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Cardiology Expert System
VALVULAR HEART DISEASE
Is any disease process involving one or more of the valves of the heart (the aortic and mitral valves on the left and the pulmonary and tricuspid valves on the right). Valve problems may be congenital (inborn) or acquired (due to another cause later in life). Treatment may be with medication but often (depending on the severity) involves valve repair or replacement (insertion of an artificial heart valve ). Specific situations include those where additional demands are made on the circulation, such as in pregnancy .
Valvular heart diseases are
. Mitral Stenosis
. Pulmonary HTN
In normal cardiac physiology, the mitral valve opens during left ventricular diastole , to allow blood to flow from the left atrium to the left ventricle . Blood flows in the proper direction because during this phase of the cardiac cycle the pressure in the left ventricle is lower than the pressure in the left atrium, and the blood flows down the pressure gradient . In the case of mitral stenosis, the valve does not open completely, and to transport the same amount of blood the left atrium needs a higher pressure than normal to overcome the increased gradient.
Most cases of mitral stenosis are due to disease in the heart secondary to rheumatic fever and the consequent rheumatic heart disease . Less common causes of mitral stenosis are calcification of the mitral valve leaflets, and as a form of congenital heart disease . However, there are primary causes of mitral stenosis that emanate from a cleft mitral valve . Other causes include Bacterial endocarditis where the vegetations may favor increase risk of stenosis.
Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart . This causes increased resistance to blood flow through the valve. It is almost always caused by rheumatic fever and is generally accompanied by mitral stenosis . Rare other causes include carcinoid syndrome , endocarditis , endomyocardial fibrosis , lupus erythematosus , right atrial myxoma and congenital tricuspid atresia .
A mid diastolic murmur can be heard during auscultation caused by the blood flow through the stenotic valve. It is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide splitting S1. May increase in intensity with inspiration ( Carvallo's sign ). The diagnosis and the severity can be assessed by echocardiography .
The treatment is usually by surgery (tricuspid valve replacement ) or percutaneous balloon valvuloplasty . The resultant tricuspid regurgitation from percutaneous treatment is better tolerated than insufficiency occurring during mitral valvuloplasty
The aortic valve controls the direction of blood flow from the left ventricle to the aorta . When in good working order, the aortic valve does not impede the flow of blood between these two spaces. Under some circumstances, the aortic valve becomes narrower than normal, impeding the flow of blood. This is known as aortic valve stenosis, or aortic stenosis, often abbreviated as AS .
Pulmonary valve stenosis is a valvular heart disease in which outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve . This results in the reduction of flow of blood to the lungs . Valvular pulmonic stenosis accounts for 80% of right ventricular outflow tract obstruction.  While the most common cause of pulmonary valve stenosis is congenital heart disease, it may also be due to rheumatic heart disease or a malignant carcinoid tumor. 
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