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Week 4 & 5: Mitral Regurgitation > The Basics > Flashcards

The Basics Flashcards

1
Q

What are the components of the MV complex?

A
  1. Annulus
  2. Leaflets
  3. Chords
  4. Papillary muscles
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2
Q

Definition of primary MR?

A
  • Structural alteration of ≥1 component of the MV complex or apparatus
  • Also known as valvular/organic/degenerative MR
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3
Q

Possible causes of primary MR?

A
  1. Degeneration
  2. Inflammation
  3. Infection
  4. Trauma
  5. Congenital
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4
Q

Definition of secondary/functional MR?

A
  • Structurally normal MV with insufficient coaptation due to chamber remodeling
  • Also known as atrial/ventricular MR
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5
Q

Possible causes of secondary/functional MR?

A
  1. CAD
  2. Dilated CM
  3. Restrictive CM
  4. HOCM
  5. AF
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6
Q

Carpentier Classification: Definition and example of Type I MR?

A

Normal leaflet motion

Eg. annular dilatation

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7
Q

Carpentier Classification: Definition and example of Type II MR?

A

Excessive leaflet motion

Eg. mitral valve prolapse

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8
Q

Carpentier Classification: Definition and example of Type IIIa MR?

A

Restricted leaflet motion in systole and diastole

Eg. Rheumatic

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9
Q

Carpentier Classification: Definition and example of Type IIIb MR?

A

Restricted leaflet motion in systole only

Eg. ischaemic

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10
Q

Carpentier Classification: Definition and example of Type IV MR?

A

Systolic anterior motion (SAM)

Eg. HOCM

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11
Q

Carpentier Classification: Definition and example of Type V MR?

A

Hybrid (> 1 pathology)

Eg. rheumatic MV + perforation

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12
Q

Perforated leaflet:

Carpentier Classification? Primary or secondary MR?

A
  • Type I: normal leaflet motion

- Primary MR: MR due to valve problem - perforated due to IE

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13
Q

Cleft leaflet:

Carpentier Classification? Primary or secondary MR?

A
  • Type I: normal leaflet motion

- Primary MR: MR due to valve

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14
Q

MVP (Barlow’s disease, FED, MAD)

Carpentier Classification? Primary or secondary MR?

A
  • Type II: excessive leaflet motion

- Primary MR: MR due to valve

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15
Q

Rheumatic MVD:

Carpentier Classification? Primary or secondary MR?

A
  • Type IIIa: restricted leaflet motion in systole and diastole
  • Primary MR: MR due to valve
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16
Q

Annular calcification:

Carpentier Classification? Primary or secondary MR?

A
  • Type IIIa: restricted leaflet motion in systole and diastole
  • Primary MR: MR due to valve
17
Q

Radiation heart disease:

Carpentier Classification? Primary or secondary MR?

A
  • Type IIIa: restricted leaflet motion in systole and diastole
  • Primary MR: MR due to valve
18
Q

Dilated (non-ischaemic) CM:

Carpentier Classification? Primary or secondary MR?

A
  • Type I: normal leaflet motion

- Secondary MR: MR due to annular dilatation

19
Q

AF (isolated LA dilatation):

Carpentier Classification? Primary or secondary MR?

A
  • Type I: normal leaflet motion

- Secondary MR: MR due to annular dilatation

20
Q

Ischaemic Heart Disease:

Carpentier Classification? Primary or secondary MR?

A
  • Type IIIb: restricted leaflet motion in systole only

- Secondary MR: abnormal leaflet motion - systolic restriction due to leaflet tethering

21
Q

Ischaemic CM:

Carpentier Classification? Primary or secondary MR?

A
  • Type IIIb: restricted leaflet motion in systole only

- Secondary MR: abnormal leaflet motion as a result of ischaemic CM

22
Q

Normal MV closing forces?

A
  1. LV contraction
  2. Basal rotation
  3. Annular contraction
23
Q

Normal tethering forces?

A
  1. Passive annular constraint

2. Tethering

24
Q

Closing and Tethering Forces in Secondary MR: Global LV Dilatation

A
  1. Increased tethering/tenting
  2. Impaired closing
  3. Annular dilatation
  4. Reduced basal rotation
    Note: symmetric tethering = central MR jet
25
Q

Closing and Tethering Forces in Secondary MR: Inferior regional dysfunction

A
  1. Increased tethering/tenting
  2. Impaired closing
  3. Annular dilatation
    Note: asymmetric tethering = eccentric MR jet
26
Q

Pathophysiology of Primary MR: Phases?

A
  1. Acute Phase
  2. Chronic Compensated Phase
  3. Chronic Decompensated Phase
27
Q

Pathophysiology of Acute Phase of Primary MR?

A
  1. LA and LV size is normal
  2. Acute MR occurs due to sudden rupture of chords or papillary muscle
  3. Sudden LA volume overload => ↑↑ in LAP => pulmonary venous congestion and acute pulmonary oedema (APO)
  4. LV volume overload => ↑ LVEDP and ↓ LVESP (due to reduced afterload) allows LV to eject more completely => ↑ LVEF and ↑ total SV
  5. However, significant portion of total SV regurgitates into LA therefore ↓ forward SV (and CO)
28
Q

Pathophysiology of Chronic Compensated Phase of Primary MR?

A
  1. ↑ LA and LV size
  2. Severity of MR increases slowly
  3. LA more compliant so LAP only slightly ↑
  4. LV develops eccentric hypertrophy or remodeling to better manage larger SV => ↑↑ LVEDV and LVESV near normal => ↑ LVEF and ↑↑ in total SV
  5. ↑↑ in total SV means forward SV is now near normal
29
Q

Pathophysiology of Chronic Decompensated Phase of Primary MR?

A
  1. ↑↑ LA and LV size
  2. LV systolic dysfunction due to prolonged LV volume overload (which causes muscle damage and therefore reduces contractile function)
  3. ↑↑ LVEDV still but weakened LV can no longer shorten adequately and LVESV ↑
  4. = ↓ LVEF and ↓ total and forward SVs
  5. ↑↑ LAP => pulmonary congestion, acute pulmonary oedema (APO) and PHTN
30
Q

Indicators of LV dysfunction in severe MR?

A
  1. Increased LVESD ≥ 40mm

2. LVEF ≤ 60% = impaired

31
Q

Management of MR?

A
  • Stages
  • Diagnosis
  • Medical therapy
  • Interventions
32
Q

What are the MR management stages based on?

A
  1. Valve anatomy
  2. Valve haemodynamics
  3. Haemodynamic consequences (primary, organic MR)
  4. Associated cardiac findings (secondary, functional MR)
  5. Symptoms

Week 4 & 5: Mitral Regurgitation (3 decks)

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