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Common Congenital Heart Lesions - page 21 / 126

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Diagnostic imaging/testing:

  • Chest X-Ray:

oIn Chronic MR: LV and LA enlargement, calcification of mitral annulus may be seen if it is the cause of MR

  • Electrocardiogram:

oTypically shows LA enlargement and signs of LV hypertrophy.

  • Echocardiography: oCan often identify structural cause of MR. oCan grade its severity by color Doppler analysis. oLV size and function (stroke volume often increased due to Frank-Sterling compensation for the inc. volume)

  • Cardiac Catheterization:

    • o

      Useful for identifying a coronary ischemic cause and for grading the severity of the MR.

  • The characteristic hemodynamic abnormality is a large “v” wave on the pulmonary capillary wedge pressure tracing (this reflects the LA pressure).

Treatment:

  • Aims of treatment are to augment forward CO, reduce regurgitation into the LA, and relieve pulmonary

congestion. Acute MR needs treatment IMMEDIATELY; Chronic MR is a wait and see deal.

  • Medications:

oMR w/ heart failure: I.V. diuretics to relieve pulmonary edema, vasodilators to reduce resistance to forward CO oIn Chronic MR, give oral arteriolar vasodilators to improve forward CO

  • Mechanical correction:

oMitral valve surgery: can have valve replacement or repair…either should be performed before heart failure comes about, but must delay surgery as long as possible due to operative mortality (8-10% for replacement; 2- 4% for repair)

  • Valve replacement: drawbacks of prosthetic valves – timing for chronic MR replacement is difficult to

determine as life with replacement is not always clearly better than the natural history of the disease. 10-year survival rate is 50%. Better for older patients with extensive pathology.

  • Valve repair: eliminates many problems due to artificial valves; involves surgical reconstruction of parts of

valve responsible for the regurgitation. Postoperative survival rate seems to be better than natural history of MR…allows for earlier surgical intervention. 10-year survival rate is 80%. Better for young patients with myxomatous involvement of the mitral valve.

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