on 11-May-2016 (Wed)

Atrioventricular valves are leaflets not cusps.
Both valves have partial annuli (ring structure).
Valves are attached to the subvalvular apparatus (chorda and papillary muscles).
Mobility is passive – chorda and papillary muscles tether and provide structural support.

Valvular disease can be acute (endocarditis) or chronic (chronic rheumatic valvulitis) disease.
It can be a primary disease or secondary to some other pathological process (e.g. MR with atherosclerotic heart disease b/c impedes ability of leaflets to come together and form a good seal).
May be associated with systemic conditions (e.g. Marfan Syndrome).

Aortic Insufficiency is associated with:
-Lesions of the valve
-Lesions with adjoining ascending aorta causing annular dilatation and loss of sufficient coapting of valve cusps (valves get moved farther and farther away)
-Acute or chronic insufficiency
-Associated with left ventricular hypertrophy and remodelling (esp. dilatation)

Aortic insufficiency:
chronic aortitis or aortopathy often associated with ascending aortic aneurysms. The aneurysm pulls the root apart so valve cusps can't touch each other.

Mitral stenosis: most common cause is chronic rheumatic valvulitis. Fibrous thickening of leaflets with thickening, shortening and fusion of chordae tendinae (as consequence of fibrous tissue thickening) – commissural fusion also common.

Post‐inflammatory mitral valvular stenosis -> “Fish mouth” deformity of Mitral valve.

Mitral Stenosis can be associated with enlarged left atrium, mural thrombi, pulmonary hypertension and arrhythmias.

Other causes for mitral insufficiency include: Mitral annular calcification, Ischemic mitral regurgitation, Cardiac myxoma interfering with valve orifice, Endocarditis, Papillary muscle rupture

Infectious Endocarditis: aortic valve vegetations -> abn functioning cusps (might get better with abx)
-even after healing, can end up with healed perforation
-septic vegetations can be very destructive

Non‐bacterial thrombotic endocarditis (marantic endocarditis): Mitral valve vegetations are sterile and non‐inflamed. Vegetations are smaller and doesn't destroy underlying structures. Forms as consequence of multiple conditions but often associated with hypercoagulable state or mucin secreting cancers or collagen vascular disease (e.g. lupus – called Limban‐Sacks endocarditis)

mechanical valves generally put in younger pt's because they're more prone to form fibrous tissue & calcium, which leads to acceleration of valve degeneration

pts will need significant anticoagulation with mechanical valves

most common = bi-leaflet

Prosthetic Valve Complications: Mechanical valve thrombosis (if not properly anticoagulated), Pannus overgrowth (fibrous tissue) causing stenosis (slow reaction against foreign object)

Natural History

"Etyka marksizmu.
Zgadzam się, że komunizm urodził się stokroć bardziej
z obrażonego poczucia moralnego, niż z pragnienia poprawy
bytu materialnego. Sprawiedliwość! - oto jego krzyk.
Nie mogą znieść, że jeden ma pałac a drugi - barłóg.
Nie mogą znieść przede wszystkim, że jeden ma możliwość
rozwoju a drugi nie ma - że jeden ją ma kosztem drugiego.
To nie zawiść, to żądza słusznego prawa."

Witold Gombrowicz, Dziennik 1953-1956

"I'd go to your funeral, firmly believing
You'd gone mad
To try to love by not living.

But Margarida,
If this giving of my life to you
Were merely poetry?"

Alvaro de Campos