Mitral Critical And Methods : Case Study

The flow of blood through the heart is controlled by four valves. If any are not working correctly, blood cannot flow or be pumped effectively to the heart. The four valves are: the tricuspid, pulmonary semilunar, mitral, and aortic semilunar. There are many abnormalities or defects that can affect their operation and in this paper, I will discuss the most common one which is a “mitral valve prolapse.” A valvular prolapse is an abnormal protrusion of a heart valve that causes the valve to not close completely. It is also known as “click murmur syndrome” and “Barlow’s syndrome” and is more prevalent in women than men. It has a strong hereditary

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Mitral valve prolapse (MVP) was first characterized by Barlow and Bosman in the 1960s.(Barlow and Bosman) It was first called Barlow’s Syndrome before being called mitral valve prolapse by Criley (Barlow and Bosman),(Criley et al.). Barlow’s syndrome was diagnosed by electrocardiogram, phonocardiogram and chest X-ray.3 The mitral valve apparatus includes tow leaflets, chordae tendineae, anulus, left atrium, papillary muscles and left ventricular wall (Devereux et al.). Mitral valve prolapse involves the leaflets, chordae, annulus and left ventricular wall.(Devereux et al.) The anterior leaflet is relatively long and semi-circular, while the posterior leaflet is shorter in normal patients.(Irvine et al.) Most commonly the posterior leaflet is affected.(Devereux et al.) During systole the leaflet balloons in to the left ventricle.(Devereux et al.) Physically, in a patient with mitral valve prolapse, the leaflet is displaced beyond the mitral anulus.(Levine et al.)

Mitral valve prolapse is usually detected through a routine physical. Most patients do not have any symptoms when the murmur may be heard. When auscultation occurs, you will hear a normal S1 and quiet systole. The valve will then have a mid-systolic click that is very pronounced. A crescendo-decrescendo is immediately heard after the mid-systolic click. This is best heard in the apex area of the chest. (Systolic Murmurs- Mitral Valve Prolapse) To properly diagnose the disorder an echocardiogram has to be done. An echocardiogram is an ultrasound of the heart that can show the characteristics of the valve and to examine if the valve is allowing leakage or backflow. (National Heart, Lung, and Blood Institute, 2011) Misdiagnosis in the past effected 5-15 percent of patients who were actually suffering from other conditions that were causing the valves to bulge and mimic mitral valve prolapse. In the years past doctors would prescribe antibiotics to patients who was having dental procedures done but The American Heart Association does not recommend the prescribing

A doctor may also suggest treatment later in a person’s life, if the disease worsens. If a cardiologist suggests medical treatment, two options include: Mitral Valve Repair or Mitral Valve Replacement. “If the patient chooses to have Mitral Valve Replacement, he or she should find a surgeon who satisfies three criteria; the surgeon should have a 90 percent or greater rate of successful repair, should have an extremely low rate of death from surgery (less than 1 percent) and should be proficient in operating with less invasive approaches, if your surgeon cannot provide these sorts of numbers, you need to move to another” (Gillinov 326). By reconnecting valve leaflets a surgeon can perform Mitral Valve Repair (mayoclinic.org). A surgeon can also remove excess tissue from the valve for a repair (mayoclinic.org). “The traditional approach to most aortic valve problems is to open the chest, remove the old valve, and sew in a new one” (Gillinov

Mitral Valve Prolapse (MVP) is also knows as Barlow’s Syndrome or Click Murmur Syndrome and it affects about 2-6% of the United States population. While Mitral Valve Prolapse is one of the most common heart valve abnormality that can develop in any person at any age. It is usually not life-threatening and the patient might not even have symptoms. A patient might feel symptoms such as Fatigue, chest pain, or palpitations, which will cause a doctor to run tests such as an echocardiogram; causing a detection and confirmation of the Mitral valve prolapse. The MVP abnormality is caused when one or both of the mitral valve flaps are enlarged or have extra tissue. Causing the valve leaflets to not close correctly and allow leakage of blood back into

The right and left side of the heart are similar in structural components. Both sides contain a AV valve, semilunar outflow valve and smooth and muscular parts. The main difference between the two sides is size. The muscle of the left ventricles is thicker than the right side. The cavities are the same size and pump the same amount of blood. The left ventricle pumps with more power to profuse the entire body. The right ventricle profuse the lungs. The systemic resistance of the left ventricle is much higher than the pulmonary flow. The right

This method demonstrates impaired relaxation and filling because it delivers straight measurement of ventricular diastolic pressure. But, the balance of benefit, harm and cost can debate against its use to diagnose diastolic dysfunction. The other technique which can be used to diagnose diastolic heart failure is Doppler echocardiography. Doppler echocardiography is used to assess cardiac diastolic function, which can confirm the diagnosis of diastolic heart failure. For example, according to the online article, “Diastolic heart failure: challenges of diagnosis and treatment” states “echocardiographic measurement of tau, the time constant of left ventricular pressure decay during isovolunteric relaxation, can be performed to assess left ventricular stiffness.” Doppler echocardiography plays an important role to evaluate the characteristic of diastolic Trans-mitral-value- blood flow. Doppler echocardiography helps to measure the peak velocities of blood flow during early diastolic filling (E wave) and atrial contraction (A wave) and then ratio is calculated. When the heart is working normal, the early filling E-wave velocity is greater than the A-wave velocity and E to A wave ratio is 1.5. But, in diastolic dysfunction, this correlation reverses, because stiffness increases and the relaxation of heart occur slowly and E to A wave ratio decreases to 1.0. Also, as the diastolic

Background: most of the previous studies agreed that the moderate rheumatic aortic regurgitation is a benign disease that has a slow progression over a very long period of time. There is no major consensus on how to deal with concomitant moderate rheumatic aortic regurgitation during mitral valve surgery.

The significance of establishing and confirming a diagnosis is important in the management of any health conditions , Aortic regurgitation is a progressive heart failure related with a calcified inadequate aortic valves and a very large heart. Therefore the plan is to implement investigations that will confirm the diagnosis and severity of aortic regurgitation , in order to agree on treatment options. Cox, C (2010) states that recognizing the red flags in the history and physical examination helps to determine the treatment of underlying physical conditions. Investigations included respiratory and cardiac monitoring for example a 12 lead ECG to establish any signs of arrhythmias and measurement of oxygen saturation. The ECG in patients

Aortic stenosis is the narrowing down of the opening of the aortic heart valve, this is a common valvular disease in the modern world. The aortic stenosis is classified into two types, congenital and acquired. In congenital aortic stenosis, it is often observed that the malformation of a bicuspid valve instead of a natural tricuspid valve. The leaflets are fused to create a bicuspid structure. While in acquired stenosis, there is narrowing down of the valve opening due to calcification which usually starts from the roots and extends to the end of the opening creating a stiffened and narrowed opening as shown in Figure 7 [22]. This calcification process formed over the course of decades of unhealthy diet, smoking, obesity and other cardio vascular

Precise measurements of aortic valve stenosis are fundamental in determining whether or not an aortic valve replacement is necessary when managing patients with aortic stenosis. Doppler echocardiography is used to evaluate the progression of aortic stenosis, however, this imaging technique involves certain limitations. One of the limitations, is determining which parameter to use when evaluating the severity of aortic stenosis. There are four parameters used: transvalvular gradient, aortic valve area, peak aortic jet velocity and multidetector computed tomography; each parameter have their own advantages and disadvantages. Another limitation, is determining which modality to use when a single parameter is the cause of inaccurate grading of

Mitral stenosis refers to narrowing of the mitral valve resulting in obstruction of blood flow from the left atrium to the left ventricle. The mitral valve is damaged and deformed predisposing it to scarring and narrowing (stenosis) later in life. Rheumatic mitral stenosis is associated with thickening of the mitral valve leaflets and fusion of commissures and chordae tendineae together with fibrosis and calcification. Hypertrophy of the left atrium develops and may be followed by right sided heart failure and pulmonary edema. Symptoms usually develop when the mitral valve area decreases below 2.5cm2 and it is classified as “mild” stenosis .When the mitral valve area decreases below 1.5cm2 it is regarded as “moderate’ stenosis and when

Thus, the results of EVEREST II and the fact that long-term outcomes of MitraClip® therapy (even if successful) are not yet available; both present the clinician caring for patients with MR a mixed portfolio of outcomes (Table 20.2). The bottom line question that must be applied to patients being considered for MitraClip® therapy is whether a therapy which is less effective, but safer is acceptable. In a report from the Cleveland Clinic surgical repair of degenerative (prolapse) MR provides an operative risk of <0.1% and 15-year survival of 76%, superior to the age- and sex-matched U.S. population (13). At 10 years, freedom from mitral reoperation was 97%, and 77% had no or 1+ MR. Given such excellent results of surgical repair of degenerative

Subclinical carditis i.e. valve regurgitation detected with echocardiography but not associated with a murmur typical of mitral or aortic regurgitation, is included as a major manifestation of ARF. Valve regurgitation will improve in 25-50% within one year of the acute episode if secondary prophylaxis is well delivered.It also endorses the 2012 World Heart Federation guidelines for echocardiographic diagnosis of chronic RHD. As there is no differentiation of the colour-Doppler findings of acute carditis and that of chronic rheumatic valve regurgitation the same criteria are recommended for defining the acute phase and the chronic phase.The minimal echo criteria for diagnosis of pathological MR are delineated. The jet should be seen in atleast 2 views with jet length more than 2 cm in atleast one view.The peak velocity should be >3m/s and it should be pansystolic in atleast one envelope. A regurgitant jet length should be measured from the vena contracta to the last pixel of regurgitantcolour (blue or red).These criteria assume importance in the light of the finding that the proportion of children with physiological valve regurgitation in a New Zealand population was 15%and this proportion increases in later decades.