Tricuspid Stenosis
Introduction
Background
Tricuspid valve dysfunction can result from morphological alterations in the valve or from functional aberrations of the myocardium. Tricuspid stenosis is almost always rheumatic in origin and is generally accompanied by mitral and aortic valve involvement.1 Read more…
Tricuspid Regurgitation
Introduction
Background
Tricuspid regurgitation may result from structural alterations of any one or all of the components of the tricuspid valve apparatus. Components include the leaflets, chordae tendinea, annulus, and papillary muscles or adjacent right ventricular (RV) muscle. The lesion may be classified as primary when it is caused by an intrinsic abnormality of the valve apparatus or as secondary when it is caused by RV dilatation.
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Tricuspid Atresia
Introduction
Background
Tricuspid atresia is the third most common form of cyanotic congenital heart disease, with a prevalence of 0.3-3.7% in patients with congenital heart disease. The deformity consists of a complete lack of formation of the tricuspid valve with absence of direct connection between the right atrium and right ventricle.
Pathophysiology
Three types of tricuspid atresia are described, depending on the associated relationship of the great vessels. In type I, the great arteries are related normally; in type II, the great arteries are d-transposed; and in type III, the great arteries are l-transposed. The types are further subclassified according to the presence or absence of ventricular septal defects and pulmonary valve pathology.1, 2
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Pulmonic Stenosis
Introduction
Background
Pulmonic stenosis (PS) refers to a dynamic or fixed anatomic obstruction to flow from the right ventricle (RV) to the pulmonary arterial vasculature. Although most commonly diagnosed and treated in the pediatric population, individuals with complex congenital heart disease and more severe forms of isolated PS are surviving into adulthood and require ongoing assessment and cardiovascular care.
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Pulmonic Regurgitation
Introduction
Background
The pulmonic valve is normally a thin tricuspid structure that prevents blood from regurgitating into the right ventricle once ejected into the low-pressure pulmonary circulation. Pulmonic regurgitation refers to retrograde flow from the pulmonary artery into the right ventricle during diastole. Physiologic (trace-to-mild) pulmonic regurgitation is present in nearly all individuals, particularly in those with advanced age. However, pathologic conditions that produce excessive and clinically significant regurgitation can result in impairment of right ventricular function and eventual clinical manifestations of right-sided volume overload and heart failure. Often, pulmonic regurgitation is not the primary process but a finding secondary to an underlying process such as pulmonary hypertension or dilated cardiomyopathy. Read more…
Mitral Valve Prolapse
Introduction
Background
Mitral valve prolapse (MVP) is the most common valvular abnormality, affecting approximately 2-6% of the population in the United States. MVP usually results in a benign course. However, it occasionally leads to serious complications, including clinically significant mitral regurgitation, infective endocarditis, sudden cardiac death, and cerebrovascular ischemic events. MVP is also the most common cause of isolated mitral regurgitation in the United States, and it is the most common reason for mitral valve surgery.
Pathophysiology
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Mitral Stenosis
Introduction
Background
Mitral stenosis is an obstruction to left ventricular inflow at the mitral valve level due to the structural abnormality of the mitral valve apparatus. Rheumatic fever is a main cause of mitral stenosis. Other uncommon etiologies include congenital mitral stenosis, such as parachute mitral valve; marked mitral annular calcification of the mitral valve; and infective endocarditis with large vegetations (often fungal). Sometimes, conditions such as left atrial myxoma can mimic mitral stenosis by obstructing outflow. Read more…
Mitral Regurgitation
Introduction
Background
Mitral regurgitation (MR) is defined as an abnormal reversal of blood flow from the left ventricle to the left atrium. It is caused by disruption in any part of the mitral valve apparatus, which comprises the mitral annulus, the leaflets (a large anterior [aortic] leaflet and a small posterior [mural] leaflet), the chordae tendineae, and the papillary muscles (anteromedial and posterolateral). The most common etiologies of MR include mitral valve prolapse (MVP), rheumatic heart disease, infective endocarditis, annular calcification, cardiomyopathy and ischemic heart disease. The pathophysiology, clinical manifestations and management of MR differ with the chronicity of the disease and the etiology.
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Aortic Stenosis
Introduction
Background
With the aging of the United States population, diseases in the elderly are a major interest among health care professionals. Valvular aortic stenosis (AS) is no exception; senile degenerative AS is now the leading indication for aortic valve replacement (AVR). The favorable long-term outcome following aortic valve (AV) surgery and the relatively low operative risk emphasize the importance of an accurate and timely diagnosis.
Pathophysiology
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Aortic Regurgitation
Introduction
Background
Primary disease of the aortic valve leaflets, the wall of the aortic root, or both may cause aortic regurgitation (AR). With the decline in the incidence of syphilitic aortitis and rheumatic valvulitis in the second half of the 20th century, various aortic root disorders such as Marfan disease and degeneration of bicuspid aortic valves have become the most common causes of AR.
Pathophysiology
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