The normal cardiac valves help to maintain the unidirectional flow and allow the four chambers of the heart to function as individual units (with different pressure and flow characteristics) without interfering with each other. In developed countries, the prevalence of valvular heart disease is estimated at 2.5%. Anaesthetists must know the pathophysiology of these conditions thoroughly to formulate a meticulous peri-operative plan ensuring a favourable outcome for the patient.
Classification of valvular heart disease:
- Congenital valvular heart disease (atresia, stenosis, malposition, abnormalities of valve structure-bicuspid valves)
- Acquired heart valve disease
- Endocarditis (regurgitation more common)
- Rheumatic heart disease: Mitral stenosis (MS), mitral regurgitation (MR), aortic stenosis (AS), aortic regurgitation (AR)
- Senile calcific AS
- Myxomatous mitral valve prolapse leading to regurgitation.
The most common valvular lesions in clinical settings are MS and AS.
A diseased valve, may become inefficient and allow back-flow: Regurgitation or become stenotic and hinder forward flow: Stenosis.
We can get Aortic/Mitral/Pulmonary/tricuspid stenosis or regurgitation or a combination of these.
We shall be discussing only the most important and exam-relevant lesions.
Mitral stenosis
The most important valvular heart disease. A diseased mitral valve has severe implications.
Characteristics of a normal mitral valve-
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