Exam 2 - Mitral & Aortic Valve

Mitral Annular Calcification (MAC)

Annulus of MV degenerates

Results in echogenic, shelf-like, irregular lumpy deposits

Exacerbates MV stenosis & regurgitation

Causes of Mitral Annular Calcification

Advancing age

Atherosclerosis

Hypertension

Hypercholesterolemia

Diabetes

Chronic kidney disease

MV prolapse

Post Radiation treatments

Congenital metabolic disorders

Most likely valve to prolapse

MV

Mild Mitral Annular Calcification

Focal areas of increased echogenicity around MV annulus

Moderate Mitral Annular Calcification

1/3 to 1/2 of the MV annulus has increased echogenicity

Severe Mitral Annular Calcification

More than ½ of the MV annulus has increased echogenicity

Causes of MV Stenosis

Rheumatic Heart Disease

Calcium deposits

Radiation therapy

Signs & Symptoms of MV Stenosis

Difficulty breathing

Hemoptysis - coughing blood

Hoarseness

Syncope

Peripheral edema

Palpitations

Murmur

CVA/TIA

ABNL EKG

2D Features of MV Stenosis

Hockey stick appearance of anterior leaflet

Fibrosis & shortening of chordae

"Smoke" in chambers

LA enlargement

LV enlargement & hypertrophy

RV enlargement & hypertrophy

M-Mode Features of MV Stenosis

Decreased E-F slope

Decreased A wave

Reduced D-E excursion

Doppler Features of MV Stenosis

Increased A wave

Increased pressure half-time

Spectral broadening

Causes of MV Regurgitation

Mitral annular calcification

Marfan's Syndrome

Myxomatous MV disease

Hypertrophic obstructive cardiomyopathy

Signs & Symptoms of MV Regurgitation

Murmur

Difficulty breathing

Pulmonary HTN

Arrhythmia

ABNL EKG

2D Features of MV Regurgitation

LA enlargment

LV volume overload

IAS bowing

M-Mode Features of MV Regurgitation

Incomplete closure of MV in systole

Increased E-F slope

Early AV closure or mid-systolic notching

Possible prolapse

Doppler Features of MV Regurgitation

Retrograde flow into LA during systole

Parabolic flow profile below baseline

Spectral broadening

Decreased S & D waves of pulmonary V. inflow

MV Prolapse is almost always associated with...

MV regurgitation

Causes of MV Prolapse

Unknown

Connective tissue disorders - Marfan's

Heredity

Drugs

Rheumatic fever

Graves' disease

MV Prolapse is best viewed in...

PLAX

Apical 4 chamber

Clinical Findings of MV Prolapse

Mid-systolic click

Cardiomegaly

Murmur

Normal EKG

Signs & Symptoms of MV Prolapse

Asymptomatic

Chest pain/discomfort

Palpitations

Lightheadedness/syncope

Shortness of breath

Headaches

Cough

M-Mode Features of MV Prolapse

Posterior displacement of leaflet(s)

Posterior hammocking of C-D segment

2D Features of MV Prolapse

Arching of leaflet(s) into LA

Scalloped appearance of leaflets

Doppler Features of MV Prolapse

Mitral regurgitation

Posterior jet - if anterior leaflet prolapses

Anterior jet - if posterior leaflet prolapses

Maneuvers to enhance diagnostic accuracy of MV Prolapse

Patient supine, sitting, standing

Valsalva maneuver

Amyl nitrate

Sequelae of MV Prolapse

Risk for infective endocarditis

Ruptured chordae

Embolis

Sudden death

Treatments for MV Prolapse

Medications to prevent infection & regulate heart rhythm

Blood thinners

Diuretics

MV repair or replacement

Causes of LVOT Obstructions

Hypertrophy of IVS

Features of LVOT Obstruction

Narrowed outlet

Turbulence & increased velocities

LV hypertrophy, enlargement, and eventual failure

Can be subvalvular, valvular, or supravalvular

Causes of AV Stenosis

Rheumatic Heart Disease

Obstruction

Endocarditis/vegetations

Prosthetic valve dysfunction

Bicuspid or unicuspid valve

AO stenosis/coarctation

Age related degeneration

Signs & Symptoms of AV Stenosis

Angina

Heart attack/stoke

Congestive heart failure

Murmur/arrythmia

Syncope/dizziness

Difficulty breathing

Pulmonary edema

Decreased cardiac output

Sudden death

2D Features of AV Stenosis

Thickened cusps with restricted motion

Doming of cusps

Reduced valvular orifice

Possible fusion of cusps

LA enlargement

LV enlargement & hypertrophy

Ascending AO dilation

M-Mode Features of AV Stenosis

Decreased cusp separation

Doppler Features of AV Stenosis

Increased velocities

Spectral broadening

Causes of AV Regurgitation

Chamber Enlargement

Trauma

Intracardiac devices

Endocarditis/vegetations

Masses

Valve Prolapse

Rheumatic heart disease

Prosthetic valve dysfunction

Age related degeneration

Bicuspid AV

Ascending Aortic dilatation

Aortic dissection

Signs & Symptoms of AV Regurgitation

Angina

Difficulty breathing

Excessive sweating

Pounding pulse

Murmur

Syncope/dizziness

2D Features of AV Regurgitation

LV enlargement & hypertrophy

Decreased LV function

Thickened, non-coapting leaflets with abnormal motion

Annular dilatation

M-Mode Features of AV Regurgitation

Non-coaptation of cusps in diastole

Decreased D-E excursion

Prominent A wave

Doppler Features of AV Regurgitation

Retrograde flow into LV during diastole

Trapezoidal flow profile above baseline

Spectral broadening

AV Prolapse

Abnormal motion of cusps

If present, there should be AI

Not common here

AV Masses

Endocarditis - vegetations

Masses from LV