VALVULAR

HEART
DISEASE

By: CHARLEMAGNE B. PULGAN, RN

VALVULAR HEART DISEASE
 •The function of normal heart valves is to maintain the
forward flow of blood from the atria to the ventricles and from
the ventricles to the great vessels.
•Valvular damage may interfere with valvular function by
stenosis (obstruction) or by impaired closure that allows
backward leakage of blood (valvular insufficiency,
regurgitation, or incompetence).
A. Mitral Valve Prolapse
 the valve leaflets bulge into the left
atrium during ventricular systole
a condition in which the valve's flaps
(or leaflets) become enlarged or
stretched.
Clinical manifestation:
Tachycardia
Light-headedness, syncope
Fatigue, weakness, dyspnea
Chest discomfort
Anxiety, palpitations
Regurgitant murmur
B. Mitral Regurgitation
 Isejection of blood from the
left ventricle to the left atrium
Clinical manifestation
 fatigue, dyspnea
Orthopnea, paroxysmal
nocturnal dyspnea (PND)
Peripheral Edema
Systolic murmur
Atrial Fibrillation
 MITRAL VALVE DISEASE
C. Mitral Stenosis
 narrowing of the mitral
valve
 clinical manifestations:
Diastolic Murmur
(whooshing or swishing
sounds)
Atrial Fibrillation
Systemic Embolization
 COLLABORATIVE MANAGEMENT
A. Mitral Valve Stenosis B. Mitral Regurgitation C. Mitral Valve Prolapse
 oral diuretics  diuretics and reduction  Beta-blockers (to
 Sodium-restricted diet of sodium intake ( to relieve syncope,
reduce cardiac palpitations, and chest
 Digitalis for atrial workload) pain
fibrillation
Nitrates Antibiotic prophylaxis
 beta-blockers – to for invasive procedure
decrease the heart rate Digitalis
 Anti-coagulants to  ACE inhibitors
prevent embolization
SURGICAL MANAGEMENT
A. FOR MITRAL STENOSIS
1. Closed Mitral Valvotomy – introduction of a dilator through
the mitral valve to split its commissures
2. Open Mitral Valvotomy – direct incision of the commissures
3. Mitral Valve Replacement
4. Balloon Valvuloplasty – a balloon-tipped catheter is
percutaneously inserted, threaded to the affected valve, and
positioned across the narrowed office
The balloon is inflated and deflated, causing a cracking of the
calcified commissures and enlargement of the valve orifice
 AORTIC VALVE DISEASES
A.Aortic Stenosis
Narrowing of the orifice of the
aortic valve
Clinical Manifestation:
 chest pain
Syncope
Dyspnea
PND
Pulmonary edema
Left Ventricular Hypertrophy
Systolic murmur
B. Aortic Regurgitation
Blood Propelled into the aorta
regurgitate back into the left
ventricle
Clinical Manifestation:
 Palpitations
 permanent Pulsation of the
neck
Sinus tachycardia
PVC
 Corrigan or water hammer
pulse (sudden sharp pulse
followed by a swift collapse
of the diastolic pulse)
 COLLABORATIVE MANAGEMENT
A.Aortic Valve Stenosis and Regurgitation

 Avoidvigorous exercise
Prophylactic antibiotic for invasive procedure
Balloon Valvuloplasty
Replacement of aortic valve
 TRICUSPID VALVE DISEASE
A.Tricuspid Stenosis and
Regurgitation
Usually develop from
rheumatic heart
 clinical manifestation:
Dyspnea
Fatigue
Pulsation of the neck
Hepatomegaly
Peripheral edema
Diastolic murmur
 COLLABORATIVE MANAGEMENT
A. Tricuspid Stenosis and Regurgitation

 Diuretics and Digitalis Therapy

Valvuloplasty or replacement may be done at time of surgical
intervention for associated rheumatic mitral or aortic disease
 PULMONARY VALVE DISEASE
A.Pulmonary Stenosis and
Regurgitation
Usually congenital defects
Clinical Manifestation
 due to right-sided heart
failure
Dyspnea
Fatigue
Characterized by crescendo-
decrescendo murmur
 COLLABORATIVE MANAGEMENT
A. Pulmonary Valve Stenosis and Regurgitation

Valve Repair
 same management with right-sided heart failure
 COMPLICATIONS

Left-sided heart failure

Possible right-sided heart failure
Dysrhythmias
 SURGICAL MANAGEMENT
Valvuloplasty
Repair, rather than replacement, of a cardiac valve

A. Commissurotomy -Repair may be made to

commissures between the leaflets
B. Annuloplasty- to the annulus of the valve
C. Chordoplasty -to leaflets, or to chordae
COMMISSUROTOMY
• Each valve has leaflets; the site where the
leaflets meet is called the commissure.
A. Closed commissurotomies/Balloon
Valvuplasty do not require cardiopulmonary
bypass. The valve is not directly visualized.
B. Open Commissurotomy are performed
with direct visualization of the valve.
• Cardiopulmonary bypass is initiated, and an
incision is made into the heart
ANNULOPLASTY
• The annulus functions as a sphincter
that contracts and reduces the surface
area of the valve during systole to
ensure complete closure of the
leaflets
• Annuloplasty is repair of the valve
annulus
• General anesthesia and
cardiopulmonary bypass are required
for most annuloplasties.
CHORDOPLASTY
• Chordoplasty is repair of
chordae tendineae.
• The mitral valve is most
often involved with
chordoplasty.
VALVE REPLACEMENT
• When valvuloplasty is not a viable
alternative
• General anesthesia and cardiopulmonary
bypass are used for most valve
replacements.
• The standard surgical procedure is
performed through a median sternotomy
Common mechanical and tissue
valve replacements.
A. Transcatheter aortic valve (Edwards
SAPIEN transcatheter heart valve,
tissue).
B. Transcatheter aortic valve (Medtronic
The CoreValve® system, tissue)
C. MitraClip (Abbott Vascular).
D. Bi-leaflet
E. Tilting-disc valve
F. Caged ball valve
G. Porcine heterograft valve
TISSUE VALVE REPLACEMENT
1.Bioprostheses are tissue valves (e.g., heterografts) used for
aortic, mitral, and tricuspid valve replacement. Most
bioprostheses are from pigs (porcine), but some are from
cows (bovine) or horses (equine) . Viability 7-15 years
2.Homografts, or allografts (i.e., human valves), are obtained
from cadaver tissue donations and are used for aortic and
pulmonic valve replacement
3.Autografts (i.e., autologous valves) are obtained by excising
the patient’s own pulmonic valve and a portion of the
pulmonary artery for use as the aortic valve.
 NURSING MANAGEMENT
Nursing Diagnoses

 Decreased Cardiac Output related to altered preload,

afterload, or contractility
 Activity Intolerance related to reduced oxygen supply
 Ineffective Coping related to acute or chronic illness
 NURSING MANAGEMENT
Nursing Interventions
• Maintaining Adequate Cardiac Output
• Assess frequently for change in existing murmur or new murmur.
• Assess for signs of left- or right-sided heart failure
• Monitor and treat dysrhythmias as ordered.
• Prepare the patient for surgical intervention
• Maintain bed rest while symptoms of heart failure are present.
• Begin activities gradually (eg, chair sitting for brief periods).
• Assist with or perform hygiene needs for patient to reserve strength for
ambulation.