Mitral Stenosis

• 1.) stenotic MV
• 2.) obstruction of flow from LA to LV
• 3.) increased pressure in the LA causes LA to enlarge
• 4.) blood begins to back up into the right side
• 5.) increases the right heart pressures
• 6.) right sided hypertrophy

a unifocal attachment of the chordae to a single papillary muscle

A-Fib

coughing up bloody septum

usually develops when MVA is 1.1- 1.5 cm2

hoarsness

• 1.) Progressive dyspnea
• 2.) Fatique
• 3.) Chest pain
• 4.) Syncope
• 5.) Hemoptysis
• 6.) Nocturnal cough
• 7.) Ortner's syndrome
• 8.) palpitations

a diastolic rumble, opening snap

• 1.) LA thrombus due to stasis in LA
• 2.) Embolization
• 3.) A-Fib
• 4.) Pulmonary hypertension
• 5.) Vegetations

Patient is symptomatic and MVA is less than 1.0 cm2.

1.) closed MV commissurotomy

2.) open heart valve replacement

procedure to break apart the commissures.

• Patient has:
• 1.) severe MR
• 2.) valve calcification
• 3.) LA thrombus

Percutaneous ballon mitral valvutomy performed in cath lab. A balloon catheter through the ASD and then inflate the balloon when it is in the valve. It splits the commissures.

Patient may end up with ASD

• 1.) thickening of the MV
• 2.) Diastolic "doming" of the anterior MV
• 3.) Fusion at the commissures of MV causing doming.
• 4.) Concordant motion of MV
• 5.) Enlarged LA
• 6.) Normal LV
• 7.) Enlarged right heart

yes

"hockey-stick"

Anterior motion of the posterior leaflet in diastole.

(the posterior leaflet is pulled anteriorly when the valve opens)

> 4 cm

• 1.) thickened MV leaflets
• 2.) decreased E-F slope of anterior MV leaflet
• 3.) Concordant motion of the posterior MV leaflet
• 4.) Decreased a wave
• 5.) reduced d-e amplitude/not as bright
• 6.) enlarged LA
• 7.) flying W = pulmonary HTN
• 8.) enlarged RV
• 9.) LV is normal size

> 1.5 m/s

• 1.) CW > 1.5 m/s
• 2.) shallow E-F slope
• 3.) increased P 1/2 time
• 4.) spectral broadening
• 5.) A wave small or absent

• 1.) Planimetry                   - MVA
• 2.) Pressure half-time        - MVa
• 3.) Mean Gradient
• 4.) Continuity Formula       - MVA

Planimetry

Not influenced by hemodynamics, only by image limitations.

because of the small opening it takes longer for the pressure to drop to half its initial value.

Smaller MVA and more severe MS.

Larger MVA and less severe MS.

• 1.) angle of the ultrasound beam is not perpendicular
• 2.) gain settings on machine are too low
• 3.) an image is taken through the domed portion of the ALMV rather than through the leaflets.

• 1.) Receiver gain too high
• 2.) Lack of lateral resolution
• 3.) Areas of calcification at orifice making margins difficult to see.

Making it look better than what it is.

Making it look worse than what it is.

Color = AI, PI, TR, MR

Doppler = stenosis

4 chamber with CW

on prothetic valves 

Native vessels

looking at the drop in pressure and flow

anything that will alter the pressure in the LV or change LV compliance

• 1.) AI
• 2.) A-Fib
• 3.) AS
• 4.) Stiff non-compliant ventricle

• Patient has MS and an ASD which causes RVVO.
• Rheumatic or congenital
• Women
• 1.) cyanosis due to increase LA pressure
• 2.) pulmonary HTN
• 3.) heart failure

Mitral Annular Calcification

MS

• 1.) HTN
• 2.) AS
• 3.) Hypertrophic cardiomyopathy

Pressure overloads

• 1.) advanced age
• 2.) female gender
• 3.) stress on mitral valve annulus

A unifocal attachment of the chordae to a single or dominant papillary muscle.

MS

a diffuse, inflammatory disease that is caused by group A-B-Hemolytic streptococcus.

fibrotic changes cause fusion of the cusps at the commissures leading to shortening, thickening and fusion of the chordea producing a funnel shape valve.

starts at the tips and spreads towards the annulus.

than spreads to the chordae and throughout the apparatus.

• 1.)15 to 20 years after having rheumatic fever.
• 2.) Patients in their 30's or 40's
• 3.) Probably had it in their teens.

1.) Yes. Occurs in 5-15 year olds.

2.) May occur 2 to 3 weeks after infection

3%

fever 104 degrees by day two

• 1.) Arthritis
• 2.) Carditis
• 3.) Chorea
• 4.) Subcutaneous nodules -rare
• 5.) Erythema marginatum

an inflammation of the joints

inflammation of the heart lining- Pericardium

1.) MR

2.) Erythema marginatum

produces involuntary movement of and facial grimaces.

not often in adults expect for pregnant women.

Nodules that develop on elbows, knees or wrists.

• 1.) Skin rash that is on the chest, abdomen, and inner arms and thighs.
• 2.) Is not itchy.
• 3.) Occurs in 2-10% of patients
• 4.) Occurs only if patients also have carditis

• Have to have both of these!!!
• 1.) Fever > 104
• 2.) Positive cultures for streptococcus.

MV and AV the most

PV and TR the least

1.) MR

2.) pericardial effusion