1- Mitral valve stenosis:
* The RAA is affect almost every RM etiologies (2 years after the CEOS)
* Lutembacher syndrome: combines RM and CIA.
* Ortner syndrome: compression récurrentiel nerve at the left side of the ectasia OG => dysphonia (very rarely)
* The LV diastolic pressure remains unchanged (there is no-Fri triculaire failure in pure RM).
* Hemoptysis is a classic sign of RM; Dyspnea is the main symptom
* Rx: Average convex arc left double hump (the upper part corresponds to the pulmonary infundibulum and the lower part to the left atrial appendage).
* Cardiomegaly with supradiaphragmatic tip if there is dilation of the VD
* Silhouette mitral: triangular appearance
* Echo TM mode: paradoxical movement of the small mitral valve
* TEE is essential: for therapeutic choice and to look for intra-atrial thrombi.
* Pulmonary arterial resistance is normal in cases of post capillary pulmonary hypertension (increased if mixed PAH -> later stage)
* Atrial fibrillation is common; its occurrence is not correlated to the closeness of the RM.
* The RM is the valve disease that complicates the least bacterial endocarditis
* Mitral lung, realizing a real hemosiderosis is complicated willingly repeated bronchial infections, pulmonary infarction and hemoptysis.
* Curative treatment: Percutaneous mitral valvuloplasty (mitral dilatation)
* Indications of anticoagulation: atrial fibrillation (even a single episode paroxysmal); history of systemic embolism;OG very dilated (+/-).
AUSCULTATION:
Durozier pace with:
– A burst of B1 to mitral
– Slam mitral opening (COM) perceived trimmed B2; it reflects the sudden tensioning ropes reworked
– Bearing that early diastolic with the Commission, will then decrescendo strengthens end-diastolic (strengthening presystolic)
NB: auscultatory findings increase if left lateral decubitus
2- mitral insufficiency:
* The VG is expanded without hypertrophy (diastolic pure type of overload). The resistance to ejection (afterload) are down (hence the absence of LV hypertrophy).
* This is a self-sustaining disease: LV dilation => aggravates IM
* ECG: left atrial hypertrophy (bifid P wave in DII and biphasic in V1); left ventricular diastolic overload (large positive T wave in V5-V6)
* Coronary angiography (pre-op assessment) is systematic if the presence of angina or topic> 40 years and / or with many vascular risk factors.
* Rx: AIG lying, diving (LV dilation)
+ BARLOW: The valves are thickened, myxoid, flanges with ballooning; predominance of PVM; ropes are stretched (if rempotent often!). Prolapse is accompanied by a significant mitral regurgitation and typically +/- tele-systole.
Most asymptomatic; symptomatic forms with rich procession of functional signs; chest pain, palpitations, dyspnea, faintness, psychological profile. ECG usually normal; sometimes negative T waves … (papillary muscle ischemia post pillar). Echo: TV systolic displacement of two leaflets of the VM to the wall of the left atrium (hammock)
AUSCULTATION:
* The breath of IM is holosystolic; steam jet (sometimes peeping) radiating to the axilla (prolapse GVM) or the sternum (prolapse MVP)
* Not reinforced after the long diastole
* It is poorly correlated with the size of the leak: an important breath is a major leak, but the reverse is not true
* Bearing diastolic mitral of hyperdébit => leak important
* Galop early diastolic (B3): signs of abortion
* Disease Barlow: click mésosystolique followed by a tele-systolic murmur
3- Aortic stenosis:
* Degenerative RA: disease Monckeberg
* Disorders of atrioventricular conduction are connected with the extension of limestone suffering from the valve to the septum.
* The presence of functional signs always brought a tight RA. But even a tight RA may be asymptomatic.
* The exertional dyspnea is late in evolution (earlier angina and syncope)
* Note: in the original tightly RA rheumatic B2 can be kept
* ECG LVH with systolic type of overload (negativation T waves in V5-V6); must systematically seek increased PR (BAV); Holter (arrhythmias)
* Rx: dilatation of the aortic root and left hyperconcavité arc means (?)
* No sign is specific for aortic stenosis with ultrasound
* Ventricular hypertrophy concentric left (ie affecting both the septum as the posterior wall); the importance of the hypertrophy is poorly correlated with the degree of aortic stenosis
* Tight RA: Aortic area <1 cm; mean gradient (VG-Aorta)> 40 mmHg
* Coronary angiography: a systematic under pre-op assessment in case of the existence of angina; topic> 40 years or associated vascular risk factors
* ECG: strictly against-indicated for symptomatic RA;
shown () if RA tight symptomatic.
* Spontaneous average survival:
+ Angina -> 4 years
+ Syncope -> 3 years
+ Heart Failure -> 2 years
+ PAO -> 6 months
* The VG / Aorta gradient depends on the degree of stenosis and systolic function
* Increased afterload => alteration of the diastolic and systolic function
AUSCULTATION:
* The first sound (B1) is often decreased
* Click proto-systolic if the valves remained flexible
* The breath is harsh and raspy mésosystolique timbre; max home aor-tic or left sternal border; radiating to the carotid
* It is reinforced after long diastole (when arrhythmia)
* B2 is normal in the RA bit tight; decreased or abolished in tight RA
* Presence of audible B4 (presystolic gallop): This is due to gallop LVH and does not indicate heart failure.
* Tight RA: B2 decreased or abolished; B2 split at the base (the aortic cusps close later).
4- aortic insufficiency:
* Syndrome Laubry-Pezzy = IA + CIV (congenital)
* In front of chest pain onset of an unknown aortic insufficiency breath has great diagnostic value for aortic dissection
* Maintain a normal systemic flow-through hypertrophy left ventricular dilatation. Hypertrophy is suitable for expansion
* De Musset’s sign: rhythmic movement of the head from the heart beat
* Functional Angor two mechanisms -> drop in diastolic aortic pressure and LVH; it is readily nitrorésistant
* A diastolic pressure <50 mmHg translated severe aortic insufficiency
* ECG LVH with diastolic type of overload; incomplete block is common; by against the complete LBBB is rare unless associated with RA.
* Rx: arc left hyperconcave way; dilatation of the ascending aorta (upper right arc); enlargement of the AIG with plunging tip under the diaphragm.
* Fluoroscopy: sign of the bell (aortic pedicle hyperpulsatile)
* Coronary angiography: same as RA
* The 2 best prognostic factors are age and size of the LV; to report to the body surface.
* Nifedipine and ACE inhibitors in promoting the ejection into the aorta earlier than the decrease regurgitation and LV dilatation
AUSCULTATION:
* Protodiastolic Breath; max frequently along the left sternal border; radiating to the tip or xiphoid. Soft patch, aspirative
* Aortic systolic murmur in common household (even without RA)
* Pistol-shot: mésosystolique slamming perceived subclavian region; it reflects the vigorous systolic jet on the aortic wall (important IA)
* Diastolic Bearing Flint to mitral valve; reflects the partial closure of the mitral valve (functional RM)
5- mechanical prosthesis:
* The most used mechanical prosthesis is currently the prosthesis double swivel blade types Jude Medical.
* For ball valves (Starr-Edwards) means a burst of openness noise and other mechanical valves mean a burst of closing noise (B1 or B2)
* In the aortic position: breath éjectionnel (2/6) Constant
* In the mitral position: Inaudible diastolic rumble or very low
* Never regurgitation breath always pathological
* Need for prevention of endocarditis Osler
* Early infective endocarditis prosthetic: the usual germ is Staphylococcus coagulase negative.
