Mitral Valve disease (Stenosis,Insuficiency)
F.S.SADR MD FACS
MITRAL VALVE DISEASE COULD CAUSE MITRAL STENOSIS (MS) OR REGURGITATION (MR).IN MITRAL STENOSIS(MS) TOO LITTLE BLOOD DRAINS TO THE MAIN PUMPING CHAMBER OF THE HEART (LEFT VENTRICLE,LV),IN CONTRAST WITH MITRAL REGURGITATION (MR) PORTION OF THE BLOOD FROM LEFT VENTRICLE WILL REGURGITATE IN TO THE LEFT ATRIUM (CHAMBER ABOVE MITRAL VALVE) THROUGH THE MITRAL VALVE AND SUBSEQUENTLY BLOOD WILL BACK UP IN TO THE LUNGS AND CAUSES NUMEROUS SYMPTOMS.
INDICATIONS FOR SPECIFIC VALVE TYPE WHETHER THEY BE MECHANICAL OR BIOPROSTHESIS ,HAVE BEEN REGOROUSLY DEFINED IN RECENT YEARS .CANDIDATE FOR BIOPROSTHESIS WOULD BE:-
OLDERS PATIENT
- PATIENTS WHO ARE NONCOMPLIANT.
- PATIENTS WHO HAVE CONTRAINDICATIONS TO ANTICOAGULATION .
- PATIENT IN NORMAL SINUS RHYTHEM.
- YOUNG FEMALE DESIROUS OF FUTURE PREGNANCY.
RECENT DATA SUGGEST THAT PATIENT AGE AND PRESENCE OF CORONARY ARTERY DISEASE MAY SIGNIFICANTLY ALTER THE INDICATIONS FOR MECHANICAL OR BIOPROSTHESIS(TISSUE VALVES).SURVIVAL FOR MITRAL VALVE REPLACEMENT IS AFFECTED BY ETIOLOGY OF THE VALVE DISEASE NECESSITATING THE OPERATION.
THE BEST SURVIVAL OCCURS IN PATIENTS IN WHOM THE MITRAL VALVE REPLACEMENT IS FOR MYXOID DEGENERATION (NONRHEUMATIC,NON CALCIFIC)
MEDIAN SURVIVAL FOR MITRAL VALVE REPLACEMENT IN THE 60 AND 70 YEARS OLD GROUPS IS 11 YEARS IF THER IS NO CORONARY ARTERY DISEASE ,BUT ONLY 5.5 YEARS IF CORONARY ARTERY BY PASS HAS TO BE PERFRMED.OTHER FACTORS BEING EQUAL ,TISSUE VALVES APPEAR MOST APPROPRITE FOR MITRAL VALVE PATIENTS WITH CORONARY ARTERY DISEASE OVER AGE 60.
IN PATIENTS 60 TO 70 YEARS OF AGE WITHOUT CORONARY DISEASE , SURVIVAL AFTER MITRAL VALVE REPLACEMENT IS SIMILAR TO THAT AFTER AORTIC VALVE REPLACEMENT AND SUGGEST MECHANICAL VALVES MAY BE PREFERABLE,AS IT IS IN ALL PATIENTS LESS THAN 60 YEARS OF AGE. PATIENTS WITH MITRAL INSUFCIENCY IN MAJORITY,VALVE REPAIR COULD BE DONE.
Click to view the Mitral valve homograft movies.
Mozart.