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MIRAL  VALVE  
Connects  LA  to  LV
...
   
 
• Congenital  –  ASD  and  rheumatic  fever  =  Lutembacher  Syndrome  
• Acquired  –  Valve  becomes  thickened  and  calcified  –  leading  to  stenosis
...
   
This  leads  to  LA  dilation,  which  could  lead  to  AF  (risk  of  thromboembolism,  increased  risk  of  
stroke)  
LV  filling  is  impaired  so  there  is  a  reduced  cardiac  output    
Pulmonary  hypertension  may  develop;  this  can  be  as  a  result  of  retrograde  transmission  of  
LA  pressure/  pulmonary  arteriolar  pressure/  interstitial  oedema      
As  pulmonary  arteriolar  pressure  increases  it  leads  to  RV  dilation  and  tricuspid  regurgitation    
As  severity  of  stenosis  increases,  cardiac  output  decreases    
 
TREATMENT:  
Medical  therapy  –  treat  cause  (e
...
 rheumatic  fever)  
 
Surgical  valve  repair/  replacement    
 
Balloon  valvuloplasty  –  minimal  valve  disease    
 
Transcathater  repair    
 
 
 

MITRAL  VAVLVE  REGURGITATION:  
 
Abnormal  reversal  of  blood  flow  from  the  LV  to  the  LA  caused  by  disruption  in  the  mitral  
valve  apparatus
...
   
 
Prevalence  is  5  in  10,000
...
   
 
ACUTE:  
Increase  in  preload  and  decrease  in  afterload  causes  an  increase  in  end  diastolic  volume  and  
a  decrease  in  end  systolic  volume
...
 This  increases  LA  pressure    
This  increased  pressure  is  transmitted  to  the  lungs  resulting  in  acute  pulmonary  edema  and  
SOB  
 
CHRONIC:  
LA  and  LV  have  enough  time  to  compensate  and  dilate  to  accommodate  regurgitant  volume  
so  LA  pressure  is  often  normal  or  there  is  minimal  elevation
...
 This  can  lead  to  pulmonary  oedema  and  if  left  untreated  cardiogenic  shock
...
 
 
Prevalence:  5%  of  population  with  a  2:1  female  to  male  ratio    
It  is  associated  with  connective  tissue  disorders  such  as  Marfans  syndrome    
Autosomal  dominant  expression  of  a  gene  –  variable  expression    
 
It  leads  to  severe  mitral  regurgitation  
 
TREATMENT:  
Valve  reapair  or  replacement  
 



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