanical valve or a valve made from cow, pig or human heart
tissue (biological tissue valve).
 AORTIC VALVE REGURGITATION

 Aortic valve regurgitation — also called aortic

regurgitation — is a type of heart valve disease. The
valve between the lower left heart chamber and the
body's main artery doesn't close tightly. As a result,
some of the blood pumped out of the heart's main
pumping chamber, called the left ventricle, leaks
backward.
 CAUSES AND RISK Factor
 Narrowing of the aortic valve, called aortic stenosis. Calcium

deposits can build up on the aortic valve as you age. The buildup causes
the aortic valve to stiffen and become narrow. It prevents the valve from
opening properly. Aortic stenosis also may prevent the valve from
closing properly.

 Inflammation of the inner lining of the heart's chambers and

valves. This life-threatening condition also is called endocarditis. It's

usually caused by an infection. It can damage the aortic valve.

 Rheumatic fever. This condition was once a common childhood illness

in the United States. Strep throat can cause it.

 SIGN AND SYMPTOMS
 Shortness of breath with exercise or when lying down.

 Tiredness and weakness, especially when being more active than

usual.
 Irregular heartbeat.

 Lightheadedness or fainting.

 Pain, discomfort or tightness in the chest, which often gets worse

during exercise.
 Sensations of a rapid, fluttering heartbeat, called palpitations.

 Swollen ankles and feet.

 DIAGNOSTIC EVALUATION

 Chest X-ray

 Echocardiogram (also called "echo" or cardiac

ultrasound) - sound waves used to see the heart
 Electrocardiogram (ECG) - measures the electrical
activity of the heart
 Cardiac MRI - a three-dimensional picture of the heart
arteries and veins
 CT SCAN

 STRESS TEST
 SURGICAL MANAGEMENT
 Aortic valve replacement. The surgeon removes the
damaged valve and replaces it. The replacement might be a
mechanical valve or one made from cow, pig or human heart
tissue. A tissue valve also is called a biological tissue valve.