Penyakit Katup : Mitral Stenosis Mitral Regurgitation Andrianto

THE PAST : Majority cases was pts with a history of rheumatic fever

TO DAY : Degenerative valve disease in aging population as the leading etiology.

Passik CS et al, Temporal changes in the causes of aortic stenosis: Mayo Clin Proc 1987;62:119123.

Valvular lesions is mechanical disease, need interventions for definitive therapy .

The clinical presentation & cardiac dysfunction of valvular HF varies depending on : - the valve involved, - its defect, - the precipitating cause.

Medical treatment as alternative realistic option in high risk patients for surgical intervention.

High exciting advance in medical treatment to delaying and avoiding for surgical correction.

Interested Points.

Stenotic valve lesions:Need a long latent periodCorrelates with severity of stenosis

Regurgitant valve lesions:Present in acute or chronic stagesCorrelates less-well with extent of regurgitation

Require little additional tx when symptom-freeNeed mechanical intervention (non-surgical or surgical correction)

Mild-moderate disease : medical tx & periodic f.u No medical therapy is proven to effectively treat Almost need surgical correction for defintive tx. Surgical approach: REPAIR or REPLACEMENT

The most common cause :Rheumatic FeverCardiac morphology : LA enlargementBalloon Mitral Valvoplasty /PTMC preferred over surgical valve repair or replacementPTMC Procedure

Management strategy for pts with MS. The AHA guidelines & scientific statements handbook,2009

Salt restrictionDiuretics Cardioversion or rate control in AF Long term anticoagulant Quite limited . Primarily aimed at treating complication.

The most common cause : MV prolapse, ischemia or any cause of LV dilatation.Cardiac morphology : Massive LV enlargement & hypertrophy, LA enlargementDefinitive tx : Mitral Valve Replacement

Management strategy for pts with MS.

The AHA guidelines & scientific statements handbook,2009

Restricting physical activitiesReducing sodium intake DiureticVasodilatorAfterload reducing agents (ACE-I, ARB, hydralazine-nitrates)Digoxin Anticoagulant tx.

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