Seminar in Medicine, 20.10.2017, Prof. Dr. Afksendiyos Kalangos

Author: KUSOM
Time: 14:00
Location: MED 176



Friday, October 20th, 2017


Speaker        : Prof.Dr. Afksendiyos Kalangos /University of Geneva /Koç University Hospital /Department of Cardiovascular Surgery
Title             : Mitral valve diseases; from etiologies to their surgical treatment
Time            : 14.00 (Refreshments will be served at 13:45)
Place            : RF / MED 176                                          

TelePresence  : AH Dean's Office / KUH 9th floor Meeting Room

Mitral valve diseases; from etiologies to their surgical treatment

Statement : Ms N Y, 55 years old wakes suddenly up, in the middle of the night with shortness of breath and has transferred to the emergency department of Koc University  by her family members. At her arrival to the emergency department, her hemodynamic condition is stable despite  tachypnea and orthopnea

How to take care of this patient ? :

- Anamnesis :

            -Since when she is breathless ? She has been out of breath for 10 years at big effort and for a few days at least effort and  sometimes at rest.

            -Aggravating or triggering factors : efforts, lying down position

            -Did she feel palpitations in the past ? : yes intermittent in the past and constant now

            -Did she suffer from episodes of bronchitis in the past or hemoptysis whe she was coughing ? No hemoptysis but frequent episodes of bronchitis

-Did she develop episodes of upper respiratory tract infections during her childhood ? Yes

            - Did she remember if her physician had evoked a heart murmur during her childhood ? Yes,  it was once evoked by her pediatrician

-Physical examination 

            Inspection : erythromatosis of the cheekbones (facies mitral), swollen legs

Palpation : pulse : irregular,  apical shock : no,  hepatomegaly : 1 finger, pretibial edema : mild to moderate

Percusion : thoracic and abdominal percusion normal. No pleural effusion, no ascites

            Auscultation :Heart Murmur : Unlike a normal mitral valve, which opens silently, the abnormal valve makes a snapping sound as it opens to allow blood into the left ventricle. -Diastolic murmur - and a snapping sound as it closes.

-Clinical investigations :

            ECG : Atrial fibrillation, right axis deviation

            Chest X ray :  A-P : Left atrial enlargement causes double right heart border, straightened left heart border or convex, protruding medium arch of the left heart border: aortic knuckle-  prominent left pulmonary conus (due to pulmonary hypertension) and enlarged left appendage - normal left ventricular shadow , Lateral : RV enlargement- reduced retrosternal space

            Echocardiography : Normal mitral orifice in adults : 4- 6 cm2 (patient : < 1 cm2 (indication for surgery or ballon dilation), mean transmitral gradient : 20 mmHg ), left atrial enlargement, normal left ventricular size, no hypertrophy, RV enlargement, Pulmonary hypertension : 50 mmHg systolic PAP, mild to moderate tricuspid regurgitation

            Coronary angiography , carotid doppler : Patients older than 40 yrs old in whom the surgical indication was retained

            Dental control when surgery is indicated: prevention of endocarditis

-Treatment : Surgery versus balloon dilation

-Surgery : Replacement versus repair

            Replacement : Biological versus metallic prostheses (explain advantages and potential disadvantages which influence the choice)

Anticoagulation : (Antivitamin K (warfarin), International normalized ratio (INR))