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Double Orifice Mitral Valve Follow-up

  • Author: Georgios A Hartas, MD; Chief Editor: Stuart Berger, MD  more...
 
Updated: Mar 19, 2014
 

Further Outpatient Care

Monitor medication for compliance, dose requirements, and adverse effects.

Periodically check for electrolyte disturbances.

Provide follow-up care for prompt detection and treatment of intercurrent infections, arrhythmia, and other complications.

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Further Inpatient Care

The following are indicated in patients with double orifice mitral valve (DOMV):

  • Hemodynamic study by cardiac catheterization and angiography
  • Surgical treatment
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Inpatient & Outpatient Medications

Medications for double orifice mitral valve include diuretics, digoxin, potassium chloride, and vasodilators.

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Transfer

Transfer to a tertiary cardiac facility may be required for further diagnostic evaluation and surgical treatment.

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Deterrence/Prevention

Symptomatic patients with double orifice mitral valve should avoid sports and other strenuous activity that could aggravate their pulmonary congestion and congestive heart failure (CHF).

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Complications

Possible complications are mitral regurgitation, mitral stenosis, pulmonary edema, recurrent respiratory infection, atrial fibrillation and other atrial arrhythmias, infective endocarditis, left atrial thrombus, and pulmonary arterial hypertension.

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Prognosis

Encourage activity restrictions on symptomatic patients. Advise the patient/parents concerning the need for periodic medical review. Counsel the patient/parents about the need for regular anticoagulant therapy with warfarin (Coumadin) in those who undergo valve replacement.

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Patient Education

Impose activity restrictions on symptomatic patients.

Advise the patient concerning the need for periodic medical review.

Inform the patient regarding prophylaxis for infective endocarditis and prompt attention to all infections.

Counsel the patient about the need for regular anticoagulant therapy with warfarin (Coumadin) in those who undergo valve replacement.

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Contributor Information and Disclosures
Author

Georgios A Hartas, MD Pediatric Interventional Cardiologist, The Children's Heart Institute

Georgios A Hartas, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Texas Medical Association, Texas Pediatric Society, Harris County Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

P Syamasundar Rao, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

P Syamasundar Rao, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Duraisamy Balaguru, MBBS MRCP, FACC, FAAP, FSCAI, Associate Professor of Pediatrics, Division of Pediatric Cardiology, University of Texas Medical School at Houston; Attending Physician, Division of Pediatric Cardiology, Children’s Memorial Hermann Hospital

Duraisamy Balaguru, MBBS is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, American Stroke Association, Pediatric Cardiac Intensive Care Society, International Society of Invasive Cardiology in Congenital Heart Disease, World Society for Pediatric and Congenital Heart Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Autonomic Society, American Physiological Society

Disclosure: Received grant/research funds from Lundbeck Pharmaceuticals for none.

Chief Editor

Stuart Berger, MD Medical Director of The Heart Center, Children's Hospital of Wisconsin; Associate Professor, Department of Pediatrics, Section of Pediatric Cardiology, Medical College of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

Juan Carlos Alejos, MD Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine

Juan Carlos Alejos, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, International Society for Heart and Lung Transplantation

Disclosure: Received honoraria from Actelion for speaking and teaching.

References
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Two-dimensional echocardiogram (apical view) in a patient with duplicate mitral valve. Two mitral valves can be seen opening into the left ventricle. Each valve has a separate annulus, and a separate set of mitral valve leaflets and subvalvar apparatus.
Two-dimensional echocardiogram (parasternal short-axis view) shows double-orifice mitral valve, the orifice being divided by a bridge of tissue.
Two-dimensional echocardiogram of a double-orifice mitral valve (apical view) with color flow mapping, which shows diastolic flow through 2 separate orifices.
Two-dimensional echocardiogram (parasternal short-axis view) in a patient with duplicate mitral valve. This diastolic frame shows two typical mitral valve orifices opening into the left ventricle. The two orifices are placed apart unlike the more common type of double-orifice mitral valve (see image above) where the orifice is divided by a bridge of tissue.
Real-time two-dimensional echocardiogram (apical view) in a patient with duplicate mitral valve. Two mitral valves can be seen opening into the left ventricle. Each valve has a separate annulus, and a separate set of mitral valve leaflets and subvalvar apparatus.
Real-time two-dimensional echocardiogram (subcostal short-axis view) in a patient with duplicate mitral valve showing two typical mitral valves opening into the left ventricle. The two orifices are placed apart unlike the more common type of double-orifice mitral valve (see image above) where the orifice is divided by a bridge of tissue.
 
 
 
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