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22 Cards in this Set
- Front
- Back
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definition
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narrowing of mitral valve impeding diastolic flow from LA to LV
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Causes
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rheumatic heart disease, mitral annular calcification, congenital, iatrogenic.
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Mitral Valve Papillary muscles
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2 - posteromedial fed by RCA and anterolateral dual fed.
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Mitral Valve structure
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6 scallop shape with 3 each on posterior and anterior. 1 most lateral and 3 most medial
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Secondary effects
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increased LA pressures, LA dilation, Afib, thrombus, PHTN with chronic, RV enlargement, MR
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Patient Symptoms
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dysnpnea on exertion, hemoptysis, CP, heart failure
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Physical exam
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low pitched diastolic murmur, opening snap can reflect severity of pressure gradient. an increase in LA pressure will cause an earlier opening. a decreased interval between A2 and open snap is more severe
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Echo evaluation
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thickened MV leaflets, leaflet tips hockey stick doming deformity, decreased EF slope, LA enlargement
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Rheumatic Heart Disease and MS
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most common cause, commissural and chordae tendineae fusion results in shortening and doming of valve leading to decrease valve area.
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Mitral Annular Calcification
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extend toward leaflets causing narrowing of diastolic flow area. distinguished from rheumatic due to thin and mobile leaflets tips without commissure fusion.
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Congenital - Parachute
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all chordae insert into a single papillary muscle restricting flow. increased echogenicity and decreased leaflet motion.
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congenital - double orifice MV
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two openings into the MV
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M - Mode
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thickened leaflets, loss of A wave, decreased EF slope <150 mm/sec
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MS and planimetry
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at mitral valve level, at beginning of diastole
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Normal MV measurements
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E: .7-1.2 m/s
A:.4-.7 m/s E/A ratio: `1-2 MV decel time: 150-240msec A duration: <120msec |
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Severity of MS with MVA
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normal 4-6 cm sqaured
mild 1.5-2.5 severe <1.9 |
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Severity of MS with MV gradient
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MPG
mild <5mmHg moderate 6-10 Severe >10 |
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AI and MS
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the AI jet may strike the AML flattening it and mimicing MS
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Pressure half time
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the time interval between the max early pressure gradient and the time point where pressure gradient is 1/2 max value.
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MVA with PHT
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MVA = 220/PHT
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Severity of MS with PHT
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normal 30-60
mild 90-150 moderate 150-219 severe >220 Increase slope decrease severity |
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Co existing AI
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rapid increase in LV diastolic pressure which decreases pressure gradient. will overestimate MVA by shortening PHT so underestimates MS
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