VALVULAR HEART DISEASE

MITRAL STENOSIS:

congenital (rare):

parachute valve [all chordae inserted into one papilla]

acquired:

rheumatic heart disease

MITRAL REGURGITATION:

abnormalities of leaflets / commisures:

rheumatic heart disease (80%)

infective endocarditis (usually occurs in previously diseased valve)

floppy mitral valve (mitral valve prolapse):

congenital (isolated)

WPW syndrome

abnormalities of tensor apparatus:

papillary muscle rupture (post-MI)

papillary muscle dysfunction (fibrosis)

rupture of chordae tendineae

abnormalities of left ventricle / annulus:

LV enlargement (congestive heart failure, congestive cardiomyopathy, myocarditis)

relapsing polychondritis

AORTIC STENOSIS:

congenital:

[very rare; even rarer is supra-valvular stenosis or sub-valvular diaphragm]

acquired:

calcification of congenitally abnormal valve [sclerosis; usually of a bicuspid valve]

rheumatic heart disease

AORTIC REGURGITATION:

valvular disease:

rheumatic (common)

infective endocarditis [esp. if bicuspid]

congenital, eg. bicuspid valve

aortic disease with dilatation of proximal aorta:

relapsing polychondritis

TRICUSPID STENOSIS:

rheumatic [usually mitral stenosis also present]

carcinoid syndrome (very rare)

TRICUSPID REGURGITATION:

congenital

Ebstein's anomaly ['atrialisation' of portion of right ventricle]

2° to right ventricular dilatation (commonest cause):

congestive cardiomyopathy

acquired valvular disease:

rheumatic (usually associated with mitral disease)

endocarditis (especially in iv drug abusers)

carcinoid syndrome (very rare)

PULMONARY STENOSIS:

congenital:

true valve stenosis [commonest cause; isolated or as part of Fallot's tetralogy]

acquired:

carcinoid syndrome (very rare)

PULMONARY REGURGITATION:

secondary to RV dilatation:

pulmonary hypertension [causes Graham-Steele murmur, usually 2° to mitral stenosis]

valvular disease:

bacterial endocarditis (especially in iv drug abusers)