26 / 56
38
Chapter 2
•
Cardiovascular Care
PICTURING
PATHO
Disease of the aortic valve as viewed from the aorta.
A.
Stenosis of
the valve opening.
B.
An incompetent valve that is unable to close
completely. (Reprinted with permission from Porth C.
Essentials of
Pathophysiology
. 4th ed. Philadelphia: Wolters Kluwer; 2015.)
Thickened and
stenotic valve
leaflets
A
Retracted
fibrosed valve
leaflets
B
Affected
Valve
Causes
Aortic
stenosis
Bicuspid aortic valve (or
other congenital valve
anomaly)
Aortic valve sclerosis
Aortic
regurgitation
Dilation of the ascending
aorta, usually related to
hypertension and age
Mitral
stenosis
Rheumatic heart disease
Mitral
regurgitation
Myxomatous
degeneration (mitral
valve prolapse)
Tricuspid
regurgitation
Rheumatic heart disease
Prolapse
Congenital (Ebstein’s)
IE
Radiation
Carcinoid
Blunt chest wall
Trauma
RV endomyocardial
biopsy-related trauma
Intra-annular RV
pacemaker
Implantable cardioverter-defibrillator leads
Tricuspid
Stenosis
Rheumatic heart disease
Pulmonic
Stenosis
Congenital disorder
Less common etiologies
include carcinoid and
obstructing vegetations
or tumors
Pulmonic
regurgitation
Primary follows childhood
surgery for tetralogy of
Fallot or other congenital
lesions that may progress
insidiously
Aortic valve stenosis
Mitral valve regurgitation
Mitral valve stenosis
Aortic valve regurgitation
Pulmonary veins
Aortic valve
Mitral valve
Systole
Diastole
Left atrium
Left ventricle
Alterations in hemodynamic function that accompany aortic valve stenosis, mitral valve
regurgitation, mitral valve stenosis, and aortic valve regurgitation. The
thin arrows
indicate
direction of normal flow and the
thick arrows
indicate the direction of abnormal flow.
(Reprinted with permission from Porth C.
Essentials of Pathophysiology
. 4th ed. Philadelphia:
Wolters Kluwer; 2015.)
Treatment
Treatment depends on affected valve: