How to check your heart valves. Human heart valves

A human being, having a low weight, is the most important muscle in the body.

It works continuously and makes more than 100 thousand. strokes per day, pumping 760 liters of blood through 60 thousand. vessels.

How does the human heart work, given that it consists of four chambers:

• left ventricle;
• left atrium;
• right ventricle;
• right atrium.

Caused by the formation of a plaque of cholesterol that forms in the coronary arteries and causes a decrease in blood flow to the heart muscle and further possible damage to the heart or heart attack.

What does the conducting system of the heart look like?

The heartbeat, which is its rhythm, is regulated by electrical impulses that are generated by the heart muscle itself. These impulses start from the sinus node and cause the heart to beat. The sinus rhythm is correlated with the pulses from the presmakers, which makes the rhythm constant and unchanged. The impulse then travels to the atrioventricular node, where it is tested and travels through the ventricles, causing them to contract.

The heart can change under certain conditions, such as diet, exercise, stress, or even hormonal changes. All these conditions affect how a person's heart works throughout his life.

Heart defects - these are changes in the structure of the heart, which cause disturbances in its work. These include defects in the wall of the heart, ventricles and atria, valves, or outgoing vessels. Heart defects are dangerous because they can lead to impaired circulation in the heart muscle itself, as well as in the lungs and other organs, and cause life-threatening complications.

Heart defects are divided into 2 large groups.

• Congenital heart disease
• Acquired heart defects

Congenital malformations appear in the fetus between the second and eighth week of pregnancy. 5-8 babies out of a thousand are born with various anomalies of the heart. Sometimes the changes are minor, and sometimes major surgery is required to save a child's life. The reason for the abnormal development of the heart can be heredity, infections during pregnancy, bad habits, the effect of radiation and even the excess weight of a pregnant woman.

It is believed that 1% of babies are born with a defect. In Russia, this amounts to 20,000 people annually. But to these statistics it is necessary to add those cases when congenital defects are revealed after many years. The most common problem is a ventricular septal defect, 14% of all cases. It happens that several defects are simultaneously revealed in the heart of a newborn, which usually occur together. For example, Fallot's tetrad is about 6.5% of all newborns with heart defects.

Acquired vices appear after birth. They can be the result of injuries, heavy loads or diseases: rheumatism, myocarditis, atherosclerosis. The most common cause of the development of various acquired defects is rheumatism - 89% of all cases.

Acquired heart defects are quite common. Do not think that they appear only in old age. A large proportion falls on the age of 10-20 years. But still the most dangerous period is after 50. In old age, 4-5% of people suffer from this problem.

After suffering diseases, violations of the heart valves mainly appear, which ensure the movement of blood in the right direction and do not allow it to return back. Most often, problems arise with the mitral valve, which is located between the left atrium and the left ventricle - 50-75%. In second place in the risk group is the aortic valve located between the left ventricle and the aorta - 20%. The pulmonary and tricuspid valve accounts for 5% of cases.

Modern medicine has the ability to correct the situation, but surgery is necessary for a complete cure. Treatment with medications can improve well-being, but will not eliminate the cause of the disorder.

Anatomy of the heart

In order to understand what changes cause heart disease, you need to know the structure of the organ and the features of its work.

A heart - a tireless pump that pumps blood throughout our body without stopping. It is a fist-sized organ, cone-shaped and weighs about 300 g. The heart is divided lengthwise into two halves, right and left. The upper part of each half is occupied by the atria, and the lower ventricles. Thus, the heart has four chambers.
Oxygen-poor blood comes from the organs into the right atrium. It contracts and pumps a portion of blood into the right ventricle. And he sends her to the lungs with a powerful push. This is the beginning small circle of blood circulation: right ventricle, lungs, left atrium.

In the alveoli of the lungs, the blood is enriched with oxygen and returns to the left atrium. Through the mitral valve, it enters the left ventricle, and from it goes through the arteries to the organs. This is the beginning a large circle of blood circulation:left ventricle, organs, right atrium.

The first and main condition the correct functioning of the heart: the blood spent by the organs without oxygen and the blood enriched with oxygen in the lungs should not mix. For this, the right and left halves are normally tightly separated.

Second prerequisite: blood should only move in one direction. This is provided by valves that prevent the blood from taking "a step back".

What the heart is made of

The function of the heart is to contract and expel blood. The special structure of the heart helps it pump 5 liters of blood per minute. This is facilitated by the structure of the organ.

The heart has three layers.

1. Pericardium -outer two-layer connective tissue bag. There is a small amount of fluid between the outer and inner layers, which helps to reduce friction.
2. Myocardium - the middle muscle layer, which is responsible for the contraction of the heart. It consists of special muscle cells that work around the clock and have time to rest in a split second between impacts. The thickness of the heart muscle is not the same in different areas.
3. Endocardium -the inner layer that lines the chambers of the heart and forms the septa. Valves are endocardial folds along the edges of the holes. This layer is made up of strong and elastic connective tissue.

Valve anatomy

The chambers of the heart are separated from each other and from the arteries by fibrous rings. These are layers of connective tissue. They have holes with valves that launch the blood in the right direction, and then close tightly and prevent it from returning back. Valves can be compared to a door that only opens in one direction.

There are 4 valves in the heart:

1. Mitral valve - between the left atrium and the left ventricle. Consists of two valves, papillary or papillary muscles and tendon filaments - chords that connect the muscles and valves. When blood fills the ventricle, it presses on the valves. The valve closes under blood pressure. Tendon chords prevent the leaflets from opening towards the atrium.
2. Tricuspid, or tricuspid valve - between the right atrium and the right ventricle. Consists of three cusps, papillary muscles and tendon chords. Its principle of operation is the same.
3. Aortic valve - between the aorta and the left ventricle. Consists of three petals, which have a crescent shape and resemble pockets. When blood is pushed into the aorta, the pockets fill, close and prevent it from returning to the ventricle.
4. Pulmonary valve - between the right ventricle and the pulmonary artery. It has three leaflets and works on the same principle as the aortic valve.

The structure of the aorta

It is the largest and most important artery in the human body. It is very elastic, easily stretched due to the large amount of elastic fibers of the connective tissue. An impressive layer of smooth muscle allows it to taper and not lose its shape. Outside, the aorta is covered with a thin and loose sheath of connective tissue. It carries oxygen-rich blood from the left ventricle and splits into many branches, these arteries wash over all organs.

The aorta looks like a loop. It rises up behind the sternum, spreads over the left bronchus, and then goes down. In connection with this structure, there are 3 departments:

1. Ascending aorta. At the beginning of the aorta, there is a small enlargement called the aortic bulb. It sits just above the aortic valve. Above each of its lunar petals there is a sinus - a sinus. In this part of the aorta, the right and left coronary arteries originate, which are responsible for feeding the heart.
2. Aortic arch. Important arteries emerge from the aortic arch: the brachiocephalic trunk, the left common carotid and the left subclavian artery.
3. The descending part of the aorta. It is divided into 2 sections: the thoracic aorta and the abdominal aorta. Numerous arteries branch off from them.

Arterial or botall duct

While the fetus develops inside the uterus, it has a duct between the aorta and the pulmonary trunk - the vessel that connects them. Until the baby's lungs are working, this window is vital. It protects the right ventricle from overflow.

Normally, after birth, a special substance is released - bradycardin. It causes the muscles of the ductus arteriosus to contract and it gradually turns into a ligament, a cord of connective tissue. This usually occurs within the first two months after birth.

If this does not happen, then one of the heart defects develops - an open arterial duct.

Oval hole

The foramen ovale is the doorway between the left and right atria. The baby needs it while he is in the uterus. During this period, the lungs do not work, but they need to be nourished with blood. Therefore, the left atrium through the foramen ovale transfers part of its blood to the right one, so that there is something to fill the pulmonary circulation.

After childbirth, the lungs begin to breathe on their own and are ready to supply oxygen to the small body. The oval hole becomes unnecessary. Usually it is closed with a special valve, like a door, and then it is completely overgrown. This happens during the first year of life. If this does not happen, then the oval window can remain open throughout life.

Interventricular septum

There is a septum between the right and left ventricles, which is made up of muscle tissue and is covered with a thin layer of connective cells. Normally, it is solid and tightly separates the ventricles. This structure ensures the supply of oxygen-rich blood to the organs of our body.

But some people have a hole in this partition. Through it, the blood of the right and left ventricles is mixed. Such a defect is considered a heart defect.

Mitral valve

Mitral valve anatomy The mitral valve is located between the left atrium and the left ventricle. It consists of the following elements:

• Atrioventricular ring from connective tissue. It is located between the atrium and the ventricle and is a continuation of the connective tissue of the aorta and the base of the valve. There is a hole in the center of the ring, its circumference is 6-7 cm.
• Valve flaps. The leaves resemble two doors covering the hole in the ring. The front flap deepens more and resembles a tongue, while the back flap is attached around the circumference and is considered the main one. In 35% of people, it breaks down, and additional valves appear.
• Tendon chords. These are dense fibers of connective tissue that resemble threads. In total, 30-70 chords with a length of 1-2 cm can be attached to the valve leaflets. They are fixed not only to the free edge of the leaflets, but also over their entire surface. The other end of the chordae is attached to one of the two papillary muscles. The job of these small tendons is to hold the valve during ventricular contraction and prevent the leaflet from opening and releasing blood into the atrium.
• Papillary or papillary muscles... This is an extension of the heart muscle. They look like 2 small papillary outgrowths on the walls of the ventricle. It is to these papillae that the chords are attached. The length of these muscles in adults is 2-3 cm. They contract with the myocardium and pull the tendon threads. And they firmly hold the valve flaps and do not allow it to open.

If we compare the valve with the door, then the papillary muscles and tendon chords are its spring. Each leaflet has a spring that prevents it from opening towards the atrium.

Mitral valve stenosis

Mitral valve stenosis is a heart defect associated with a narrowing of the valve lumen between the left atrium and the left ventricle. In this disease, the valve flaps thicken and grow together. And if the normal area of \u200b\u200bthe hole is about 6 cm, then with stenosis it becomes less than 2 cm.

The reasons

The causes of mitral valve stenosis can be congenital anomalies in the development of the heart and past diseases.

Birth defects:

• fusion of valve flaps
• supravalvular membrane
• reduced annulus fibrosus

Acquired valve defects appear as a result of various diseases:

Infectious diseases:

• sepsis
• brucellosis
• syphilis
• angina
• pneumonia

During illness, microorganisms enter the bloodstream: streptococci, staphylococci, enterococci and fungi. They attach to microscopic blood clots on the valve leaflets and begin to multiply there. Above these colonies are covered by a layer of platelets and fibrin, protecting them from immune cells. As a result, outgrowths similar to polyps are formed on the valve leaflets, which lead to the destruction of valve cells. Inflammation of the mitral valve begins. In response, the connecting cells of the valve begin to multiply actively and the leaflets become thicker.

Rheumatic (autoimmune) diseases cause 80% of mitral stenosis

• rheumatism
• scleroderma
• systemic lupus erythematosus
• dermatopolymyositis

Immunity cells attack the connective tissue of the heart and blood vessels, mistaking it for pathogens. Connective tissue cells are impregnated with calcium salts and grow. The atrioventricular ring and valve leaflets shrink and enlarge. On average, it takes 20 years from the onset of the disease to the appearance of the defect.

Regardless of the cause of the narrowing of the mitral valve, the symptoms of the disease will be the same.

Symptoms

Narrowing of the mitral valve increases the pressure in the left atrium and in the pulmonary arteries. This explains the disruption of the lungs and the deterioration of oxygen supply to all organs.

Normally, the area of \u200b\u200bthe opening between the left atrium and the ventricle is 4-5 cm 2. For small changes in the valve well-being remains normal. But the smaller the gap between the chambers of the heart, the worse the human condition.

When the lumen is narrowed by half to 2 cm 2, the following symptoms appear:

• weakness that gets worse when walking or performing daily duties;
• increased fatigue;
• dyspnea;
• irregular heartbeat - arrhythmia.

When the diameter of the mitral valve opening reaches 1 cm, the following symptoms appear:

• cough and hemoptysis after active exertion and at night;
• swelling in the legs;
• chest and heart pain;
• bronchitis and pneumonia often occur.

Objective symptoms -these are the signs that are visible from the outside and what the doctor can notice during the examination.

Manifestations of mitral stenosis:

• the skin is pale, but a blush appears on the cheeks;
• cyanotic areas appear on the tip of the nose, ears and chin (cyanosis);
• attacks of atrial fibrillation, with a strong narrowing of the lumen, the arrhythmia can become permanent;
• swelling of the limbs;
• "Heart hump" - a protrusion of the chest in the region of the heart;
• strong blows of the right ventricle against the chest wall are heard;
• "Cat's purr" occurs after squats, in the position on the left side. The doctor puts his hand to the patient's chest and feels the blood flowing with fluctuations through the narrow valve opening.

But the most significant signs by which the doctor can diagnose "mitral valve stenosis" is listening with a medical tube or stethoscope.

1. The most characteristic symptom is diastolic murmur. It occurs in the phase of relaxation of the ventricles in diastole. This noise appears due to the fact that blood rushes at high speed through the narrow valve opening, turbulence appears - the blood flows with waves and turbulence. Moreover, the smaller the hole diameter, the louder the noise.
2. If in adults, the normal contraction of the heart consists of two tones:
   • 1 ventricular contraction sound
   • 2 the sound of closing the valves of the aorta and pulmonary artery.

And with stenosis, the doctor hears 3 tones in one contraction. The third is the sound of the mitral valve opening. This phenomenon is called "quail rhythm".

Chest x-ray - allows you to determine the state of the vessels that bring blood from the lungs to the heart. The picture shows that the large veins and arteries that pass through the lung are dilated. And the small ones, on the contrary, are narrowed and are not visible in the picture. X-ray makes it possible to determine how much the size of the heart is enlarged.

Electrocardiogram (ECG). Reveals an increase in the left atrium and right ventricle. It also makes it possible to assess whether there are heart rhythm disturbances - arrhythmia.

Phonocardiogram (PCG). With mitral valve stenosis, graphical recordings of heart sounds appear:

• characteristic murmurs that are heard before the contraction of the ventricles. It is created by the sound of blood passing through a narrow opening;
• "Click" of the closing mitral valve.
• the abrupt "pop" that the ventricle creates when it pushes blood into the aorta.

Echocardiogram (ultrasound of the heart). The disease is confirmed by such changes:

• an increase in the left atrium;
• sealing of valve flaps;
• the valve flaps close more slowly than in a healthy person.

Diagnostics

The diagnosis process begins with interviewing the patient. The doctor asks about the manifestations of the disease and conducts an examination.

The following objective symptoms are considered direct evidence of mitral valve stenosis:

• the murmur of blood during the period while it fills the ventricles;
• The "click" heard when the mitral valve opens;
• tremor of the chest, which is caused by the passage of blood through the narrow opening of the valve and vibration of its valves - "cat's purr".

The diagnosis is confirmed by the results of instrumental studies, which show an increase in the left atrium and expansion of the branches of the pulmonary artery.

1. X-ray shows dilated veins, arteries and the esophagus displaced to the right.
2. An electrocardiogram shows an increase in the left atrium.
3. The phonocardiogram reveals a murmur during diastole (relaxation of the heart muscle) and a click from the closing of the valve.
4. The echocardiogram shows a slowdown in valve operation and an increase in the heart.

Treatment

Through medicines it is impossible to eliminate heart disease, but blood circulation and the general condition of a person can be improved. For these purposes, various groups of drugs are used.

• Cardiac Glycosides: Digoxin, Celanide
These remedies help the heart beat faster and slow down the frequency of beats. They are especially necessary for you if your heart cannot cope with the load and begins to ache. Digoxin is taken 4 times a day, 1 tablet. Celanide - one tablet 1-2 times a day. The course of treatment is 20-40 days.
• Diuretics (diuretics): Furosemide, Veroshpiron
They increase the rate of urine production and help to remove excess water from the body, reduce pressure in the vessels of the lungs and in the heart. Usually, 1 tablet of a diuretic is prescribed in the morning, but the doctor can increase the dose several times if the need arises. The course is 20-30 days, then they take a break. Together with water, useful minerals and vitamins are removed from the body, therefore it is advisable to take a vitamin-mineral complex, for example, Multi-Tabs.
• Beta-blockers: Atenolol, Propranolol
They help to return the heart rhythm to normal if atrial fibrillation or other rhythm disturbances appear. They decrease the pressure in the left atrium during exercise. Take 1 tablet without chewing before meals. The minimum course is 15 days, but usually the doctor prescribes long-term treatment. It is necessary to cancel the drug gradually so as not to cause deterioration.
• Anticoagulants: Warfarin, Nadroparin
You need them if a heart defect has caused an enlarged left atrium, atrial fibrillation, which increases the risk of atrial blood clots. These products thin the blood and prevent blood clots. Take 1 tablet 1 time per day at the same time. The first 4-5 days, a double dose of 5 mg is prescribed, and then 2.5 mg. The treatment lasts 6-12 months.
• Anti-inflammatory and antirheumatic agents: Diclofenac, Ibuprofen
  These non-steroidal anti-inflammatory drugs relieve pain, inflammation, swelling, and lower fever. They are especially needed for those who have heart disease caused by rheumatism. Take 25 mg 2-3 times a day. Course up to 14 days.
  Remember that each drug has its own contraindications and can cause serious side effects. Therefore, do not self-medicate and do not take drugs that have helped your friends. Only an experienced doctor can decide which medications you need. In doing so, he takes into account whether the drugs that you are taking will be combined.

Types of operations for mitral stenosis

Childhood surgery

Whether an operation is necessary for congenital mitral valve stenosis, the doctor decides, depending on the condition of the child. If the cardiologist has determined that it is impossible to do without urgent elimination of the problem, then the baby can be operated on immediately after birth. If there is no danger to life, and there is no developmental delay, then the operation can be performed before the age of three years or postponed to a later date. Such treatment will allow the baby to develop normally and keep up with his peers in anything.

Mitral valve repair.
If the changes are small, the surgeon will dissect the fused portions of the leaflets and expand the valve lumen.

Mitral valve replacement. If the valve is badly damaged or there are developmental abnormalities, the surgeon will replace it with a silicone prosthesis. But after 6-8 years the valve will need to be replaced.

Indications for surgery for congenital mitral valve stenosis in children

• the area of \u200b\u200bthe opening in the mitral valve is less than 1.2 cm 2;
• severe developmental delay;
• a strong increase in pressure in the vessels of the lungs (small circle of blood circulation);
• deterioration of health, despite the constant intake of drugs.

Contraindications to surgery

• severe heart failure;
• left atrial thrombosis (you must first dissolve blood clots with anticoagulants);
• severe damage to several valves;
• infective endocarditis inflammation of the inner lining of the heart;
• exacerbation of rheumatism.

Types of operations for acquired mitral valve stenosis in adults

Balloon valvuloplasty

This surgery is performed through a small incision in the femoral vein or artery. Through it, a balloon is inserted into the heart. When it is in the opening of the mitral valve, the doctor inflates it sharply. The operation takes place under the control of X-ray and ultrasound.

• the mitral valve opening area is less than 1.5 cm 2;
• rough deformation of the valve flaps;
• the valves retain their mobility;
• no significant thickening and calcification of the valves.

Advantages of the operation

• rarely gives complications;
• shortness of breath and other phenomena of circulatory failure disappear immediately after the operation;
• it is considered a low-traumatic method and makes it easier to recover from surgery;
• recommended for all patients with minor changes in the valve;
• gives good results even when the valve blades are deformed.

Disadvantages of the operation

• cannot eliminate serious changes in the valve (calcification, deformation of the leaflets);
• should not be carried out with severe damage to several heart valves and left atrial thrombosis;
• the risk that a second operation will be required reaches 40%.

Commissurotomy

Transthoracic commissurotomy. This is an operation that allows you to dissect adhesions on the valve cusps, which narrow the lumen between the left atrium and the ventricle. The operation can be performed through the femoral vessels using a special flexible catheter that reaches the valve. Another option - a small incision is made on the chest and a surgical instrument is brought through the atrial groove to the mitral valve, with which the valve opening is widened. This operation is performed without a heart-lung machine.

Indications for this type of operation

• the size of the duct of the mitral valve is less than 1.2 cm 2;
• the size of the left atrium reached 4-5 cm;
• increased venous pressure;
• there is blood stasis in the vessels of the lungs.

Advantages of the operation

• gives good results;
• does not require cardiopulmonary bypass, when blood is pumped through the body by the apparatus, and the heart is excluded from the circulatory system;
• a small incision in the chest heals quickly;
• well tolerated.

Disadvantages of the operation

The operation is ineffective if there is a blood clot in the left atrium,mitral valve calcification or lumen narrowed too much. In this case, you will have to make an incision between the ribs, connect the cardiopulmonary bypass and conduct open commissurotomy.

Open commissurotomy

Indications for this type of operation

• the diameter of the mitral valve opening is less than 1.2 cm;
• mild to moderate mitral regurgitation;
• calcification and low valve mobility.

Advantages of the operation

• gives good treatment results;
• helps to reduce pressure in the atrium and pulmonary veins;
• the doctor sees what changes have occurred in the structures of the valve;
• if during the operation it is found that the valve is badly damaged, then you can immediately put an artificial one;
• can be performed if there is a blood clot in the left atrium or several valves are affected;
• effective when balloon valvuloplasty and transthoracic commissurotomy failed.

Disadvantages of the operation

• the need for artificial blood circulation;
• a large incision in the chest heals longer;
• 50% of people within 10 years after surgery again have stenosis.

Mitral valve replacement

Doctors may supply a mechanical mitral valve made of silicone, metal, and graphite. It is durable and does not wear out. But these valves have one drawback - they increase the risk of blood clots in the heart. Therefore, after the operation, you will have to take drugs for life to thin the blood and prevent the formation of clots.

Biological valve prostheses can be donated or from the heart of animals. They do not cause blood clots, but they wear out. Over time, the valve may burst or calcium accumulates on its walls. Therefore, young people will need a second operation in 10 years.

• women of childbearing age who are planning to have children. Such a valve does not cause spontaneous abortion in pregnant women;
• over the age of 60;
• people who cannot tolerate anticoagulant drugs;
• when there are infectious lesions of the heart;
• repeated heart surgery is planned;
• blood clots form in the left atrium;
• there are bleeding disorders.

Indications for valve prosthetics

• narrowing of the valve (less than 1 cm in diameter) if for some reason it is impossible to cut the adhesions between its petals;
• wrinkling of valves and tendon filaments;
• a thick layer of connective tissue (fibrosis) has formed on the valve flaps and they do not close well;
• large calcium deposits on the valve cusps.

Advantages of the operation

• the new valve allows you to completely solve the problem, even in patients with strong changes in the valve;
• the operation can be performed at a young age and after 60 years;
• repeated stenosis does not occur;
• after recovery, the patient will be able to lead a normal life.

Disadvantages of the operation

• it is necessary to exclude the heart from the circulatory system and immobilize it.
• it takes about 6 months to fully recover.

Mitral valve prolapse

Mitral valve prolapse (MVP) or Barlow Syndrome is a heart defect in which the mitral valve folds into the left atrium during the contraction of the left ventricle. In this case, a small amount of blood returns to the atrium. She joins a new serving, which comes from two pulmonary veins. This phenomenon is called "regurgitation" or "backfill".

This disease is in 2.5-5% of people and most of them do not even know about it. If the changes in the valve are minor, then there are no symptoms of the disease. In this case, doctors consider mitral valve prolapse a variant of the norm - a feature of the development of the heart. Most often it is found in young people under 30 years old, and in women several times more often.

It is believed that with age, changes in the valve may disappear on their own. But in any case, if you have a mitral valve prolapse, then you must visit a cardiologist at least once a year and do an ultrasound of the heart. This will help avoid heart rhythm disturbances and infective endocarditis.

Reasons for the appearance of PMK

Doctors identify congenital and acquired causes of prolapse.

Congenital

• disturbed structure of the leaflets of the mitral valve;
• weakness of the connective tissue of which the valve consists;
• too long tendon chords;
• violations of the structure of the papillary muscles, to which the chords are attached, fixing the valve.

The chords or tendon threads that are supposed to hold the leaflets of the mitral valve are stretched. The doors do not close tightly enough, under the pressure of the blood with a contraction of the ventricle, they protrude towards the atrium.

Infectious diseases

• angina
• scarlet fever
• sepsis

In infectious diseases, bacteria enter the bloodstream. They penetrate the heart, linger on its shells and multiply there, causing inflammation of different layers of the organ. For example, sore throat and scarlet fever caused by streptococcus are often complicated after 2 weeks by inflammation of the connective tissue that makes up the cusps of the valve and chord.

Autoimmune pathologies

• rheumatism
• scleroderma
• systemic lupus erythematosus

These diseases affect the connective tissue and impair the functioning of the immune system. As a result, immune cells attack the joints, the inner lining of the heart and its valves. Connective cells in response begin to multiply rapidly, causing a thickening and the appearance of nodules. Sashes are deformed and sag.

Other reasons

• strong blows to the chest can cause the chord to break. In this case, the valve flaps will also not close tightly.
• consequences of myocardial infarction. When the papillary muscles responsible for closing the valves are disrupted.

Symptoms

20-40% of people diagnosed with mitral valve prolapse do not have any symptoms of the disease. This means that little or no blood is leaking into the atrium.

MVP often occurs in tall, slender people, they have long fingers, a depressed chest, flat feet. Such features of the body structure are often accompanied by prolapse.

In some cases well-being may get worse. This usually occurs after strong tea or coffee, stress or action. In this case, a person can feel:

• pain in the heart;
• palpitations
• weakness and fainting;
• dizziness attacks;
• increased fatigue;
• attacks of fear and anxiety;
• heavy sweating;
• shortness of breath and feeling short of breath;
• fever not associated with infectious diseases.

Objective symptoms - signs of MVP, which the doctor detects during examination. If you seek help during an attack, your doctor will notice such changes:

• tachycardia - the heart beats faster than 90 beats per minute;
• arrhythmia - the appearance of extraordinary "unplanned" contractions of the heart against the background of a normal rhythm;
• rapid breathing;
• systolic tremor - a tremor of the chest that the doctor feels at hand during palpation. It is created by vibrating valve cusps, when a stream of blood breaks through a narrow gap between them under high pressure. This occurs at the moment when the ventricles contract and blood, through small defects in the valves, returns to the atrium;
• tapping (percussion) can reveal that the heart is constricted.
  Listening to the heart with a stethoscope allows the doctor to identify the following disorders:
• systolic murmur. It is produced by blood, seeping through the valve back into the atrium during the contraction of the ventricles;
• instead of two tones when the heart contracts (I - the sound from the contraction of the ventricles, II - the sound from the closing of the valves of the aorta and pulmonary arteries), as in people with a healthy heart, you can hear three tones - "quail rhythm". The third element of the melody is the click of the mitral petals at the moment of closing;

These changes are not permanent, depending on the position of the body and breathing of a person. And after the attack they disappear. Between attacks, the condition normalizes and the manifestations of the disease are not noticeable.

Regardless of whether congenital or acquired MVP, it is felt by a person in the same way. The symptoms of the disease depend on the general condition of the cardiovascular system and the amount of blood that seeps back into the atrium.

Instrumental examination data

Electrocardiogram. With MVP, Holter monitoring is often used, when a small sensor continuously records a cardiogram of the heart for several days while you do your usual business. It can detect heart rhythm disturbances (arrhythmias) and untimely contraction of the ventricles (ventricular extrasystoles).

Two-dimensional echocardiography or ultrasound of the heart. It reveals that one or both valve flaps bulge, bend towards the left atrium, and during contraction they move backward. You can also determine how much blood returns from the ventricle to the atrium (what is the degree of regurgitation) and whether there are changes in the valve cusps themselves.

Chest X-ray. May show that the heart is normal or reduced in size, sometimes there is an expansion of the initial section of the pulmonary artery.

Diagnostics

In order to correctly diagnose a doctor listens to the heart... Typical signs of mitral valve prolapse:

• click of the valve cusps when the heart contracts;
• the noise of blood passing through a narrow gap between the valve cusps in the direction of the atrium.

The main diagnostic method for MVP is echocardiography... She identifies changes that confirm the diagnosis:

• bulging cusps of the mitral valve, they look like a rounded bath;
• the outflow of blood from the ventricle to the atrium, the more blood returns, the worse one feels;
• thickening of valve flaps.

Treatment

There are no drugs that can cure mitral valve prolapse. If the form is not severe, then treatment is not required at all. It is advisable to avoid situations that provoke heartbeat attacks, drink tea, coffee, and alcoholic beverages in moderation.

Medication is prescribed if you feel worse.

• Calming drugs (sedatives)
Preparations based on medicinal herbs: tinctures of valerian, hawthorn or peony. They not only calm the nervous system, but also improve the functioning of blood vessels. These medicines help to get rid of the manifestations of vegetative-vascular dystonia, from which all those who have mitral valve prolapse suffer. Tinctures can be taken for a long time 25-50 drops 2-3 times a day.

Combined drugs: Corvalol, Valoserdin will help reduce the frequency of heart contractions and make the attacks of the disease more rare. These drugs are drunk daily 2-3 times a day. Usually the course is 2 weeks. After 7 days of rest, the treatment can be repeated. Do not abuse these funds, addiction and disorders of the nervous system can occur. Therefore, always adhere to the exact dose.

• Tranquilizers: Diazepam
Helps relieve anxiety, fear and irritability. It improves sleep and slows down the heart rate. Take half a tablet or a whole 2-4 times a day. Duration of treatment is 10-14 days. The drug should not be combined with other sedatives and alcohol, so as not to overload the nervous system.
• B-blockers: Atenolol
Reduces the effect of adrenaline on nerve receptors, thereby reducing the effect of stress on blood vessels and heart. It balances the effect on the heart of the sympathetic and parasympathetic nervous systems, which control the frequency of contractions, while simultaneously reducing the pressure in the vessels. Relieves arrhythmias, palpitations, dizziness and migraines. Take 1 tablet (25 mg) once a day before meals. If this is not enough, the doctor will increase the dose. The course of treatment is 2 weeks or longer.
• Antiarrhythmics: Magnesium orotate
Magnesium in its composition improves the production of collagen and thereby strengthens the connective tissue of which the valve consists. The ratio of potassium, calcium and sodium also improves, and this normalizes the heart rhythm. Take 1 g daily for a week. Then the dose is halved to 0.5 g and continue to drink for 4-5 weeks. Cannot be taken by people with kidney disease and children under 18 years of age.
• Means for lowering pressure: Prestarium, Captopril
  They inhibit the action of a special enzyme that causes an increase in pressure. Restores the elasticity of large vessels. Do not allow the atria and ventricles to stretch from high blood pressure. Improves the condition of the connective tissue of the heart and blood vessels. Prestarium take 1 tablet (4 mg) 1 time per day in the morning. After a month, the dose can be increased to 8 mg and taken with diuretics. Treatment, if necessary, can last for years.

Mitral valve prolapse surgery

Surgery for MVP is extremely rare. Depending on your health, age and degree of valve damage, the surgeon will suggest one of the existing techniques.

Balloon valvuloplasty

The operation can be performed under local anesthesia. A flexible cable is introduced through a large vessel of the thigh, which is advanced under X-ray control to the heart and stopped in the lumen of the mitral valve. The balloon is inflated, thus expanding the valve opening. At the same time, its sashes are aligned.

Indications for this type of operation

• a large volume of blood that returns to the left atrium;
• constant deterioration in health;
• medications do not help relieve symptoms of the disease;
• increased pressure in the left atrium by more than 40 mm Hg

Advantages of the operation

• carried out under local anesthesia;
• easier to carry than open heart surgery;
• no need to stop the heart during the operation and connect a heart-lung machine;
• faster and easier is the recovery period.

Disadvantages of the operation

• should not be performed if there are problems with other valves or right ventricular failure;
• a high risk that the disease will return within 10 years, a relapse will occur.

Heart valve replacement

This operation to replace a damaged heart valve with an artificial one is very rare, because MVP is considered a relatively mild pathology. But in exceptional cases, the doctor will advise you to put a mitral valve prosthesis. It can be biological (human, porcine, equine) or artificial, made of silicone and graphite.

Indications for this type of operation

• a sharp deterioration in the condition;
• heart failure;
• a break in the chord that holds the valve leaflets.

Advantages of the operation

• excludes recurrence of the disease;
• allows you to get rid of any valve defects (calcium deposits, growths of connective tissue).

Disadvantages of the operation

• valve replacement may be required after 6-8 years, especially with a biological prosthesis;
• increased risk of blood clots in the heart - blood clots;
• open heart surgery (an incision between the ribs) will take up to 1-1.5 months to recover.

Mitral valve prolapse

The word prolapse means sagging. With MVP, the leaflets of the mitral valve are slightly stretched and this prevents them from closing tightly at the right time. In some people, MVP is a small feature of the structure of the heart, almost normal, and there are no signs of illness. And others have to drink medicine regularly and even have heart surgery. Determining the correct treatment helps determine the degree of mitral valve prolapse.

Degrees of prolapse

• I degree - both leaflets bend towards the atrium by more than 2-5 mm;
• II degree - the valves swell by 6-8 mm;
• III degree - the sashes bend by more than 9 mm.

How to determine the degree of prolapse

Ultrasound examination of the heart helps to determine the degree of MVP - echocardiography... On the monitor screen, the doctor sees how much the valve flaps are deflected into the atrium, and measures the degree of deviation in millimeters. This feature underlies the division into degrees.

It is preferable that before echocardiographyyou've done 10-20 squats. This will make heart disorders more visible.

The main diagnostic criteria

• echocardiographyreveals bulging of the leaflets of the mitral valve in the atrium;
• doppler echocardiographydetermines how much blood seeps through the formed gap back into the atrium - the volume of regurgitation.

Swelling and regurgitation are independent of each other. For example, the III degree of prolapse development does not mean at all that a lot of blood is thrown into the left atrium. It is regurgitation that causes the main symptoms of the disease. And its volume is used to determine if treatment is necessary.

results listening to the heart (auscultation) help to distinguish the disease from atrial septal aneurysm or myocarditis. PMK is characterized by:

• clicks that are heard during the closing of the mitral valve;
• noises that blood creates, under pressure, breaking through a narrow gap between the valve folds.

Sensations experienced by a sick person, results ECGand x-ray help to clarify the diagnosis, but they do not play a major role in this case.

Mitral valve insufficiency

Mitral insufficiency valveor mitral insufficiency is one of the acquired heart defects. With this disease, the mitral valve flaps do not close completely - there is a gap between them. Each time the left ventricle contracts, some of the blood returns to the left atrium.

What happens in the heart? The volume of blood in the left atrium increases, and it swells and thickens. The annulus fibrosus - the basis of the mitral valve, stretches and weakens. As a result, the valve condition is gradually deteriorating. The left ventricle is also stretched, into which too much blood flows after the atrial contraction. There is increased pressure and stagnation in the vessels going from the lungs to the heart.

Mitral valve insufficiency is the most common defect, especially in men - 10% of all acquired defects. It is rarely found on its own, and often with it there is mitral stenosis or defects of the aortic valves.

The reasons

The disease can appear during the formation of the heart during pregnancy or be the result of a previous illness.

Congenital mitral valve insufficiency is very rare. She is called by:

• underdevelopment of the left half of the heart;
• too small mitral valve cusps;
• bifurcation of valves;
• tendon chords that are too short that prevent the valve from closing completely.

Acquired mitral regurgitation appears after illnesses.

Infectious diseases

• pharyngitis
• bronchitis
• pneumonia
• periodontal disease

These diseases, caused by streptococci and staphylococci, can cause a serious complication - septic endocarditis. Inflammation of the valve cusps leads to the fact that they contract and shorten, become thicker and deformed.

Autoimmune pathologies

• rheumatism
• systemic lupus erythematosus
• multiple sclerosis

These systemic diseases cause changes in the structure of the connective tissue. Cells with collagen fibers multiply rapidly. The valve flaps are shortened and look wrinkled. Compression and thickening of the petals leads to the appearance of insufficiency and stenosis of the mitral valve.

Other reasons

• capillary muscle damage after myocardial infarction;
• rupture of the valve leaflets with inflammation of the heart;
• rupture of the chords that close the valve leaflets, due to a blow to the heart.

All of these reasons can cause disturbances in the structure of the valve. Regardless of what caused the disorder, the symptoms of mitral valve insufficiency are similar in all people.

Symptoms

In some people, mitral valve insufficiency does not worsen well-being and is detected by chance. But when the disease progresses, the heart can no longer compensate for the disturbance in blood flow. The severity of the disease depends on two factors:

1. how large the clearance remains between the valve flaps at the time of closing;
2. how much blood returns to the left atrium when the ventricle contracts.

Feeling well person with mitral valve insufficiency:

• shortness of breath during physical exertion and at rest;
• weakness, fatigue;
• cough that gets worse when lying down;
• sometimes there is blood in the sputum;
• aching and pressing pains in the region of the heart;
• swelling of the legs;
• heaviness in the abdomen under the right rib, caused by an enlarged liver;
• accumulation of fluid in the abdomen - ascites.

During the examination, the doctor identifies objective symptoms mitral insufficiency:

• bluish skin on the fingers, toes, tip of the nose (acrocyanosis);
• swelling of the neck veins;
• "Heart hump" elevation to the left of the sternum;
• when tapping, the doctor notices an increase in the size of the heart;
• during palpation (palpation) after squats, the doctor feels the chest in the heart region tremble. These vibrations are created by blood, which passes through an opening in the valve, forming turbulences and waves.
• atrial fibrillation - small irregular contractions of the atria.

The doctor receives a lot of information during auscultation - this is listening to the heart with a stethoscope.

• the sound from the contraction of the ventricles is weakened or not heard at all;
• you can hear how the mitral valve closes;
• the most characteristic symptom is the noise that is heard during systole - contraction of the ventricles. It is called "systolic murmur". It arises from the fact that blood under pressure breaks back into the atrium through the loosely closed valve leaflets during the contraction of the ventricles.

Data instrumental research specify changes in the heart and blood vessels of the lungs.

Chest x-ray... In the picture you can identify:

• an increase in the left atrium and left ventricle;
• the esophagus shifted 4-6 cm to the right;
• the right ventricle may be enlarged;
• arteries and veins in the lungs are dilated, their contours are fuzzy, blurry.

Electrocardiogram. The cardiogram may remain normal, but if the pressure in the chambers of the heart and pulmonary veins is increased, then changes appear. These can be signs of an increase and overload of the left atrium and left ventricle. If the defect is highly developed, then the right ventricle is enlarged.

Phonocardiogram. Most informative research that examines heart sounds and murmurs:

• the sound from ventricular contraction is poorly audible. This is due to the fact that the ventricles hardly close;
• the sound of blood that is thrown from the left stomach into the left atrium. The louder the noise, the more severe mitral regurgitation;
• an additional click is heard when the valve is closed. This sound is created by the papillary muscles, the valve cusps, and the chordae that hold them.

Echocardiography(Ultrasound of the heart) indirectly confirms the insufficiency of the mitral valve:

• an increase in the size of the left atrium;
• stretching of the left ventricle;
• incomplete closing of the valve flaps.

Doppler study doppler echocardiography- Ultrasound of the heart, which records the movement of blood cells. It helps to determine if there is a reverse flow of blood, and to establish how much of it is in the atrium during each contraction.

Diagnostics

In order to make a diagnosis, the doctor pays attention to the characteristic signs of mitral valve insufficiency.

1. Echocardiography - reveals attenuation of sound from ventricular contraction and noise, which creates a reverse flow of blood. Changes in the valve flaps are also visible.
2. Electrocardiogram shows an increase in the left atrium, left and right ventricles.
3. X-ray... On the x-ray dilated vessels are visible over the entire surface of the lungs with a fuzzy edge and the expansion of the heart to the left.

Treatment

It is impossible to cure mitral valve insufficiency with medication. There are no drugs that could restore valve flaps and make them close tightly. But with the help of drugs, you can improve the work of the heart and relieve it.

• Diuretic drugs: Indapamide
This is a diuretic that is prescribed to rid the lungs of blood stagnation. It speeds up the production of urine and helps to remove excess water from the body. As a result, the pressure in the chambers of the heart and blood vessels of the lungs decreases. Take 1 tablet in the morning. The course of treatment is from 2 weeks. Your doctor may recommend taking diuretics daily for a long time. It must be remembered that the urine excretes the minerals potassium, sodium, calcium necessary for the proper functioning of the heart. Therefore, it is necessary to take mineral supplements with the permission of a doctor.
• ACE Inhibitors: Captopril
Reduces stress on the heart and blood vessels in the lungs, improves blood circulation. It also reduces the size of the heart and allows it to more efficiently discharge blood into the arteries. Helps to better carry loads. Take 1 tablet 2 times a day one hour before meals. If necessary, after 2 weeks the dose can be doubled.
• Beta-blockers: Atenolol
Blocks the action of receptors that cause an acceleration of the heart rate. It reduces the effect of the sympathetic nervous system, and it is precisely it that makes the heart contract faster. Atenolol reduces the contractility of the heart muscle, makes the heart beat evenly, in the right rhythm, and lowers blood pressure. The first week the drug is taken half an hour before meals at 25 mg / day, for the second dose it is increased to 50 mg / day, in the third week it is adjusted to 100 mg / day. It is also necessary to cancel this medicine gradually, otherwise the state of health may deteriorate sharply and myocardial infarction will occur.
• Cardiac Glycosides: Digoxin
Increases sodium concentration in heart cells. Improves the functioning of the conduction system of the heart, which is responsible for the rhythm of its contractions. Beats become more rare, and the pauses between them lengthen, and the heart has the opportunity to rest. Improves lung and kidney function. You especially need digoxin if mitral valve insufficiency is accompanied by atrial fibrillation. The first days of treatment should be taken at 1 mg / day. The dose is divided into 2 parts and drunk in the morning and evening. After a few days, they switch to a maintenance dose, which is 0.5 mg / day. But remember that for each person, the amount of the drug is prescribed individually.
• Antiplatelet agents: Aspirin
  This medicine prevents platelets and red blood cells from sticking together and forming blood clots. In addition, antiplatelet agents help red blood cells become more flexible and pass through the narrowest capillaries. This improves blood circulation and nutrition of all tissues and organs. Aspirin is a must for people who have an increased risk of blood clots. Take 1 time a day before meals, 100 mg / day. To reduce the risk of damage to the gastric mucosa, you can drink aspirin with food or drink a pill with milk.

Remember that all these drugs can not be taken by people with severe kidney disease, pregnant women and nursing mothers, as well as those who have individual intolerance to any component of the drug. Be sure to tell your doctor about any co-morbidities and medications you are already taking. During treatment, you will have to periodically take a blood test so that the doctor can determine if the treatment is harmful and can, if necessary, change the dosage.

Types of operations

In order to assess whether the heart needs surgery, the stage of mitral valve insufficiency is determined.

1 degree - the return of blood into the left atrium is not more than 15% of the volume of blood in the left ventricle.
Grade 2 - reverse blood flow 15-30%, the left atrium is not dilated.
Grade 3 - the left atrium is moderately dilated, 50% of the blood volume from the ventricle returns to it.
Grade 4 - the reverse blood flow is more than 50%, the left atrium is enlarged, but its walls are not thicker than in other chambers of the heart.

If the mitral valve of stage 1 is insufficient, the operation is not performed. At 2, they can offer clipping, at 2 and 3 stages, they try to plastic the valve. Stages 3-4, which are accompanied by serious changes in the cusps, chords and papillary muscles, require valve replacement. The higher the stage, the greater the risk of complications and re-development of the disease.

Clipping method

A special clip is delivered to the heart through an artery on the thigh using a flexible cable. This device is attached in the middle of the mitral valve. Due to its special design, it passes blood from the atrium into the ventricle and prevents it from moving in the opposite direction. In order to monitor everything that happens during the operation, the doctor uses an ultrasound probe placed in the esophagus. The procedure takes place under general anesthesia.

Indications for this type of operation

• Stage 2 mitral regurgitation;
• the flow of blood into the left atrium reaches 30%;
• there are no major changes in the tendon chords and papillary muscles.

Advantages of the operation

• allows to reduce the pressure in the left ventricle and the load on its walls;
• well tolerated at any age;
• does not require the connection of a heart-lung machine;
• there is no need to make an incision in the chest;
• the recovery period takes several days.

Disadvantages of the operation

• not suitable for severe valve damage.

Mitral valve reconstruction

Modern doctors try to preserve the valve whenever possible: if there is no severe deformation of the leaflets or significant calcium deposits on them. Reconstructive mitral valve repair is performed in lighter patients at any age. To correct the flaws of the valve, the doctor dissects the chest and, with the help of a scalpel, repairs the damage to the valves and aligns them. Sometimes a rigid support ring is inserted into the valve to narrow it or the tendon chords are shortened. The operation takes place under general anesthesia and requires connection to a machine that works like an artificial heart.

Indications for this type of operation

• 2 and 3 stages of mitral regurgitation
• reverse flow of blood from the left ventricle into the left atrium more than 30%;
• moderate deformation of the valve leaflets caused by any reason.

Advantages over valve replacement

• saves the "native" valve and improves its work;
• less often heart failure occurs;
• lower mortality after surgery;
• complications occur less often.

Disadvantages of the operation

• not suitable for significant calcium deposits on the valve flaps;
• can not be done if other heart valves are affected;
• there is a risk that mitral insufficiency will reappear within 10 years.

Mitral valve replacement

The surgeon removes the affected valve leaflets and replaces them with a prosthesis.

Indications for this type of operation

• 3-4 stages of mitral valve insufficiency;
• the amount of blood that is thrown back into the atrium is 30-50% of the volume of blood in the ventricle;
• the operation is performed even if there are no tangible symptoms of the disease, but the left ventricle is greatly enlarged and there is congestion in the lungs;
• severe dysfunction of the left ventricle;
• significant deposits of calcium or connective tissue on the valve petals.

Advantages of the operation

• allows you to correct any violations in the valve apparatus;
• immediately after the operation, blood circulation is normalized and blood stagnation in the lungs disappears;
• helps patients with 4 degrees of mitral regurgitation, when other methods are already ineffective.

Disadvantages of the operation

• there is a risk that the left ventricle will contract worse;
• a valve made from human or animal tissue can wear out. Its service life is about 8 years;
• silicone valves increase the risk of blood clots.

The choice of the type of operation depends on the age, degree of valve damage, acute and chronic diseases, the wishes of the patient and his financial capabilities.

After any open heart surgery, the first day will have to be spent in intensive care and about 7-10 days in the cardiology department. After that, another 1-1.5 months will be needed for rehabilitation at home or in a sanatorium, and you can return to normal life. It takes six months to fully restore the body. Proper nutrition, good rest and physiotherapy exercises will allow you to fully restore your health and live a long and happy life.

MINISTRY OF BRANCH OF RUSSIA
Federal State Budgetary Educational Institution higher professional education "Moscow State Technical University of Radio Engineering, electronics and automation " MGTUMIREA
	Faculty economics and Management__________________________ (name of faculty)
	The department Economic theory_______________________________ (department name)

abstract
by discipline
« Physical education» (name of the discipline)
Abstract on the topic: "Mitral valve prolapse. OSU complex. Means and methods of prevention and recovery "
Student group ___ GEB-1-14__________ (study group)	Surname I.O
Coursework Supervisor Associate Professor, Ph.D.	Burmistrova E.N. Pryakhin S.V.

Moscow 2015

Heart (lat.cor, Greek καρδιά) - fibro-muscular hollow organ, providing through repeated rhythmic contractions, blood flow through the blood vessels. It is present in all living organisms with a developed circulatory system, including all vertebrates, including humans. The heart of vertebrates consists mainly of cardiac, endothelial and connective tissue. In this case, the heart muscle is a special type of striated muscle tissue found exclusively in the heart. A human heart, contracting on average 72 times per minute, will perform about 2.5 billion heart cycles over 66 years. A person’s heart weight depends on gender and usually reaches 250-300 grams (9-11 ounces) in women and 300-350 grams (11-12 ounces) in men.

The human heart is a four-chamber. Distinguish between right and left atrium, right and left ventricle; Between the atria and the ventricles there are fibro-muscular entrance valves - on the right is tricuspid, on the left is bicuspid (mitral). At the exit from the ventricles, tricuspid valves of a similar structure are located (pulmonary on the right and aortic on the left).

What is a heart valve?

The valve is a part of the heart formed by the folds of its inner shell, which provides unidirectional blood flow by blocking the venous and arterial passages.

The heart is a kind of pump that makes blood circulate throughout the body. This becomes possible by maintaining pressure in the cavities (chambers) of the heart. The human heart has 4 chambers: 2 ventricles and 2 atria. Valves are special flaps located between the chambers of the heart that regulate the pressure in the chambers of the heart and support the movement of blood in the right direction.

There are 4 valves in the heart:

The mitral valve is located between the left atrium and the left ventricle. This valve consists of two flaps: front and back. Prolapse (bulging) of the anterior cusp of the mitral valve is more common than prolapse of the posterior cusp. Attached to each valve leaflet are thin threads called chords. These threads, in turn, are attached to small muscles (papillary, papillary muscles). For the valve to function normally, the leaflets, chords and papillary muscles must work together. During the contraction of the heart, the pressure in it rises greatly. Under the influence of this pressure, the mitral valve opens the valves that are held by the chords and papillary muscles.

The tricuspid (tricuspid) valve consists of 3 leaflets and is located between the right atrium and the right ventricle of the heart.

The aortic valve sits between the left ventricle and the aorta and prevents blood from flowing back into the ventricle.

How do heart valves work normally?

The left ventricle has 2 openings: one communicates with the left atrium (the mitral valve is located here), the second communicates with the aorta (the aortic valve is located here). Blood moves through the heart in the following direction: from the atrium through the open mitral valve into the ventricle and then from the ventricle through the open aortic valve into the aorta. So that during the contraction of the left ventricle the blood does not return back to the atrium, but moves into the aorta, the mitral valve closes tightly. During relaxation of the ventricle, the aortic valve closes and the blood cannot return back to the heart.

The tricuspid (tricuspid) valve and the pulmonary valve act on the same principle. Thus, due to the normal functioning of the heart valves, blood moves through the parts of the heart and maintains blood circulation throughout the body.

Valve disease Symptoms of the disease and its treatment Surgical methods of treatment Valve replacement surgery Mechanical and allografts

Heart valves provide the movement of blood in the right direction, preventing its reverse outflow. Therefore, it is very important to maintain the correct rhythm of their work and, in case of violation, conduct strengthening procedures.

Valve disease

Most often, heart valves begin to hurt when a person's age exceeds 60-70 years. At a similar age, the wear and tear of the body increases, as a result of which the work of the heart apparatus will be complicated. But heart defects can also occur as a result of infectious diseases that affect the cardiovascular system. At the same time, the spread of infectious bacteria occurs quite rapidly and takes from 2 to 5 days.

The human heart muscle has 4 cavities, which include 2 atria and 2 ventricles. It is in them that blood from the veins enters, and from there it is distributed through the arteries of the body. The valves of the heart are located at the junction of the atrium with the ventricles. Their structure helps maintain the direction of blood flow.

The heart valve has characteristic features that determine the changes in its work, which are divided into 2 main groups. In the first case, the valve apparatus of the heart does not close completely, which leads to the return of the blood mass (regurgitation). The second group of disorders includes incomplete valve opening (stenosis). This greatly impedes the flow of blood fluid, which greatly loads the heart and causes premature fatigue.

Valvular defects are a fairly common disease. They make up 25-30% of all ailments of the cardiovascular system. In this case, most often there is a defect of the mitral and aortic valve. Similar diagnoses can be established in children, since they can be of a viral origin. Infectious diseases that worsen the functioning of the heart muscle include endocarditis, myocarditis and cardiomyopathy.

Most often, doctors diagnose mitral valve prolapse, in which the heart will be accompanied by extraneous noise or clicks. A similar violation occurs due to the fact that at the time of ventricular contraction, its opening does not close tightly. This causes a deflection of the atrial cavity, which leads to the outflow of blood in the opposite direction.

Prolapse is primary and secondary. Primary is a congenital disease that develops due to a genetic defect in connective tissue. Secondary prolapse can occur due to mechanical damage to the chest, myocardial infarction, or rheumatism.

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Symptoms of the disease and its treatment

If a person's heart valve does not work well, then he will experience the following symptoms of the disease:

severe tiredness; swelling of the legs and ankles; pain and shortness of breath when walking and lifting weights; dizziness accompanied by fainting.

If such symptoms appear, you should immediately seek the advice of a qualified specialist. He will help to understand why the valve apparatus of the heart is not working, and will develop the required course of treatment. Initially, patients are prescribed conservative treatments. They are aimed at relieving pain, adjusting the heart rate and preventing possible complications. Similar methods are prescribed after the transferred operations of the cardiovascular system, they help to prevent the occurrence of relapses.

To determine a more effective method of treatment, the doctor should take into account the severity of the course of the disease, the age of the patient and all individual contraindications. Patients are prescribed medications that will increase the intensity of the heart muscle, with an improvement in its functionality. In the case when the medicinal methods of treatment do not help, then surgery is prescribed.

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Surgical treatments

Diseases of the valvular apparatus of the heart are physical diseases, therefore, surgery may be prescribed to completely restore the heart. Most often, during such operations, damaged valves are replaced.

Before the operation, a diagnostic examination of the patients is prescribed, which will help to identify the damaged valves and to reveal the severity of the course of the disease. In addition, with such examinations, doctors should receive information about the structure of the heart and underlying diseases of the body.

To improve the efficiency of the surgical intervention, such a procedure is combined with simultaneous bypass surgery, with the treatment of aortic aneurysm, or with atrial fibrillation.

Currently, there are two main types of surgical intervention for the treatment of the cardiovascular apparatus. The first type is sparing. It provides for the restoration of damaged valves. The second type of operation is more complex: during its implementation, a complete replacement of the damaged organ is performed.

If cardiologists prescribe surgical recovery, then in this case the use of individual parts is not provided. The mitral valve lends itself best to such restoration. Sometimes, reconstructive operations help to establish the work of the tricuspid and aortic systems.

During reconstructive surgery, the degree of possible infection of the body is reduced, since foreign materials will not be rejected. In addition, patients will not need to take anticoagulants throughout their lives to help thin the blood.

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Valve replacement operation

A complete heart valve replacement is prescribed when the recovery procedure is not possible. Most often, complete replacement is performed when the aortic valves fail.

During such a surgical intervention, a complete replacement of the damaged organ is performed. In the course of this process, the flap is changed, which is sewn to the native ring. For this, biocompatible materials with body tissues are used so that their rejection does not occur.

After a complete replacement of the internal flaps, all patients are prescribed a mandatory intake of pills that can thin the blood. Among these medications, Coumadin, Marevan, or Warfarin can be listed. They will help significantly reduce the formation of large blood clots and delay their coagulation. This quality will help prevent the occurrence of strokes or heart attacks. In addition, all patients after surgery must necessarily take blood tests that will help track and evaluate the performance of the heart and the effectiveness of the drugs taken.

Heart prostheses can have different structures: biological and mechanical.

Biological are made from bioprosthetic tissue based on the internal organs of cows or pigs. Less commonly, human donor material can be used. To facilitate their installation, several artificial components are used that will help to qualitatively place and attach the implantable organ.

Biological prostheses work for a long time without causing irregularities in the heart rhythm. The duration of their work can reach 15-20 years, while patients do not need to take anticoagulants on a daily basis.

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Mechanical and allografts

Allografts are living donor tissue that is transplanted to a sick person after the sudden death of the donor. Such operations correspond to the Ross method, which makes it possible not only to easily carry out the operation, but also to postpone a further recovery period.

Tissue engraftment takes place rather quickly, and there are no cases of donor organ rejection. Most patients operated on according to the Ross method recover quickly, without the need for constant monitoring by their doctors and taking supportive medications.

Mechanical shutters are made of artificial elements. The material from which they are made, pretty well survives in the human body. A medical grade alloy with carbon parts is best suited for this. This design is quite reliable and can work without fail for 10-12 years.

The most common mechanical design is a butterfly valve, which is made of a metal ring and carbon flaps. The upper part of such a valve is covered with polyester fabric. The disadvantage of such a mechanical damper is that during its operation, mechanical clicks will be observed. In addition, patients are advised to take regular medications.

The recovery period after surgery is 60 to 90 days. After 8-10 months, a person can already drive, without worrying about loss of consciousness. During the recovery period, smoking and alcohol intake are contraindicated in patients. Nutrition should be dietary, it eliminates difficult to digest foods and requires reduced levels of cholesterol.

Any heart defect is associated with a valve abnormality. Aortic valve defects are especially dangerous, since the aorta is the largest and most important artery in the body. And when the work of the apparatus supplying oxygen to all parts of the body and the brain is disrupted, a person is practically inoperable.

The aortic valve is sometimes formed in utero already with defects. And sometimes heart defects are acquired with age. But whatever the cause of the disruption of this valve, the medicine in such cases has already been found - prosthetics of the aortic valve.

Anatomy of the left side of the heart. Aortic valve functions

The four-chambered structure of the heart must work in perfect harmony in order to fulfill its main function - to provide the body with nutrients and air carried by the blood. Our main organ consists of two atria and two ventricles.

The right and left parts are separated by an interventricular septum. Also in the heart there are 4 valves that regulate blood flow. They open in one direction and close tightly so that the blood moves in only one direction.

The heart muscle has three layers: the endocardium, the myocardium (thick muscle layer) and the endocardium (outer). What's going on in the heart? The depleted blood that has given up all the oxygen returns to the right ventricle. Arterial blood flows through the left ventricle. We will examine in detail only the left ventricle and the operation of its main valve, the aortic.

The left ventricle is cone-shaped. It is thinner and narrower than the right one. The ventricle is connected to the left atrium through the atrioventricular opening. The mitral valve leaflets are attached directly to the edges of the opening. The mitral valve is bicuspid.

The aortic valve (valve aortae) consists of 3 cusps. Three flaps are named: right, left and back lunate (valvulae semilunares dextra, sinistra, posterior). The valves are formed by a well-developed endocardial duplication.

The atrial muscles from the ventricular muscles are isolated by a plate of the right and left fibrous rings. The left annulus fibrosus (anulus fibrosus sinister) surrounds the atrioventricular opening, but not completely. The front sections of the ring are attached to the aortic root.

How does the left side of the heart work? Blood enters, the mitral valve closes, and a push occurs - contraction. The contraction of the heart walls pushes blood through the aortic valve into the widest artery, the aorta.

With each contraction of the ventricle, the valves are pressed against the walls of the vessel, giving a free flow of oxygenated blood. When the left ventricle relaxes for a split second so that the cavity is again filled with blood, the aortic valve of the heart closes. This is one heart cycle.

Congenital and acquired aortic valve defects

If there are problems with the aortic valve during the intrauterine development of the baby, it is difficult to notice. Usually, the defect is noticed after birth, since the baby's blood bypasses the valve, directly into the aorta through the patent ductus arteriosus. It is possible to notice deviations in the development of the heart only thanks to echocardiography, and only from 6 months.

The most common valve anomaly is the development of 2 valves instead of 3. This heart defect is called a bicuspid aortic valve. Anomaly does not threaten the child. But 2 sashes wear out faster. And by adulthood, supportive therapy or surgery is sometimes needed. Less commonly, a defect such as a one-leaf valve occurs. Then the valve wears out even faster.

Another anomaly is congenital stenosis of the aortic valve. The semilunar valves either grow together, or the valve fibrous ring itself, to which they are attached, is excessively narrow. Then the pressure between the aorta and the ventricle is different. Over time, stenosis intensifies. And interruptions in the work of the heart prevent the child from fully developing, it is difficult for him to exercise sports even in the school gym. A serious violation of the blood flow through the aorta at some point can lead to a sudden death of the child.

Acquired defects are the result of smoking, excessive eating, sedentary and stressful lifestyle. Since everything in the body is connected, after 45-50 years all minor ailments usually develop into diseases. The aortic valve of the heart wears out little by little, as it works constantly. The exploitation of the resources of your body, lack of sleep wear out these important details of the heart faster.

Aortic stenosis

What is stenosis in medicine? Stenosis means narrowing of the lumen of the vessel. Aortic stenosis is a narrowing of the valve that separates the left ventricle of the heart from the aorta. Distinguish between minor, moderate and severe. This defect can affect the mitral and aortic valves.

With a slight valve defect, a person does not feel any pain or other signaling symptoms, because the increased work of the left ventricle will be able to compensate for the poor operation of the valve for some time. Then, when the compensatory capabilities of the left ventricle are gradually exhausted, weakness and poor health begins.

The aorta is the main blood line. If the valve is broken, all vital organs will suffer from a lack of blood supply.

The causes of stenosis of heart valves are:

Congenital valve defect: fibrous film, bicuspid valve, narrow ring A scar formed by the connective tissue just below the valve Infective endocarditis Bacteria trapped in heart tissue alter the tissue. Due to the colony of bacteria, connective tissue grows on the tissue and on the valves. Deforming osteitis. Autoimmune problems: rheumatoid arthritis, lupus erythematosus. Due to these diseases, in the place where the valve is attached, connective tissue grows. Growths are formed on which more calcium is deposited. There is calcification, which we still recall. Atherosclerosis.

Unfortunately, in most cases, aortic stenosis is fatal if valve replacement is not done on time.

Stages and symptoms of stenosis

Doctors distinguish 4 stages of stenosis. On the first, there is practically no pain or ailment. Each stage corresponds to a set of symptoms. And the more serious the stage of development of stenosis, the faster the operation is needed.

The first stage is called the compensation stage. The heart is still coping with the load. The deviation is recognized as insignificant when the valve clearance is 1.2 cm2 or more. And the pressure is 10–35 mm. Hg. Art. Symptoms at this stage of the disease are not manifested. Subcompensation. The first symptoms appear immediately after exercise (shortness of breath, weakness, palpitations). It is characterized by the fact that symptoms appear not only after exertion, but also in a calm state. The last stage is called terminal. This stage is when strong changes have already occurred in the anatomical structure of the heart.

Symptoms of severe stenosis are as follows:

pulmonary edema; shortness of breath; sometimes suffocating, especially at night; pleurisy; heart cough; chest pain.

On examination, the cardiologist discovers usually wet wheezing in the lungs while listening. The pulse is weak. Noises are heard in the heart, vibration is felt, created by the turbulences of the blood flows.

Stenosis becomes critical when the lumen is only 0.7 cm2. The pressure is more than 80 mm. Hg. Art. At this time, the risk of death is high. And even an operation to eliminate the defect is unlikely to change the situation. Therefore, it is better to consult a doctor in the subcompensatory period.

The development of calcification

This defect develops as a result of a degenerative process in the tissue of the aortic valve. Calcification can lead to severe heart failure, stroke, general atherosclerosis. Gradually, the leaflets of the aortic valve become covered with calcareous growth. And the valve is calcined. That is, the flaps of the valve stop closing completely, but they also open weakly. When a bicuspid aortic valve is formed at birth, calcification quickly leads to its inoperative state.

And also calcification develops as a result of disruption of the endocrine system. Calcium salts, when they do not dissolve in the blood, accumulate on the walls of blood vessels and on the valves of the heart. Or a kidney problem. Polycystic kidney disease or nephritis also leads to calcification.

The main symptoms will be:

aortic insufficiency; enlargement of the left ventricle (hypertrophy); interruptions in the work of the heart.

A person must monitor his health. Pain in the chest area and increasingly frequent periodic bouts of angina should be a signal to undergo a cardiological examination. Without surgery for calcification, in most cases, a person dies within 5-6 years.

Aortic regurgitation

During diastole, blood from the left ventricle is forced into the aorta by pressure. This is how the systemic circulation begins. But with regurgitation, the valve "pushes" blood back into the ventricle.

Valve regurgitation, or aortic valve insufficiency, in other words, has the same stages as valve stenosis. The causes of this condition of the valves are either aneurysm, or syphilis, or the mentioned acute rheumatism.

The symptoms of deficiency are:

low blood pressure; dizziness; frequent fainting; swelling of the legs; broken heart rate.

Severe insufficiency leads to angina pectoris and an increase in the ventricle, as with stenosis. And such a patient also needs an operation to replace the valve in the near future.

Valve seal

Stenosis can form due to the fact that endogenous factors cause the appearance of various growths on the valve cusps. The aortic valve hardens and malfunctions begin. The causes of aortic valve compression may be many untreated diseases. For example:

Autoimmune diseases. Infectious lesion (brucellosis, tuberculosis, sepsis). Hypertension. Due to prolonged hypertension, the tissues become thicker and rougher. Therefore, over time, the lumen narrows. Atherosclerosis - clogging of tissues with lipid plaques.

Tissue thickening is also a common sign of aging in the body. Compaction will inevitably result in stenosis and regurgitation.

Diagnostics

Initially, the patient must provide all the necessary information for the diagnosis to the doctor in the form of an accurate description of the ailments. Based on the patient's medical history, the cardiologist will prescribe diagnostic procedures in order to know additional medical information.

Necessarily appointed:

X-ray. The shadow of the left ventricle increases. This can be seen in the arc of the heart contour. Signs of pulmonary hypertension are also visible. ECG. The examination reveals an increase in the ventricle and arrhythmia. Echocardiography. On it, the doctor notices whether or not there is a seal of the valve flaps and a thickening of the walls of the ventricle. The cardiologist must know the exact meaning: how much the pressure in the aortic cavity differs from the pressure on the other side of the valve. Noises are recorded during heart function (systolic and diastolic murmurs). Ventriculography. It is prescribed to detect mitral valve insufficiency.

With stenosis, an electrocardiogram shows rhythm and conduction disturbances in biocurrents. On the roentgenogram, you can clearly see signs of dimming. This indicates congestion in the lungs. It is clearly visible how dilated the aorta and the left ventricle are. And coronary angiography shows that the amount of blood ejected from the aorta is less. This is also an indirect sign of stenosis. But angiography is done only for people over 35 years old.

The cardiologist also pays attention to symptoms that are visible without instruments. Pallor of the skin, Musset symptom, Muller symptom - these signs indicate that the patient is most likely to have aortic valve insufficiency. Moreover, the bicuspid aortic valve is more prone to failure. The doctor must take into account the congenital features.

What other signs can a cardiologist be told about the diagnosis? If, by measuring the pressure, the doctor notices that the upper one is much higher than normal, and the lower (diastolic) is too underestimated, this is an occasion to send the patient for echocardiography and radiographs. Excessive noises during diastole heard through a stethoscope also do not promise any good news. This is also a sign of failure.

Drug treatment

For the treatment of insufficiency at the initial stage, drugs of the following classes can be prescribed:

peripheral vasodilators, which include nitroglycerin and its analogs, diuretics are prescribed only for certain indications, calcium channel blockers, such as "Diltiazem".

If the pressure is very low, nitroglycerin preparations are combined with "Dopamine". But beta-hadron blockers are contraindicated in case of aortic valve insufficiency.

Aortic valve replacement

Aortic valve replacement surgery is now underway quite successfully. And with minimal risk.

For the duration of the operation, the heart is connected to a heart-lung machine. The patient is also given complete anesthesia. How can a surgeon perform this minimally invasive operation? There are 2 ways:

A catheter is inserted directly into the femoral vein and rises to the aorta against the flow of blood. The valve is fixed and the tube is removed. A new valve is inserted through the incision in the chest on the left. An artificial valve is inserted and snaps into place, passing through the apical part of the heart, and is easily excreted from the body.

Minimally invasive surgery is suitable for those patients who have concomitant diseases, and it is impossible to open the chest. And after such an operation, a person immediately feels relief, since the defects have been eliminated. And if there are no complaints about the state of health, it can be discharged in a day.

It should be noted that artificial valves require constant administration of anticoagulants. Mechanical can cause blood clotting. Therefore, after the operation, "Warfarin" is prescribed immediately. But there are also biological valves that are more suitable for humans. If a valve is installed from the porcine pericardium, then the drug is prescribed only for several weeks after the operation, and then canceled, since the tissue takes root well.

Aortic balloon valvuloplasty

Sometimes prescribed aortic balloon valvuloplasty. This is a painless operation according to the latest developments. The doctor controls all the actions that take place through special X-ray equipment. A catheter with a balloon is passed to the aortic orifice, then the balloon is placed in place of the valve and expanded. This eliminates the problem of valve stenosis.

Who is the operation indicated for? First of all, such an operation is performed on children with a congenital defect, when a one-leaf or bicuspid aortic valve is formed instead of a tricuspid one. It is indicated for pregnant women and people before transplanting another heart valve.

After this operation, the recovery period is only 2 days to 2 weeks. Moreover, it is transferred very easily and is suitable for people with poor health, and even for children.

Heart valves
The heart is a muscle that continually contracts and carries blood to the rest of the body. Inside the heart there are four valves that open and close in strict sequence, and contribute to the movement of blood in a certain direction. The valves are distinguished: tricuspid valve, pulmonary valve, mitral valve and aortic valve.

What is a heartbeat?

Two heart valves control blood flow from the upper chambers of the heart, or atria, into the lower chambers of the heart - the ventricles. The other two valves are responsible for the movement of blood from the ventricles to the lungs and other human organs. When the valves open or close, they produce two different sounds - which we call the heartbeat.

How does oxygen-poor blood flow through the heart?

When the heart beats normally, oxygen-poor blood returns from the body and fills the right atrium, which, contracting, pushes blood through the tricuspid valve into the right ventricle. The right ventricle then contracts and pushes blood through the pulmonary valve into the pulmonary artery. Through the pulmonary artery, blood enters the lungs and is enriched with oxygen there.

How does oxygenated blood pass through the heart?

At the same time, oxygen-rich blood flows from the lungs into the left atrium, which, by contracting, pushes it through the mitral valve into the left ventricle. The left ventricle contracts, and blood enters the aorta through the aortic valve, and from there it goes to the rest of the body.

How do the atria and ventricles of the heart work?

Blood travels through the heart through valves. When the atrium contracts, the valves in these upper chambers — the tricuspid valve and the mitral valve — open to allow blood to flow into the ventricles. When they contract, the tricuspid and mitral valves close, and at this time, under pressure, the ventricular valves open - pulmonary and aortic. The blood leaving the ventricles does not return to them due to the tight closure of the aortic and pulmonary valves.

Heart valve disorders

There are abnormalities associated with the functioning of the heart valves, such as valvular regurgitation (reverse blood flow) and valvular stenosis (narrowing of the valve lumen).

The heart is a hollow muscle organ, providing oxygen enrichment of organs and tissues due to blood circulation throughout the body. It has four chambers: two atria and two ventricles. Atrioventricular valves are divided atria and ventricles: mitral on the left and tricuspid on the right.

The vessels that leave the heart are also separated by valves: the aortic and pulmonary valve. Opening to one side, the heart valves regulate the direction of blood flow, preventing the return of blood. In the event of a change in the structure of the valves, they cannot open or close completely.

In the first case, the blood is supplied in insufficient quantities, in the second, part of the blood, during contraction, does not enter the outflowing vessels, but back into the atria or ventricles, which after a while leads to progressive heart failure. Heart failure is characterized by the development of weakness of the heart muscle, which ultimately cannot cope with its function - enrichment of the body with blood.

1 General understanding of valvular heart disease

Congenital valve defects are called congenital or acquired defects of the valvular apparatus, leading to its dysfunction. Acquired defects are much more common, moreover, mainly the left half of the heart is affected, therefore, such defects as tricuspid valve stenosis are quite rare. Changes in the structure of valves or underlying structures that regulate their operation entail hemodynamic disturbances.

Acquired valvular heart disease predispose to the development of the disease - infective endocarditis, arrhythmias and conduction disorders, and, ultimately, to heart failure. Valvular heart defects can be divided into two groups: insufficiency and stenosis.

Valve insufficiency is a condition in which the valves are not close to each other when closed and this causes blood to flow in the opposite direction.

Stenosis is a condition in which there is a narrowing of the opening blocked by the valve, which entails a decrease in the incoming blood volume.

Cases when insufficiency and stenosis affect one valve are usually called the development of a combined defect. With the defeat of two or more valves - combined.

2 Causes of valvular insufficiency

One of the causes of valvular insufficiency is the presence of a congenital defect such as prolapse or splitting of the valve. Rheumatism, systemic sclerosis, aortoarteritis, systemic lupus erythematosus and other inflammatory diseases of the connective tissue can provoke the development of valvular defects. The cause can be bacterial or viral diseases, in particular infective endocarditis and myocarditis.

Valvular insufficiency can be provoked by injury, as a result of which eversion or rupture of the leaflet is observed, or damage to the muscles and chords that regulate the opening and closing of the valves. Arterial hypertension due to expansion of the aortic root can lead to the development of aortic valve insufficiency.

3 Rheumatism as a cause of the development of acquired valvular heart diseases

Rheumatism is often the basis for the development of acquired heart valve disease. The development of rheumatism occurs against the background of a chronic inflammatory disease of the nasopharynx. This disease is caused by group A β-hemolytic streptococcus and affects the heart, joints, skin and other organs. Children and adolescents are most susceptible to this disease.

One of the problems of rheumatism is the difficulty of diagnosis, since there are no specific laboratory tests pathognomonic for acute rheumatic fever or its recurrence. Therefore, when diagnosing rheumatism, the doctor relies on certain criteria and signs that preceded streptococcal infection for a month and a half.

Most often, rheumatism affects the aortic and mitral valves. Patients with rheumatism are hospitalized in a hospital, and they receive antibacterial and anti-inflammatory therapy. The latter is determined in accordance with the individual characteristics of the patient. At the end of the treatment, the prevention of recurrence of rheumatism is carried out.

4Clinic of valvular insufficiency

In the initial stages of the disease, patients may not complain at all. This period is called the compensation stage. Further complaints of patients depend on the severity of the disease and on whether valvular heart disease is isolated or combined. When complaints appear, the stage of decompensation of the process begins, which over time can lead to heart failure.

With moderate mitral regurgitation, the patient is concerned about fatigue and shortness of breath. In more serious cases, there may be scant hemoptysis due to pulmonary edema. Due to the progressive increase in the left atrium, the nerve innervating the larynx is compressed, which is clinically manifested by hoarseness.

In aortic valve insufficiency, the initial symptoms are shortness of breath, heart palpitations, and chest pain. Hypotension and pulmonary edema can occur in severe aortic regurgitation. In the absence of timely surgical intervention, there is a high risk of death.

5 Diagnosis of acquired valvular insufficiency

1. The first stage of the diagnostic search, if an acquired heart defect is suspected, the doctor resorts to physical diagnostics, which is primarily an examination of the patient and auscultation of the heart. Altered heart sounds and murmurs are auscultated.


2. The second stage of diagnosis is research methods that include electrocardiography (ECG), chest x-ray and echocardiography (EchoCG). An ECG visualizes signs of enlargement in the left chambers of the heart. An x-ray allows you to see changes in the size and shape of the heart, as well as pathological processes in the lungs. With the help of echocardiography, you can see a decrease in the size of the hole and changes in valve flaps, as well as echocardiography allows you to determine the cause of failure, its degree, the presence of complications and compensatory abilities of the body.
   

   Echocardiography is the best method of primary diagnosis and dynamic monitoring of the patient's condition.

3. The third stage of diagnosis is invasive research methods, namely cardiac catheterization followed by ventriculography and coronography.

6Differentiated approach in the treatment of mitral valve insufficiency

In the absence of symptoms and exhibiting mild to moderate mitral regurgitation, drugs are not prescribed. Medication support with ACE inhibitors is prescribed when a diagnosis of severe mitral insufficiency with an asymptomatic course is made. Symptoms, even with moderate mitral regurgitation, are indications for surgery.

With mitral valve insufficiency, there are two types of surgical interventions, namely valve plastic and its prosthetics. If the valve was not subject to calcification and remained movable, then in this case the plastic is the choice operation. With a sufficiently pronounced thickening of the valve, preferably its prosthetics.

The advantage of valve plastic over its prosthetics is that with this operation the total number of complications is lower. With mitral valve repair, the risk of developing a disease such as infective endocarditis is lower.

7 Differentiated approach in the treatment of aortic valve insufficiency

Diagnosed asymptomatic mild aortic regurgitation does not require specialized treatment, however, it is strongly recommended to limit physical activity and an annual visit to a cardiologist. The indication for the appointment of conservative therapy is moderate aortic insufficiency in the absence of symptoms; in the case of visiting a cardiologist, it is worth at least once every six months.

With severe aortic valve insufficiency and the absence of symptoms of insufficiency, continuous medical therapy is prescribed, a cardiologist examines every six months, and echocardiography is performed once or twice a year. Indications for surgical treatment are severe aortic insufficiency in the presence of a clinic and the development of left ventricular heart failure.

Finally, it is important to remember that the success of your recovery most often depends on your emotional state.

zabserdce.ru

Heart valve disease usually develops over time, clinical symptoms appear between the ages of 60 and older, while heart defects can be the result of an infection that affects and changes the structure of the heart valves over several days.

What is heart valve disease?

Each heart valve is a complex mechanism that, like gate leaves, opens and closes the blood flow through the chambers of the heart and from the heart to the aorta and pulmonary artery. Valves allow blood to flow in only one direction.

The human heart consists of four cavities - two atria and two ventricles. Blood enters the atria of the heart through the veins, from the atria to the ventricles, from the ventricles to the large arteries (aorta and pulmonary artery). On the way of its movement in the places of transition of the atria into the ventricles and ventricles in the artery, there are heart valves - movable flaps consisting of individual elements (valves). If the heart valve does not work properly, blood flow disorders (in the form of reverse flow, or obstructed blood flow) occur.

The nature of changes in heart valves can be divided into two groups:
- valves that do not fully close (valve insufficiency), which leads to regurgitation (reverse flow) of blood through the valve in the opposite direction (for example, from the aorta to the left ventricle) and
- valves that do not open properly (valve stenosis), which makes blood flow difficult and restricted.

Valvular heart defects are relatively common, accounting for 20 to 25% of all organic heart diseases in adults. Mitral valve defects are most often detected, followed by aortic valve lesions. In almost all cases in children and in 90% of cases in adults, the occurrence of the defect is associated with rheumatism. The second most common disease is bacterial endocarditis. Rare causes of the formation of the defect can be systemic lupus erythematosus, scleroderma, rheumatoid arthritis, in adults - atherosclerosis, coronary heart disease.

Of particular note is a condition common in healthy people called mitral valve prolapse, or click syndrome, flapping valve syndrome, click and noise syndrome, mitral valve aneurysmal flexion syndrome, Barlow syndrome, Angle syndrome and etc.

ffer and Borbillon in 1887 were the first to describe the auscultatory phenomenon of systolic clicks (clicks) of the heart. The term "mitral valve prolapse", which is currently the most widespread, was first proposed by J Criley.

The mitral valve blocks the return flow of blood from the left ventricle to the left atrium. Prolapse is a condition where the valve cusps at the time of ventricular contraction do not close the hole “tightly”, but bend into the atrial cavity, letting blood flow in the opposite direction. This is accompanied by a characteristic clicking sound or heart murmur. The amount of blood returning to the atrium can be a measure of the severity of the defect.

Depending on when the heart valve defect appeared, a distinction is made between primary and secondary prolapse:
1. Primary (idiopathic) valve prolapse is congenital, caused by a genetic defect in the structure of the connective tissue that makes up the valve leaflets.
2. Secondary (acquired) prolapse of the heart valve appears as a result of chest injuries, rheumatism, myocardial infarction, and other causes.
Today, some experts consider primary mitral valve prolapse to be just a variation of the norm, and not a disease at all.

Symptoms of heart valve defects:

• fatigue
• swelling of the ankles and legs
• dizziness
• fainting
• pain in the region of the heart (angina)

Treatment of valvular heart disease

Conservative treatment for heart defects is aimed at preventing complications and relapses of the primary disease (rheumatism, infective endocarditis, etc.) and correcting rhythm disturbances and heart failure. All patients with identified heart defects need a consultation with a cardiac surgeon.

pateroclinic.ru

Valvular heart disease occurs when the valves are malfunctioning.

Varieties of heart valve defects

Stenosis of the heart valve. Stenosis occurs when the opening of the heart valve is reduced due to the narrowing or closing of the valve cusps. A narrow hole significantly enhances heart stress, as blood flow is obstructed. Such processes can cause heart failure and other troubles with the cardiovascular system. Stenosis can happen with all four heart valves. The latter phenomenon is called complete stenosis of the tricuspid valve, stenosis of the pulmonary artery valve, stenosis of the mitral valve and stenosis of the aorta.

Heart valve insufficiency. Insufficiency is observed when the heart valve is not fully closed during operation. If the valve does not close completely, then some blood will flow back into it. When there is more blood, and it does not flow through the valves in full, the function of the heart becomes difficult, since the heart muscle does not have enough strength to compensate for the insufficiency of the heart valve and the small amount of blood flowing to the internal organs. The nature of the insufficiency is determined by the degree of damage to the heart valves.

Causes of valvular heart disease

Valvular heart disease can be congenital or acquired during life. It happens that the cause of the formation of heart valve defects cannot be established.

Congenital heart valve defects. As a rule, defects of the aortic and pulmonary valves are observed. Due to damage, the valves may be deformed or incorrectly fused.

Aortic valve disease is a congenital abnormality. Instead of the correct three valve valves, the affected aortic valve has only two valves. The absence of a third flap results in the valve not being able to close completely.

Acquired heart valve defects. Acquired defects are those that developed during the life of the wasp with a healthy valve. Transformations of the valve structure due to all kinds of infections or inflammations are considered to be acquired heart valve defects.

Mitral valve prolapse is a common condition in which damage to the heart valve occurs. Mitral valve prolapse consists in sagging valve flaps into the left atrium during cardiac contractions. The consequence of mitral valve prolapse is valve leakage due to the loss of elasticity by its walls. Mitral valve prolapse usually does not require special treatment.

Other causes of valvular heart disease are cardiac ischemia, myocardial infarction, heart muscle disease, syphilis, high blood pressure, and impaired connective tissue structure. Causes such as neoplasms, certain medications, and radiation exposure are less common.

Symptoms of heart valve defects

- shortness of breath and shortness of breath. As a rule, it is observed with physical exertion or in a horizontal position of the trunk. To relieve the condition during sleep, you can raise your head on several pillows.

- dizziness and a feeling of weakness. Even minor physical exertion can quickly tire a person suffering from heart valve defects. Frequent dizziness can sometimes lead to fainting conditions.

- discomfort in the chest area. With physical exertion or going outside in frosty weather, a person may experience pain in the chest area.

- swelling of the legs and lower abdomen. With swelling of the lower abdomen, a person may feel that he has bloating.

Among the serious diseases that deprive a person of the opportunity to live a full life, heart disease is not the last place.

Statistics show that every third person who seeks help from doctors has problems with cardiac activity. Experts say that not all heart diseases lead to serious consequences.

But there are diseases that can only be cured by competent surgical intervention: a complete transplant of the heart or its parts. Among the treatments for heart disease that are popular in professional circles, the method of implantation of an artificial valve is called popular.

The life span of a person whose heart was equipped with a valve of artificial origin is a question that worries those who are recommended surgical intervention. The life expectancy of people who have undergone implantation of an artificial valve in the heart reaches 20 years. However, expert assessments prove the possibility of the implant functioning for 300 years. This fact allows them to assert that valve installation does not affect life expectancy in any way. The cause of death of people who underwent surgery to install an artificial valve 20 years ago is not the problem of the functioning of the cardiovascular system.

Grounds for installing an artificial valve

A heart valve is compared in medical circles to a door that needs to be repaired if it loses its original functionality. In the case of the heart valve, doctors use the same approach. Damage to the heart valve, requiring drastic approaches and choice of treatment methods, is classified into three types.

The first involves the processes of narrowing or sticking together, which causes a slowdown in blood flow, which negatively affects the nutrition of the heart, leading to oxygen starvation. The second is due to the processes of expansion or overextension, leading to a violation of the integrity of the heart and increased stress. The third is a combined version of the two previous types.

Diagnosing heart failure is not a cause for panic. Implantation is not always shown. Doctors perform other operations, for example, reconstruction of an organ.

Implants and their types

At the present stage, valves of artificial origin are presented in two options: the first is mechanical, the second is biological. Both have both positive and negative characteristics.

A mechanical implant is a prosthesis that replaces a natural heart valve. The task of the prosthesis is actions aimed at conducting blood flow through the heart. The use of a mechanical prosthesis is due to dysfunction of the native organ.

Tests conducted on prototypes of artificial prostheses indicate the possibility of their operation for 50 thousand years. And this is when creating conditions for forced wear. Therefore, if the installed mechanical valve takes root in the human body, then it will continuously perform its functions for as long as the person lives.

The main precaution required for execution relates to the need for additional support for the functioning of prostheses, as well as the regular use of anticoagulants, the actions of which are aimed at diluting the blood flow. This technique helps to avoid the formation of heart clots. A prerequisite is the regularity of collection and verification of analyzes.

Biological valves are also represented as prostheses, but animal tissue is used to create them. Valves borrowed from pigs can serve as consumables. An indispensable condition for the use of such material is its preliminary processing. Otherwise, the implant is unusable. Biological valves are much less durable when compared to mechanical valves.

Heart valve transplants and possible complications

According to experts, a patient who comes to a medical consultation on time practically reduces the risk of complications to zero. All other options for the development of the event indicate the minimum risk of the operation itself and the danger of non-compliance with the recommendations of doctors in the period after the implantation.

A careful attitude to one's own health is a principle that the operated patient must adhere to. The patient needs to follow the doctor's recommendations regarding: daily routine, nutrition, medication. Only in this way can a person with an artificial implant ensure a long life.