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Acquired Mitral Stenosis in the Adult PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "ACQUIRED MITRAL STENOSIS IN THE ADULT".

This medical PowerPoint presentation talks about acquired mitral stenosis in the adult.

Mitral stenosis is a condition where the mitral valve, which is located between the left atrium and the left ventricle of the heart, becomes narrowed, leading to obstruction of blood flow from the atrium to the ventricle. This can cause a range of symptoms, including shortness of breath, chest pain, and fatigue.

In adults, acquired mitral stenosis is usually caused by rheumatic fever, which is a complication of untreated streptococcal infection. The infection triggers an autoimmune response that can cause inflammation and scarring of the heart valves, including the mitral valve.

Tags : acquired mitral stenosis in the adult, mitral valve, rheumatic fever, untreated streptococcal infection, Cardiothoracic Surgery, cardiology, cardiology PowerPoint presentation

Published on : Mar 19, 2023 | Views : 1564 | Downloads : 2

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Slide 1-

ACQUIRED MITRAL STENOSIS IN THE ADULT ASE 2 Minute Tutorials: MS
Slide 2-

Rheumatic Calcific Two main etiologies Leaflet thickening most pronounced at the tips, giving the characteristic “hockey-stick” appearance. Severe calcification of the mitral annulus, extending into the leaflets. Typically seen in the elderly (“senile”). ASE 2 Minute Tutorials: MS Commissural fusion. Rheumatic mitral stenosis, although uncommon, is more frequently the cause of mitral stenosis that is severe enough to require intervention. Mitral annular calcification is much more common, though it is less often severe enough to cause significant stenosis.
Slide 3-

Anatomic - Mitral valve area (MVA) by: *Planimetry (2D and 3D) *Continuity *PISA Severity assessment ASE 2 Minute Tutorials: MS Hemodynamic - Transmitral gradient (heart rate and flow dependent) Pressure half time (PHT) Pulmonary artery systolic pressure (PASP) Classification - Severe, if MVA is ≤1.5 cm2 ; PHT ≥ 150 ms - Very severe, if MVA is ≤ 1.0 cm2 ; PHT ≥ 220 ms
Slide 4-

2D MVA by planimetry (2D and 3D) ASE 2 Minute Tutorials: MS 3D 3D planimetry, whenever feasible, is more accurate than to 2D planimetry, and is therefore the preferred methodology.
Slide 5-

Principle The stroke volumes proximal and distal to the stenotic mitral valve must be equal. Mitral inflow = Aortic outflow MVA by continuity ASE 2 Minute Tutorials: MS D= LVOT diameter VTI = Velocity time integral D VTIAortic VTIMitral
Slide 6-

Principle As flow accelerates towards the narrowed MV orifice, it forms hemispheric shells of increasing velocity and decreasing radius. Because of mitral leaflet doming and the funnel shaped inflow, an angle correction factor of â°/180° needs to be accounted for, with â being the angle between the 2 leaflets at the atrial side. MVA = 6.28 r2 x Aliasvel/PeakMSvelocity x â°/180° MVA by PISA ASE 2 Minute Tutorials: MS r = PISA radius Aliasvel = Aliasing velocity PeakMSvelocity = Peak MS velocity â° = angle between the 2 leaflets â°
Slide 7-

Principle The mean pressure gradient varies with heart rate and forward ﬂow. However, usually*: <5 mm Hg – mild MS 5–10 mm Hg – moderate MS >10 mm Hg – severe MS *at heart rates between 60-80 bpm and in sinus rhythm. Transmitral gradient ASE 2 Minute Tutorials: MS
Slide 8-

Principle The PHT reflects the time taken for the trans-mitral pressure gradient to decay to half its value at the onset of diastole. There is a linear and inverse relationship between MVA and PHT: the more severe the MS, the longer the PHT Empirical formula to derive MVA from PHT: MVA = 220/PHT Pressure Half Time (PHT) ASE 2 Minute Tutorials: MS
Slide 9-

Principle The obstruction of flow at the mitral orifice results in pulmonary hypertension. The degree of pulmonary hypertension is a measure of the hemodynamic burden of MS. Elevated pulmonary artery systolic pressure (PASP) >30 mm Hg is typically seen in severe MS. PASP can be estimated by measuring the tricuspid regurgitant jet maximum velocity by continuous wave (CW) spectral Doppler. PASP = 4 (TR VMax)2 + RA pressure Estimated pulmonary pressure ASE 2 Minute Tutorials: MS
Slide 10-

Principle Exercise stress testing ASE 2 Minute Tutorials: MS Mitral stenosis is considered hemodynamically significant, if during exercise: Pulmonary artery wedge pressure is greater than 25 mm Hg or, Mean mitral valve gradient is greater than 15 mm Hg. Mean gradient of 9 mmHg at rest (HR of 72 bpm) Exercise Mean gradient of 19 mmHg with exercise (HR of 110 bpm)
Slide 11-

Intervention ASE 2 Minute Tutorials: MS Types Indications - Mitral Valve Surgery. - PMBC: Percutaneous mitral balloon commissurotomy (typically performed under TEE guidance). Nishimura et.al. J Am Coll Cardiol. 2014;63:e57-185
Slide 12-

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, 3rd, Thomas JD. 2014 aha/acc guideline for the management of patients with valvular heart disease: A report of the american college of cardiology/american heart association task force on practice guidelines. J Am Coll Cardiol. 2014;63:e57-185 https://www.sciencedirect.com/science/article/pii/S0735109714012790?via%3Dihub Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quinones M. Echocardiographic assessment of valve stenosis: Eae/ase recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22:1-23 https://www.asecho.org/wp-content/uploads/2014/05/2009_Echo-Assessment-of-Valve-Stenosis.pdf References ASE 2 Minute Tutorials: MS