Mitral Valve Abnormalities

Mitral stenosis 2-D Findings

Thickening of the mitral valve leaflets Diastolic doming of the anterior mitral leaflet Left atrial enlargement (LAE), with a normal or small LV Decreased mitral valve orifice in diastole. Mitral valve commissural fusion Right atrial and right ventricular enlargement (later) Leads to pulmonary hypertension and associated findings

Mitral Regurgitation signs and SX

*Fatigue *Dyspnea upon exertion *Orthopnea *Palpitations * Dysrhythmias

MVA PHT =

220

normal PHT

30-60msec

Normal MVA

4.0-6.0cm2

MVA DT =

759

Severe MVA

< /1.0cm2

Severe PHT

>/ 220ms

mitral stenosis

A narrowing of the heart's mitral valve. This abnormal valve doesn't open properly, blocking blood flow into the left ventricle.

mitral valve prolapse

AMVL or and PMVL prolapses "bows' back into the LA during systole, when the MV is closed.

commonly used for valvular repair for MR

Carpentiers Ring

Mitral Annular Calcification

Degenerative calcific deposits in fibrous ring (annulus) of mitral valve. and generally doesn't affect valvular function.

mitral regurgitation murmur

High-pitched blowing systolic

Left Atrial Myxoma causes physiologic

Mitral Stenosis

Type of Mitral Valve Abnormalities

Mitral Valve Prolapse (MVP) Mitral Valve Regurgitation (MR) Mitral Valve Stenosis (MS) Mitral Annular Calcification (MAC) Parachute Mitral Valve Cleft Mitral Valve Mitral Valve Infection (endocarditis)

Best views to evaluate MVP ?

PLAX and Apical Long

afterload

The force or resistance against which the heart pumps.

cleft mitral valve

Usually associated with endocardial cushion defect, large hole in center of the heart with a common valve.

Mitral stenosis murmur

a low pitched diastolic rumble with an opening snap

most common cause for left atrial myxoma

benign tumor

LVVO is defined as ?

hyperkinetic left ventricular walls with LV dilation)

mitral valve murmur

mid-systolic click

main cause of mitral stenosis

rheumatic fever

Mitral Regurgitation

the backward flow of blood into the left atrium during systole: may be acute or chronic.

parachute mitral vallve

valvular congenital abnormality usually found in infant or young children , however it can be present later in adulthood. This occurs when all the chordae tendineae are attached to a single papillary muscle origin, may progress to mitral stenosis

2-D Echo Finding for MVP

• AMVL and or PMVL prolapse "bows" back into the left atrium during systole. • The MV leaflets must prolapse an imaginary line across the MV annulus. • Evaluate MR if present

Mitral Regurgitation 2-D Findings ?

• Anatomic basis for the presence of mitral regurgitation • LAE • LVVO • Rapid sideways expansion of the left atrium in systole • Abnormal systolic bowing if the interatrial septum • Evidence of pulmonary hypertension • Posb LVH • RVE • Dilated pulmonary veins

Mitral Regurgitation Causes

• Any abnormality of the mitral valve apparatus: mitral annulus (ex Dilation and calcification) • Mitral leaflets (prolapses , endocarditis , flail) • Chordae tendineae • Papillary muscles • Ventricular myocardium (ischemia or infarction)

Mitral Stenosis clinical findings

• Dyspnea • Cough • Hemoptysis • Fatigue • Syncope • Chest pain • Right heart failure • Hoarseness • Atrial fibrillation

Mitral Regurgitation PW Doppler Findings

• Increase mitral E velocity > 1.3 m/sec may indicate significant regurg. • Determine severity if reg. jet by mapping technique • Determine the regurgitant fraction • Determine the left ventricular diastolic filling pattern (Stage 11 • Obtain pulmonary venous inflow; diminished or reversed S wave and increased D wave may indicate significant regurgitation

Physiology of mitral regurgitation

• Increased LV end diastolic pressure • Increased LV contractility via increased preload • Decreased or stable afterload due to filling of LA • Persevered/hyperdynamic LV systolic function

Mitral Regurgitation M-mode Findings

• Left atrial enlargement • Left ventricular enlargement • Left ventricular volume overload pattern • Possible aortic valve notching, mid-systolic closure • RVE

mitral regurgitation complications

• Left ventricular volume overload with LV dilatations • Left atrial volume overload, which leads to left atrial enlargement and increased left atrial pressure • Pulmonary hypertension • Pulmonary Edema (esp. with acute MR) • Congestive heart failure • Left atrial thrombus formation: systemic embolization

mitral stenosis complication

• MS→ blood backs up in LA (↑LAP)→doming MV leaflets→ LAE → (LA can hypertrophy) possible AF → back up and enlargement of the pulmonary veins → increased pressure in the pulmonary artery (↑PASP) → pulmonary hypertension(PHTN) → increased pressure in the right ventricle and right atrium → right heart enlargement (RVE and RAE) → TR ( stretched TV annulus) → SVC and IVC dilatation → hepatic veins and jugular vein dilatation → dilatation of the systemic veins(ascites), fluid accumulation → swelling of the ankles(edema) and other peripheral symptoms • Mitral Regurgitation • Left atrial thrombus and systemic embolism • Increased risk of Infective Endocarditis • ↓Preload ↓SV ↓Cardiac Output

M-mode MVP

• Mid-late systolic prolapse of the AMVL and PMVL • Holosystolic prolapse of the AMVL and PMVL below the CD points

parameters to asses for valve morphology

• Thickening • Mobility • Subvalvular fusion • Commissural fusion • Calcification

Mitral stenosis M-mode findings?

•Decreased E-F slope (↑P½t) •Anterior motion of the posterior mitral leaflet •Bright/thickened mitral valve leaflets •Decreased mitral valve D-E excursion •Left atrial enlargement •Right atrial and right ventricular enlargement (later) •Can lead to pulmonary hypertension and associated findings

Mitral Stenosis causes

•Rheumatic Fever •Severe mitral annular calcification (MAC) •Congenital •Left atrial mass (Left atrial myxoma), tumor and/or vegetations caused by infective endocardits

↓MVA = ↓ MV E-F slope =

↑ P½t ↑DT

↑ MVA = ↑ MV E-F slope

↓ P½t ↓DT