Professeur docteur oussama chaalane

 Dr Usama Fouad Shaalan MD- PhD MiniEncyclopedia الموسوعه المصغره للدكتور  أسامه فؤاد شعلان
 
 
Mitral Valve Prolapse

 

Mitral valve anatomy
image
The mitral valve consists of the mitral annulus, anterior and posterior leaflets, chordae tendineae, and the papillary muscles. Mitral regurgitation may be due to a disease that primarily affects the valve leaflets, such as mitral-valve prolapse or rheumatic mitral-valve disease, or may result from alterations in the function or structure of the left ventricle, such as those induced by ischemic disease or dilated cardiomyopathy. Reproduced with permission from: Otto, CM. Clinical practice. Evaluation and management of chronic mitral regurgitation. N Engl J Med 2001; 345:740. Copyright © 2001 Massachusetts Medical Society.

 

 

Mitral valve prolapse, is a common condition in which the mitral valve leaflets are floppy or loose. Mitral valve prolapse is diagnosed by echocardiography (EKG) which records the heart’s electrical activity. Most patients with mitral valve prolapse do not have a leaky mitral valve and do not require surgery. When a valve with prolapse has a severe leak, surgery should be considered.

 Illustration of the mitral valve

In a normal valve, the flow of blood goes from the left atrium to the left ventricle. Upon closing, it prevents blood from going back into the left atrium. With MVP the flaps fail to close evenly. One or both flaps collapse backwards, sometimes allowing a small amount of blood to leak through the valve.

Mitral valve prolapse, sometimes known as mitral insufficiency or mitral valve regurgitation, is a genetic disorder and seems to affect women three times more than men. It is one of the most common cardiac conditions.

Infection of the mitral valve or endocarditis, is extremely rare. But, people with MVP have a slightly greater risk of contracting it. 1

About the Mitral Valve

The heart has four valves that open and close to keep blood flowing in the proper direction through the heart. The mitral valve connects the heart’s upper-left chamber (atrium) to the heart’s lower-left chamber (ventricle).

Mitral valve stenosis?or mitral stenosis?is a narrowing of the mitral valve. This narrowing causes the valve to not open properly and to obstruct blood flow between the left chambers of the heart.

Mitral valve regurgitation, or mitral regurgitation, occurs when the mitral valve doesn’t close tightly and allows blood to flow backward in the heart.

Other names for mitral valve prolapse:

  • Barlow’s Syndrome
  • Floppy mitral valve
  • Myxomatous mitral valve
  • Billowing mitral valve
  • Systolic click-murmur syndrome
  • Prolapsing mitral leaflet syndrome. 2

Symptoms of Leaky Heart Valve

Many patients with mitral valve disease have no symptoms, even with a leak that is severe. When symptoms develop, they include shortness of breath, fatigue, loss of energy, swelling of the ankles and palpitations (extra or skipped heart beats).

Usually symptoms do not show up before the age of 14 or 15, but more and more children display central nervous system symptoms before the MVP shows up. Ninety-eight percent of people with Mitral Valve Prolapse Syndrome have nothing wrong with their heart. The majority of symptoms are caused by an out-of-balance nervous system. 3

Diagnosis

The first step in diagnosing mitral valve prolapse involves listening with a stethoscope. This allows the doctor to hear a murmur, which represents turbulent blood flow across an abnormal valve. The diagnosis is confirmed by an echocardiogram. Ultrasound is used in an echocardiogram which allows the doctor to visualize the heart valves and determine the severity and cause of the leak. In most patients, a standard transthoracic echocardiogram (a probe placed on the skin of the chest) is adequate to visualize the valve. Sometimes a transesophageal echocardiogram (a probe passed through the mouth into the esophagus) is necessary to more closely visualize the valve. This is an outpatient procedure.

» Continue to Treatment of Mitral Valve Conditions

1. "Mitral valve prolapse," Medline Plus Medical Encyclopedia, http://www.mlm.nih.gov. URL: http://www.nlm.nih.gov/medlineplus/ency/article/000180.htm . See also: "Mitral valve prolapse," MayoClinic.com. URL: http://www.mayoclinic.com/health/mitral-valve-prolapse/DS00504
2. "Mitral valve prolapse," Medline Plus Medical Encyclopedia, http://www.mlm.nih.gov. URL: http://www.nlm.nih.gov/medlineplus/ency/article/000180.htm
3, Kristine A. Scordo, M.D., "Understanding the Mitral Valve Prolapse Syndrome," http://www.wright.edu. URL: http://www.wright.edu/nursing/practice/mvp/default.htm

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

 

Treatment of Mitral Valve Conditions

Most of the time, there are few or no symptoms for mitral valve conditions and treatment is not needed. But, if you have severe mitral valve prolapse, you may need to stay in the hospital. Surgery to repair or replace the valve may be needed if you have severe mitral regurgitation or your symptoms get worse. Mitral regurgitation is a condition in which your heart’s mitral valve does not close tightly, allowing blood to flow backward in your heart.

Commonly Prescribed Medications

  • Anti-arrhythmics drugs to help control irregular heart beats.
  • Vasodilators dilate (widen) blood vessels, which makes it easier for the heart to work.
  • Digitalis is used to strengthen the heartbeat.
  • Diuretics (water pills) help remove excess fluid in the lungs.
  • Propranolol is given for palpitations or chest pain.
  • Anticoagulants (blood thinners) help prevent blood clots in people who also have an irregular heartbeat.1

Surgery

Surgery should be considered in virtually all patients with a leak that is graded as a 4 (severe) and in some patients with a leak that is graded as a 3 (moderately severe). When a patient with mitral valve regurgitation develops symptoms, a decrease in heart function, or an increase in heart size, surgery is recommended. Surgery should also be considered when a patient develops atrial fibrillation – an irregular heartbeat. Surgery is also recommended in many patients who don’t have any symptoms but have a severe leak; in these patients, surgery improves long-term survival.2 During surgery, a sternotomy is typically required. This is when surgeons access the heart by making an 8- to 10-inch incision down the chest, cut through the breastbone (the sternum) and open the ribs.

Minimally Invasive Surgery

Comparison of Traditional Open Incision to Robotic Incision

Recently, minimally invasive approaches to Mitral Valve Repair are replacing sternotomy as the surgical method of choice. Of the minimally invasive approaches, robotic surgery ( da Vinci Surgery)  has many practical advantages for both the patient and the surgeon: precision, fewer complications, reduced blood loss and shorter hospital stays. According to the world-renowned Cleveland Clinic, there is a 95% chance that a leaky mitral valve can be repaired using minimally invasive techniques. 3

1. "Treatment Options for Mitral Valve Disease," Mayo Clinic, http://www.mayoclinic.org. URL: http://www.mayoclinic.org/mitral-valve-disease/treatment.html
2. "Mitral Valve Repair: Answers to our most common questions," Cleveland Clinic Heart & Vascular Institute, http://www.clevelandclinic.org. URL: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/valve/mvrepairfaq.htm
3. Ibid.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

 

ما هو الصمام الميترالي؟
الصمام الميترالي هو أحدى صمامات القلب الأربعة. فالقلب يحتوي على أربعة صمامات هم: الصمام الميترالي، الصمام الثلاثي، الصمام الأورطي، و الصمام الرئوي.
صمامات القلب الأربعة
و الصمام الميترالي موجود بين الأُذين الأيسر و البطين الأيسر للقلب. و ينفتح و ينغلق للتحكم في مجرى الدم بين الأذين و البطين الأيسر. و هو يتكون من وريقتين أمامية و خلفية. و الوريقتين متصلتين من جهة بحلقة الصمام ومن جهة أخرى بأوتار تنتهي بعضلات تمنع انزلاق الوريقات أثناء انقباض القلب. و يرتبط الصمام بالبطين الأيسر من خلال تلك الأوتار التي تربط بين الجانب السفلي من الوريقات و الجدار الداخلي للبطين الأيسر و تسمى chordae tendinea.
الصمام الميترالي
و في الأحوال الطبيعية عند انقباض البطينين فإن وريقات الصمام الميترالي تنغلق تماما و تمنع رجوع الدم من البطين الأيسر إلى الأذين الأيسر. و عند انبساط البطينين فإن الصمام يفتح للسماح بالدم الذي يحتوي على الأكسجين ( القادم من الرئة ) بأن يملأ البطين الأيسر.
الصمام الميترالي في الأحوال الطبيعية
أما في حالة الإصابة بارتخاء الصمام الميترالي فإن إحدى وريقاته أو الاثنان معا تكون أطول من الطبيعي أو يكون الوتر الذي يربط بين وريقات الصمام و جدار البطين طويل و مرتخي. و يؤدي ذلك إلى عدم انغلاق الصمام كليا أثناء انقباض القلب مما يسبب تسرب كمية صغيرة جدا من الدم في البطين الأيسر إلى الأُذين الأيسر ( الارتجاع ).

ارتخاء الصمام الميترالي

علاج ارتخاء الصمام الميترالي

أغلب المصابين بارتخاء الصمام الميترالي لا يحتاجون إلى أي علاج مادام لا يوجد أي مشكلة أخرى بالقلب. و يعيش الشخص بصورة طبيعية تماما و يطمئن تماما.

و على المصاب أن يعرف بعض الإرشادات البسيطة:

  • عند وجود سرعة و عدم انتظام ضربات القلب يجب تجنب الكافيين مثل القهوة، الشاي، و الشيكولاتة.

  • يجب عدم الإقلال من السوائل.

  • إذا أصبحت السيدة المصابة حامل فيجب عليها أن تخبر طبيب النساء و الولادة أنها مصابة بارتخاء الصمام الميترالي.

العلاج الدوائي Medical Treatment
في بعض الأحيان عند وجود سرعة و عدم انتظام ضربات القلب يمكن استخدام أقراص مغلقات البيتا beta-blockers مثل البروبرانولول. يتم استخدام المضادات الحيوية قبل زيارة طبيب الأسنان لإجراء تنظيف أو خلع للأسنان، و قبل إجراء أي عملية جراحية حتى و إن كانت بسيطة. و ذلك لتجنب أي التهاب بكتيري لصمام القلب.

الجراحة Surgery
في حالات نادرة جدا من حالات الارتخاء الشديد للصمام الميترالي أو تدهور الحالة بصورة سيئة قد يحتاج المريض إجراء عملية جراحية لإصلاح الصمام. و قد حدث تطور كبير في جراحات القلب في العشرة سنوات الأخيرة مما أدى إلى احتياج أقل لتغيير الصمام بصمام أخر صناعي.
صمام صناعي

المتابعة Follow-up
يجب على المصاب بارتخاء الصمام الميترالي المتابعة الدورية كل 2-3 سنوات.

 
 
 

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