surgical treatment for mitral valve disorders cv nurses
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Surgical treatment for mitral valve disorders cv nursesTRANSCRIPT
SURGICAL TREATMENT FOR MITRAL VALVE DISORDERS
Mohammad Shihata
Anatomy
Diastole Systole
Anatomy
Mitral Annulas
Anterior Leaflet
Posterior Leaflet
Chordae
Papillary Muscles
Left Ventricle
Normal MV
Anatomy
Echocardiography
Mitral Stenosis
Rheumatic Heart Disease Severe Degenerative Calcification Congenital LA Myxoma Carcinoid Supramitral Ring
Mitral Stenosis
Mitral Stenosis Normal
Clinical Picture
Asymptomatic
Chest Pain
Shortness of Breath
Thromboembolic complications
Atrial Fibrillation
Mitral Regurgitation
(MVP) Myxomatous Degenerative ( Annular Calcification ) Endocarditis Ischemic
Congenital Acute Rheumatic Heart Disease
Functional Classification of MR
Guidelines
PMBV
Anticoagulation in Mitral Stenosis Atrial Fibrillation
Previous embolic event
Left Atrial Thrombus
Severe MS ; LA > 55mm
Indications for Surgery in MS Symptomatic and gradient > 10mm Hg
CHF NYHA 2 – 3
Associated moderate to severe MR
Unavailable or Unsuccessful PBMV
LA thrombus
Asymptomatic with Severe PAH
Surgical Indications in Severe MR Symptomatic Severe MR Asymptomatic Severe MR LVEF < 60% LVESD > 40mm Pulmonary HTN New Onset Atrial Fibrillation Congenital Abnormality of the valve
apparatus
Repair vs. Replacement
> 80% of regurgitant Mitral valves are repairable
Repair produces more physiological flow states
It better preserves LV function
Less thromboembolic events
Long durability
Lower risk of Endocarditis
Surgical Approach
Everest II Trial
Randomized Arm High Risk Registry Arm
This study arm compares the E-valve PMR procedure to
the current standard of care, mitral valve surgery.Initiated in late 2005, this arm will enrol
approximately300 patients.
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