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Acute
Diuretics LV filling P, p oedema
Vasodilators forward SV
IABP
Chronic
No known effective therapy
Vasodilators - theoretical risks
Treat complications
Mitral Regurgitation - Surgery
Options
Valve repair
MVR with chordal preservation
MVR with destruction MV apparatus
Outcome
Mortality 80-94% v 40-60% at 5-10years
Valve function
Ventricular function
Mitral Regurgitation - Indications for surgery
No randomised trials!!
1. Symptomatic with normal LV function
prognosis worse once NYHA class II symptoms
2-4% population
females:males 2:1
diagnosis from echocardiography
subcategory according to leaflet abnormality
SBE prophylaxis; normal + MR or abnormal leaflets
Aortic Regurgitation - Aetiology
Root
Annuloaoroectasia
Marfans
Dissection
Syphillis
Ankylosing spondylitis
Leaflet
Endocarditis
Bicuspid valve
Aortic Regurgitation - Pathophysiology
Normal
Acute Aortic Regurgitation - Clinical features
Treatment
Medical therapy ineffective
AVR if symptoms/signs LVF
Chronic Aortic Regurgitation - Clinical features
2. Symptomatic
NYHA class II
Mitral Stenosis
Mitral Stenosis
Causes
rheumatic fever
congenital abnormality, calcification, myxoma
Natural history
RF age 12
murmur 1st heard 20 yrs later
symptoms in 4-5th decade
Mitral Stenosis - Clinical features
Severity MVA (cm) LAP (mm Hg) CO
Mild >2.0 <10-12 NL
Moderate 1.1-2.0 ~10-17 NL
Severe <1.0 >18
Very Severe <0.8 >20-25
Severity Symptoms
Mild Asymptomatic or mild DOE
Moderate Mild-mod DOE; orthopnea, PND, hemoptysis
Palpation
Parasternal right ventricular impulse
Palpable pulmonary arterial impulse
Palpable S1, P2, and occasionally, the diastolic rumble
Auscultation
Increased intensity of the first heart sound
Opening snap
Low-pitched diastolic rumbling murmur
Mitral Stenosis - Treatment
Medical
Diuretic - pulmonary congestion
Prevent embolism - cause of 19% deaths, with LA
size and age
anticoagulate all with PAF/AF, SR in older age
Control atrial fibrillation
Mitral Stenosis - Treatment
Balloon Mitral Valvuloplasty
Mitral Stenosis - Treatment
Balloon Mitral Valvuloplasty
100% MVA, final area ~2cm 2
Doppler AVA
AI severity
2-3+ 0-1+