Mitral Valve: Difference between revisions

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 ==Anatomy==
-The mitral valve consists of two valve leaflets , the anterior klpeblad (A) and the rear blade (P) , which together have a total of 4 - 6cm<sup>2</sup>. At the edges are chordae tendinae, which ensure that the leaflets do not tip (prolapse). These attach to two major papillairspierkoppen that are part of the muscle of the left ventricle .
+The mitral valve consists of two valve leaflets, the anterior leaflet (AMVL) and the posterior leaflet (PMVL), which together have a surface of 4 - 6 cm<sup>2</sup>. Via chordae tendineae, small tendons which ensure that the leaflets do not prolapse, the valve leaflets are attached to two major papillary muscles (anterolateral en posteromedial) in the left ventricle.
 {| class="wikitable" cellpadding="0" cellspacing="0" border="0"
 |-
-|bgcolor="#FFFFFF" align="center"|[[Image:Mvalv.png]]
+|bgcolor="#FFFFFF" align="center"|[[Image:Mvalv.svg|400px]]
 |-
-!Top view of the normal heart showing the coronary arteries and four valves including the mitral valve<cite>1</cite>
+!Top view of the normal heart showing the coronary arteries and four valves including the mitral valve with its anterior (A) and posterior (P) leaflets<cite>1</cite>
 |}
-The mitral valve is bringing many scan faces in pictures: Plax, PSAXmv, AP4Ch, AP5Ch, AP2Ch, AP3Ch and subcostaal4Ch. A prolapse of the MV is assessed on Plax . But mitral valvular insufficiency should be considered in all views. When significant abnormalities of the mitral 3D TEE can assist in assessing the severity .
+The mitral valve is bringing many scan faces in pictures: PLAX, PSAXmv, AP4Ch, AP5Ch, AP2Ch, AP3Ch and subcostal4Ch. Mitral valvular insufficiency should be considered in all views. When significant abnormalities of the mitral valve are suspected, TEE (particularly 3D TEE) can assist in assessing the severity.
 {| class="wikitable" cellpadding="0" cellspacing="0" border="0"
@@ Line 35: / Line 35: @@
 |}
 ==The scallops of the mitral valve==
-The two leaflets are divided into a total of six scallops : A1 , A2 , A3 ( anterior) , P1 , P2 , P3 ( posterior ) .
+The two leaflets are divided into a total of six scallops: A1, A2, A3 (anterior) and P1, P2, P3 (posterior).
+{| class="wikitable" cellpadding="0" cellspacing="0" border="0"
+|-
+|bgcolor="#FFFFFF" align="center"|[[Image:MV_AP2CH.svg|235px]]
+|bgcolor="#FFFFFF" align="center"|[[Image:MV_PLAX.svg|235px]]
+|bgcolor="#FFFFFF" align="center"|[[Image:MV_PSAX.svg|235px]]
+|-
+!MV AP2CH
+!MV PSAX
+!MV Surgical view
+|-
+|bgcolor="#FFFFFF" align="center"|[[Image:MV_AP4CH.svg|235px]]
+|bgcolor="#FFFFFF" align="center"|[[Image:MV_surgical_view.svg|235px]]
+|bgcolor="#FFFFFF" align="center"|[[Image:MVtee.svg|235px]]
+|-
+!MV AP4CH
+!MV PLAX
+!MV TEE views (Fig. click for animation)
+|-
+|colspan="3"|'''Source image:''' Mechanisms of Mitral regugitation - role of 3D ultrasound illustrated by case studies - ML Geleijnse.<cite>2</cite>
+|}
-AP2CH MV MV MV PSax Surgical view
+==Stenosis==
+{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="400px"
+|-
+!colspan="2"|Causes of mitral valve stenosis
+|-
+!Acquired
+|
+*Degeneracy
+*Rheumatic fever
+|-
+!Space occupying lesion
+|
+*Myxoma
+|-
+!Congenital
+|
+*Parachute valve
+*Cor triatriatum
+|}
-AP4CH MV MV MV Plax TEE views ( Fig. click for animation )
+===Effects of mitral valve stenosis:===
-Source image: Mechanisms of Mitral regugitation - role of 3D ultrasound illustrated by case studies - ML Geleijnse .
+Chest pain, of breath when lying flat, with exertion and attacks during the night or morning (cardiac asthma), possibly coughing up blood; any complaints from right valve failure, such as ankle edema. Palpitations by atrial fibrillation, which can cause embolism, such as a stroke.
-More info :
+===Treatment===
+The valve can be opened by balloon angioplasty or surgically treated by valve replacement.
-stenosis
-causes mitral
+Click [[Mitral Stenosis|'''here''']] for mitral stenosis quantification.
-acquired
-degeneracy
-rheumatic fever
-Space occupying lesion
-myxoma
-congenital
-parachute valve
-Cor triatriatum
-Effects of mitral stenosis : Chest pain , shortness of breath when lying flat , with exertion and attacks during the night or morning ( cardiac asthma ) , possibly coughing up blood ; any complaints from law failure , such as ankle edema .
-Hartkkloppingen by atrial fibrillation , which can cause embolism , such as a stroke . The valve can be opened by balloon angioplasty or surgically treated by valve replacement .
-Click for mitral stenosis quantification .
+==Insufficiency==
+{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="400px"
+|-
+!colspan="2"|Causes of mitral valvular insufficiency
+|-
+!Annular dilatation
+|
+*Atrial fibrillation
+*Left ventricular dilatation
+*Left atrial dilatation
+|-
+!Degenerative disease
+|
+*Malcoaptation at mitral valve stenosis
+|-
+!Acquired valve defect
+|
+*Billowing
+*Prolapse
+*Floppy valve
+*Flail
+*Chordal rupture
+*Papillary muscle rupture
+|-
+!Secondary
+|
+*Arrhythmias (LBBB-->diastolic MI)
+*SAM in HCM
+|}
-insufficiency
+Mitral valve insufficiency (MI) may result in left-sided congestive heart failure. An MI results in back flow of blood from the left ventricle into the left atrium. This may eventually result in pulmonary hypertension and pulmonary edema. Pulmonary edema is manifested by shortness of breath, initially with exertion, but later at rest, orthopnea and nocturnal dyspnea attacks. On physical examination, pulmonary edema can be detected by fine crackles, particularly in the dorsobasale lung fields. Increasing left atrial pressure and dimension may cause atrial fibrillation.
-causes mitral valvular insufficiency
-annulus dilatation
-atrial fibrillation
-left ventricular dilatation
-Left Atrium dilatation
-degeneracy
-Malcoaptatie at mitralisklepsteonose
-Acquired valve defect
-billowing
-prolapse
-floppy valve
-Flail
-Chordaruptuur
-Papillairspierruptuur
-secondary
-Arrhythmias ( LBBB - > diastolic MI )
-SAM in HCM
-Mitral valvular insufficiency (MI ) may result in decompensation on the left side . An MI results in back flow of blood from the left ventricle into the left atrium. This may eventually result in pulmonary hypertension and pulmonary edema. Pulmonary edema is manifested by shortness of breath , initially with exertion , but later at rest , orthopnea and nocturnal dyspnea attacks . On physical examination, pulmonary edema can be detected by fine crackles with particular dorsobasale lung fields .
-A complication that may be the left atrium increases , the electrical stimulation that is chaotic , with as a result of atrial fibrillation .
-Click for quantification mitral valvular insufficiency .
+Click [[Mitral Insufficiency|'''here''']] for quantification mitral valvular insufficiency .
 ==References==
 <biblio>
 #1 [http://www.geisinger.kramesonline.com/3,S,89116 How the heart works] from Geisinger’s Health Library.
+#2 [http://www.escardio.org/education/live-events/courses/education-resource/Documents/021-1715-Geleijnse-Wbz-Tue-S05.pdf Mechanisms of Mitral regugitation - ML Geleijnse.]
 </biblio>