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Common Congenital Heart Lesions - page 18 / 126

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Diagnostic imaging/testing:

  • Electrocardiogram:

    • o

      Typically shows left atrial enlargement; if pulmonary HTN has developed, right ventricular hypertrophy. Atrial fibrillation may be present. Note: there is no LV enlargement here!

  • Chest X-Ray:

      • o

        Reveals left atrial enlargement, pulmonary vascular redistribution, interstitial edema, Kerley B lines (due to edema within the pulmonary septae)

      • o

        If have developed pulmonary HTN, right ventricular enlargement and prominence of pulmonary arteries also appears.

  • Echocardiography:

      • o

        MAJOR diagnostic value in MS. Reveals thickened mitral leaflets, abnormal fusion of their commissures with restricted separation during diastole.

      • o

        Left atrial enlargement can be assessed and, if present, intra-atrial thrombus may be visualized

      • o

        Mitral valve area can be measured from cross-sectional views or calculated from Doppler-echocardiographic velocity measurements (normal mitral valve area = 4-6 cm2, mild MS 2 cm2, critical MS 1 cm2.

  • Cardiac Catheterization:

      • o

        Not necessary to confirm diagnosis of MS, but can assist in assessing valve area and checking for the presence of mitral regurg, pulmonary HTN, or coronary artery disease.

Treatment:

  • Medications:

oProphylaxis against recurrent ARF in young patients. oProphylaxis against infective endocarditis in all patients. oDiuretics used to treat symptoms of vascular congestion. oDigoxin useful only if MS is accompanied by impaired LV contractile function or atrial fibrillation (it can slow

the heart rate). oβ-blockers or calcium channel antagonists may be useful to slow the heart rate. oAnticoagulant therapy is given to patients with MS and associated atrial fibrillation to prevent

thromboembolism.

  • Mechanical correction (if meds don’t work):

oPercutaneous balloon mitral valvuloplasty: balloon catheter from femoral vein into the RA, through the atrial septum, into the mitral valve where the balloon is rapidly inflated to “crack” open the fused commissures (this procedure best in absence of complications such as MR, extensive calcification, or atrial thrombus). Better outcome than surgeries. oOpen mitral commissurotomy: surgery – the stenotic commissures are separated under direct visualization. oMitral valve replacement: only for severe disease – has a 1-2% perioperative mortality, but a 10 year survival rate exceeding 80%.

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