Edit concept Question Editor Create issue ticket

Mitral Valve Disease

Mitral valve diseases include stenosis, regurgitation, and prolapse. These diseases can progress and evolve into serious life-threatening complications such as heart failure and even death.


Presentation

The dynamic mitral valve is prone to three diseases, which are known as mitral stenosis (MS), mitral regurgitation (MR), and mitral valve prolapse (MVP). As a key anatomic and functional structure, advanced disease of this valve may lead to complications such as heart failure and death [1].

MS is commonly caused by rheumatic fever, which is rare in industrialized countries but still prevalent in developing regions. The disease presents in young adults usually in the third or fourth decade with symptoms such as fatigue, palpitations, chest pain, hemoptysis [2]. When MS progresses, the patient may experience dyspnea on exertion, orthopnea, as well as paroxysmal nocturnal dyspnea [3]. Among the clinical features are jugular vein distension and a displaced apical impulse. On auscultation, there is a loud S1 (first heart sound), split S2 (second heart sound), an opening snap, and a diastolic rumble.

MR typically develops as a consequence of aging mechanisms, ischemic disease, rheumatic fever, or prolapse [2] [4]. There are two forms of MR, which are acute (rare) and chronic. Often the result of valvular infection, the presentation of acute MR mimics that of acute heart failure. However, chronic MR evolves gradually and may be asymptomatic in the early stages. Features include fatigue, dyspnea, palpitations, and so forth. Auscultation findings include an apical holosystolic murmur with a soft S1, split S2, and possibly a third heart sound (S3).

MVP is found in up to 3% of the population [5] and is more predominant in young women [2]. While many individuals with prolapse do not exhibit symptoms, some will have fatigue, dizziness, dyspnea, palpitations, chest pain, anxiety, and presyncope. The palpitations may be triggered by emotional stress. The hallmark murmur is a mid-to-late systolic click.

Hyperthermia
  • A 31-year-old female patient at 30 weeks of amenorrhea was admitted to the obstetrics department with 40 degrees C hyperthermia and New York Heart Association (NYHA) class 4 dyspnea.[ncbi.nlm.nih.gov]
Heart Disease
  • KEYWORDS: IL-10; IL-4; Rheumatic heart disease; mitral valve disease; polymerase chain reaction[ncbi.nlm.nih.gov]
  • Associated rheumatic mitral valvular heart disease obscured the presence of the tumor and only with presentation of bradyarrhythmias leading to pacemaker implantation was the diagnosis suspected.[ncbi.nlm.nih.gov]
  • The similarity to lesions in carcinoid heart disease and in methysergide-associated valvular disease suggests direct stimulation of myofibroblast growth by serotonin agonist effect.[ncbi.nlm.nih.gov]
  • Abstract The myxomatous mitral valve is the most common form of valvular heart disease.[ncbi.nlm.nih.gov]
  • Left atrial (LA) reentrant tachycardias are not uncommon in regions where rheumatic heart disease is prevalent. Some of these arrhythmias may be curable by radiofrequency ablation (RFA).[ncbi.nlm.nih.gov]
Mitral Valve Prolapse
  • What is mitral valve prolapse (MVP)? Mitral valve prolapse is a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium.[heart.org]
  • Ultrasonography showed mitral valve prolapse with severe regurgitation. Surgical repair was performed, which included coronary artery bypass graft and mitral valvoplasty with tricuspid annuloplasty.[ncbi.nlm.nih.gov]
  • Recent molecular biology studies have confirmed that the myxomatous changes in mitral valve prolapse equals a cartilage phenotype, which is regulated by the Lrp5 receptor.[ncbi.nlm.nih.gov]
Heart Murmur
  • In some cases, the prolapsed valve lets a small amount of blood leak backward through the valve, which may cause a heart murmur. Watch an animation of mitral valve prolapse . Is mitral valve prolapse dangerous? In most cases, it’s harmless.[heart.org]
  • In some cases, the prolapsed valve lets a small amount of blood leak backward through the valve, which may cause a heart murmur. Watch an animation of mitral valve prolapse. Is mitral valve prolapse dangerous? In most cases, it’s harmless.[heart.org]
  • A heart murmur is the sound of blood flowing across an abnormal heart valve and may be the first clinical sign of valve disease, if you have no symptoms.[uwhealth.org]
  • The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem.[medlineplus.gov]
Late Systolic Murmur
  • Physical examination most often reveals the presence of a mid-systolic click and a mid to late systolic murmur, which reflects the timing of prolapse in the setting of excess tissue and chordal elongation without chordal rupture (i.e. flail leaflet) 2[mitralvalverepair.org]
  • systolic murmur Radiology description Echocardiography is the most useful method of diagnosing a prolapsed mitral valve Two and three dimensional echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative to[pathologyoutlines.com]
  • Late systolic murmurs and non-ejection (“mid-late”) systolic clicks. An analysis of 90 patients. Br Heart J 1968;30:203-18. [ PubMed ] Hutchins GM, Moore GW, Skoog DK.[annalscts.com]
  • Michael Criley. [3] Signs and symptoms [ edit ] Murmur [ edit ] Upon auscultation of an individual with mitral valve prolapse, a mid-systolic click, followed by a late systolic murmur heard best at the apex, is common.[en.wikipedia.org]
Diastolic Murmur
  • A mid-late diastolic murmur, best heard, with the patient in the left lateral position, with the bell of the stethoscope (see separate Heart Auscultation article). Atrial fibrillation.[patient.info]
  • The indicative low rumbling diastolic murmur is best heard in expiration at the apex, with the bell of the stethoscope. Ongoing elevated pulmonary artery (PA) pressures put strain on the right ventricle, and will eventually cause this to fail.[academic.oup.com]
Amenorrhea
  • A 31-year-old female patient at 30 weeks of amenorrhea was admitted to the obstetrics department with 40 degrees C hyperthermia and New York Heart Association (NYHA) class 4 dyspnea.[ncbi.nlm.nih.gov]
Dysarthria
  • Abstract A 77-year-old woman was admitted to our hospital with transient dysarthria. The patient had atrial fibrillation without a history of valvular disease.[ncbi.nlm.nih.gov]
Myelopathy
  • Decreased thoracic kyphosis (straight back) is a known cause of hastening back or neck problems, radiculopathy, or even myelopathy. The study aim was to examine the relationship between MMVD, straight back, and the need for cervical fusion.[ncbi.nlm.nih.gov]
Radiculopathy
  • Decreased thoracic kyphosis (straight back) is a known cause of hastening back or neck problems, radiculopathy, or even myelopathy. The study aim was to examine the relationship between MMVD, straight back, and the need for cervical fusion.[ncbi.nlm.nih.gov]

Workup

Individuals with a clinical presentation suggestive of mitral valve disease warrant a thorough workup consisting of the patient and family history, physical exam including auscultation [2], and the appropriate studies.

Laboratory tests

The workup should include a complete blood count (CBC) a complete metabolic panel (CMP).

Imaging

Echocardiography is a critical component of the assessment since it is noninvasive, accessible, and provides information for diagnosis and monitoring of the disease [6]. This modality is sensitive and specific for identifying MS [7] and is the key for diagnosing MR and MVP [8]. This study also allows the clinician to determine the etiology and stage of the valvular abnormality and functionality and size of the atria.

Transthoracic echocardiogram (TTE) reveals mobility, calcification, and thickening of the valve [9]. Moreover, real-time 3-dimensional transesophageal echocardiography (TEE), which is superior to TTE, offers excellent images of the mitral valve [10]. Very importantly, TEE is very beneficial in cases suggestive of endocarditis or presence of thrombi.

Chest radiography is another important investigative study. In patients with MS, a chest X-ray will likely display calcification of the mitral valve, left atrial enlargement, interstitial edema, and prominent pulmonary vasculature. In patients with chronic MR, chest X-ray findings may include left ventricular and left atrial enlargement, and evidence of heart failure such as pulmonary congestion. Similar observations are found in patients with MVP associated with MR.

Other imaging tests such as ventriculography and cardiac magnetic resonance imaging (MRI) may be utilized to measure the regurgitation.

Electrocardiography (EKG)

An EKG is obtained in all patients with cardiac complaints. A typical finding in patients with advanced MS is atrial fibrillation. Other remarkable features include prolonged P wave in lead II, which is indicative of left atrial hypertrophy. Features associated with chronic MR are left ventricular and left atrial hypertrophy, and ST segment changes in lateral leads. Additionally, there are P wave abnormalities in various leads. Occasionally, MVP is associated with benign arrhythmias.

Procedures

Cardiac catheterization is performed selectively prior to surgery. Also, stress EKG is used periodically to monitor MR.

P Mitrale
  • Harrison's Internal Medicine 17th edition a b medilexicon.com P mitrale Citing. Stedman's Medical Dictionary. Copyright 2006 Greenberg BH, Massie BM, Brundage BH, Botvinick EH, Parmley WW, Chatterjee K (1978).[en.wikipedia.org]
  • In asymptomatic patients, where the systolic PA pressure is 7 ECG AF is common, although p-mitrale may be noted if still in sinus rhythm. Perioperative management Like aortic stenosis, MS represents a fixed cardiac output state.[academic.oup.com]
Left Atrial Hypertrophy
  • Other remarkable features include prolonged P wave in lead II, which is indicative of left atrial hypertrophy. Features associated with chronic MR are left ventricular and left atrial hypertrophy, and ST segment changes in lateral leads.[symptoma.com]

Treatment

  • OBJECTIVES: Transcatheter-based treatment of valvular heart disease has increasingly been implemented for the treatment of high-risk patients. The impact of these new treatment modalities on surgical valve programmes is unclear at present.[ncbi.nlm.nih.gov]
  • Yet no systematic appraisal currently exists characterizing this novel treatment paradigm.[ncbi.nlm.nih.gov]
  • We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease.[ncbi.nlm.nih.gov]
  • Thus, we believe that our modified "left side only" maze procedure is a simple and efficient method for the treatment of chronic AF with mitral valve disease.[ncbi.nlm.nih.gov]
  • OBJECTIVE: Observe the efficacy of surgical treatment in patients with severe pulmonary arterial hypertension caused by mitral valve disease.[ncbi.nlm.nih.gov]

Prognosis

  • There are several reasons why left atrial size can have a significantly negative impact on prognosis.[ncbi.nlm.nih.gov]
  • OBJECTIVE: The study objective was to investigate whether, in patients undergoing surgery for degenerative mitral valve disease, associated right ventricular remodeling and dysfunction are stronger determinants of preoperative organ dysfunction and prognosis[ncbi.nlm.nih.gov]
  • BACKGROUND AND PURPOSE: Rheumatic valvular heart disease is associated with the increased risk of cerebrovascular events, although there are limited data on the prognosis of patients with rheumatic mitral valve disease (RMVD) after stroke.[ncbi.nlm.nih.gov]
  • CONCLUSION: Patients with severe mitral regurgitation due to Barlow's disease have a lower preoperative left ventricular systolic function than those with fibroelastic deficiency, which may affect their postoperative prognosis.[ncbi.nlm.nih.gov]
  • While the mechanism of ABT is likely multifactorial and still poorly understood, the proven existence of ABT in dogs offers the potential to improve the prognosis for MMVD with the addition of a mineralocorticoid receptor blocker to current therapeutic[ncbi.nlm.nih.gov]

Etiology

  • We report a patient with sepsis caused by Pasteurella haemolytica, an extremely rare etiologic agent of human infection, who had mitral valve disease and developed a splenic abscess.[ncbi.nlm.nih.gov]
  • A brief summary of the literature on pulmonary varices associated with mitral valve disease is presented, with special reference to its etiology and surgical treatment.[ncbi.nlm.nih.gov]
  • We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease.[ncbi.nlm.nih.gov]
  • Methods: We studied 20 patients with mitral valve dysfunction of rheumatic etiology, evolving with chronic atrial fibrillation, submitted to surgical treatment of valvular dysfunction and atrial fibrillation by Gomes procedure.[ncbi.nlm.nih.gov]
  • AIM: The aim of the study is to determine the impact of the underlying etiology (Barlow's disease or fibroelastic deficiency) on left ventricular function in patients with degenerative mitral valve disease and severe mitral regurgitation.[ncbi.nlm.nih.gov]

Epidemiology

  • Definition / general Degenerative valve disease occurs due to a pathological weakening / sclerosis of connective tissue Terminology Mitral valve prolapse (MVP), Floppy mitral valve, Flail leaflet, Calcific aortic valve disease Epidemiology Prevalence[pathologyoutlines.com]
  • "Pectus Excavatum: Epidemiology". Medscape. Retrieved 14 April 2016. a b c d e f g h Playford, David; Weyman, Arthur (2001). "Mitral valve prolapse: time for a fresh look". Reviews in Cardiovascular Medicine. 2 (2): 73–81.[en.wikipedia.org]
  • Aetiology/epidemiology Rheumatic fever is by far the largest cause of mitral stenosis (MS), although it is relatively rare in developed countries where degenerative calcification or endocarditis are more likely causes.[academic.oup.com]
  • NYHA III-IV 30 percent 55 mm Asymptomatic 30 - 60 percent 40 mm Asymptomatic with pulmonary hypertension LV EF 60 percent and pulmonary artery systolic pressure 50-60 mmHg Asymptomatic and chance for a repair without residual MR is 90% 60 percent 40 mm Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease.[ncbi.nlm.nih.gov]
  • Comparisons were based on intent to treat, with 3 propensity-matched groups formed based on demographics, symptoms, cardiac and noncardiac comorbidities, valve pathophysiologic disorders, and echocardiographic measurements: robotic vs sternotomy (198[ncbi.nlm.nih.gov]
  • The Current Status is organized into the following six sections: The first section is entitled Fundamentals and describes our understanding of mitral valve disease based on pathophysiological triad and Carpentier's approach of valve analysis using functional[themitralvalve.org]
  • An understanding of the pathophysiology allows the anaesthetist to not only engage in decisions regarding treatment, but to anticipate and manage the consequences of surgery and anaesthesia.[academic.oup.com]
  • […] pathological weakening / sclerosis of connective tissue Terminology Mitral valve prolapse (MVP), Floppy mitral valve, Flail leaflet, Calcific aortic valve disease Epidemiology Prevalence of degenerative valve disease is estimated at 2 - 3% of the population Pathophysiology[pathologyoutlines.com]

Prevention

  • To prevent dehiscence, we selected short bands and compared the echocardiographic changes between this method and the Cosgrove ring. METHODS: Three sutures are placed in the commissures using two bands, which shortens the annular length by 60%.[ncbi.nlm.nih.gov]
  • Patients with MMVD should be screened for straight back and, if the condition is identified, should consider preventive measures to obviate the need for cervical fusion.[ncbi.nlm.nih.gov]
  • Problems with the mitral valve may lead to irreversible changes that prevent the heart from pumping properly, which is why experts now recommend early surgery for mitral valve disease to prevent these irreversible changes.[hoag.org]
  • The obstructed mitral valve acts like a dam, preventing the blood from emptying from the lungs and causing breathlessness ( Figure 1 B).[ahajournals.org]

References

Article

  1. Levine RA, Hagége AA, Judge DP, et al. Mitral valve disease—morphology and mechanisms. Nat Rev Cardiol. 2015;12(12):689-710.
  2. Turi ZG. Mitral Valve Disease. Circulation. 2004;109(6):e38-41.
  3. Carabello BA. Modern Management of Mitral Stenosis. Circulation. 2005;112(3):432-437.
  4. Enriquez-Sarano M, Schaff HV, Frye RL. Mitral regurgitation: what causes the leakage is fundamental to the outcome of valve repair. Circulation. 2003;108(3):253-6.
  5. Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999;341(1):1–7.
  6. Hung JW, Tan TC. Echocardiography in mitral valve disease. Preface. Cardiol Clin. 2013;31(2):ix-x.
  7. Wunderlich NC, Beigel R, Siegel RJ. Management of mitral stenosis using 2D and 3D echo-Doppler imaging. JACC Cardiovasc Imaging. 2013;6(11):1191-205.
  8. Dal-Bianco JP, Levine RA. Anatomy of the mitral valve apparatus: role of 2D and 3D echocardiography. Cardiol Clin. 2013;31(2):151–164.
  9. Bruce CJ, Nishimura RA. Newer advances in the diagnosis and treatment of mitral stenosis. Curr Probl Cardiol. 1998;23(3):125-92. Review.
  10. Schlosshan D, Aggarwal G, Mathur G, Allan R, Cranney G. Real-time 3D transesophageal echocardiography for the evaluation of rheumatic mitral stenosis. JACC Cardiovasc Imaging. 2011;4(6):580-8.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 21:12