That mitral valve insufficiency is stage 1. How to treat the disease. Degree of disease development

– valvular heart disease, characterized by incomplete closure or prolapse of the leaflets of the left atrioventricular valve during systole, which is accompanied by reverse pathological blood flow from the left ventricle to left atrium. Mitral insufficiency leads to shortness of breath, fatigue, palpitations, cough, hemoptysis, swelling in the legs, and ascites. Diagnostic detection algorithm mitral insufficiency involves comparison of data from auscultation, ECG, FCG, radiography, echocardiography, cardiac catheterization, ventriculography. For mitral regurgitation, drug therapy and cardiac surgery (mitral valve replacement or plastic surgery) are performed.

General information

Mitral valve insufficiency is a congenital or acquired heart defect caused by damage to the valve leaflets, subvalvular structures, chords, or overstretching of the valve ring, leading to mitral regurgitation. Isolated mitral regurgitation is rarely diagnosed in cardiology, but in the structure of combined and concomitant heart defects it occurs in half of the cases.

In most cases, acquired mitral regurgitation is combined with mitral stenosis (combined mitral heart disease) and aortic defects. Isolated congenital mitral regurgitation accounts for 0.6% of all birth defects hearts; in complex defects it is usually combined with ASD, VSD, open ductus arteriosus, coarctation of the aorta. In 5-6% of healthy individuals, echocardiography reveals some degree of mitral regurgitation.

Causes

Acute mitral regurgitation can develop due to ruptures of the papillary muscles, chordae tendineae, rupture of the mitral valve leaflets during acute myocardial infarction, blunt cardiac trauma, and infective endocarditis. Rupture of the papillary muscles due to myocardial infarction is accompanied by death in 80–90% of cases.

The development of chronic mitral regurgitation may be due to valve damage during systemic diseases: rheumatism, scleroderma, systemic lupus erythematosus, Loeffler's eosinophilic endocarditis. Rheumatic heart disease accounts for about 14% of all cases of isolated mitral regurgitation.

Ischemic dysfunction of the mitral complex is observed in 10% of patients with post-infarction cardiosclerosis. Mitral regurgitation can result from mitral valve prolapse, tear, shortening or lengthening of the chordae tendineae and papillary muscles. In some cases, mitral insufficiency is a consequence of systemic defects connective tissue for Marfan and Ehlers-Danlos syndromes.

Relative mitral regurgitation develops in the absence of damage valve apparatus with dilatation of the left ventricular cavity and expansion of the fibrous ring. Such changes occur in dilated cardiomyopathy, progressive arterial hypertension and coronary artery disease, myocarditis, aortic defects hearts. More rare causes of mitral regurgitation include leaflet calcification, hypertrophic cardiomyopathy, etc.

Congenital mitral insufficiency occurs with fenestration, splitting of the mitral leaflets, parachute deformation of the valve.

Classification

According to the course, mitral insufficiency is acute and chronic; by etiology - ischemic and non-ischemic. There is also a distinction between organic and functional (relative) mitral insufficiency. Organic failure develops when there is a structural change in the mitral valve itself or the tendon threads that hold it. Functional mitral regurgitation is usually a consequence of expansion (mitralization) of the left ventricular cavity due to hemodynamic overload caused by myocardial diseases.

Taking into account the severity of regurgitation, 4 degrees of mitral regurgitation are distinguished: with slight mitral regurgitation, moderate, severe and severe mitral regurgitation.

The clinical course of mitral regurgitation is divided into 3 stages:

I (compensated stage)- minor mitral valve insufficiency; mitral regurgitation makes up 20-25% of the systolic blood volume. Mitral insufficiency is compensated by hyperfunction of the left heart.

II (subcompensated stage)- mitral regurgitation accounts for 25-50% of systolic blood volume. Blood stasis in the lungs and a slow increase in biventricular overload develop.

III (decompensated stage)- pronounced mitral valve insufficiency. The return of blood to the left atrium during systole is 50-90% of the systolic volume. Total heart failure develops.

Features of hemodynamics in mitral insufficiency

Due to incomplete closure of the mitral valve leaflets during systole, a regurgitant wave occurs from the left ventricle to the left atrium. If the reverse blood flow is insignificant, mitral insufficiency is compensated by increased heart function with the development of adaptive dilatation and hyperfunction of the left ventricle and left atrium of the isotonic type. This mechanism can restrain the increase in pressure in the pulmonary circulation for quite a long time.

Compensated hemodynamics in mitral insufficiency is expressed by an adequate increase in shock and minute volumes, decreased end-systolic volume and absence of pulmonary hypertension.

In severe forms of mitral regurgitation, the volume of regurgitation prevails over the stroke volume, and cardiac output is sharply reduced. Right ventricle experiencing increased load, quickly hypertrophies and dilates, resulting in severe right ventricular failure.

In acute mitral regurgitation, adequate compensatory dilation of the left heart does not have time to develop. In this case, a rapid and significant increase in pressure in the pulmonary circulation is often accompanied by fatal pulmonary edema.

Symptoms of mitral regurgitation

During the compensation period, which can last several years, mitral regurgitation may be asymptomatic. In the subcompensation stage, subjective symptoms appear, expressed by shortness of breath, fatigue, tachycardia, anginal pain, cough, hemoptysis. When increasing venous stagnation in a small circle, attacks of nocturnal cardiac asthma may occur.

The development of right ventricular failure is accompanied by the appearance of acrocyanosis, peripheral edema, liver enlargement, swelling of the neck veins, and ascites. When the recurrent laryngeal nerve is compressed by the dilated left atrium or pulmonary trunk, hoarseness or aphonia occurs (Ortner's syndrome). In the decompensation stage, more than half of patients with mitral insufficiency have atrial fibrillation.

Diagnostics

The main diagnostic data indicating mitral regurgitation are obtained during a thorough physical examination, confirmed by electrocardiography, phonocardiography, chest radiography and fluoroscopy, echocardiography and Doppler study of the heart.

Due to hypertrophy and dilatation of the left ventricle in patients with mitral insufficiency, a cardiac hump develops, an intensified diffuse apical impulse appears in the V-VI intercostal space from the midclavicular line, and pulsation in the epigastrium. Percussion determines the expansion of the boundaries of cardiac dullness to the left, up and to the right (with total heart failure). Auscultatory signs of mitral insufficiency are weakening, sometimes complete absence of the first sound at the apex, systolic murmur over the apex of the heart, accent and splitting of the second sound over the pulmonary artery, etc.

The information value of a phonocardiogram lies in the ability to characterize the systolic murmur in detail. ECG changes in mitral regurgitation indicate hypertrophy of the left atrium and ventricle, and in pulmonary hypertension - right ventricular hypertrophy. X-rays show an increase in the left contours of the heart, as a result of which the shadow of the heart acquires triangular shape, congested roots of the lungs.

Echocardiography allows you to determine the etiology of mitral regurgitation, assess its severity, and the presence of complications. Using Doppler echocardiography, regurgitation through the mitral orifice is detected, its intensity and magnitude are determined, which together makes it possible to judge the degree of mitral regurgitation. In the presence of atrial fibrillation, transesophageal echocardiography is used to identify blood clots in the left atrium. To assess the severity of mitral regurgitation, probing of the cardiac cavities and left ventriculography are used.

Treatment of mitral regurgitation

In case of acute mitral regurgitation, the administration of diuretics and peripheral vasodilators is required. To stabilize hemodynamics, intra-aortic balloon counterpulsation can be performed. Special mild treatment asymptomatic chronic mitral regurgitation is not required. In the subcompensated stage, they are prescribed ACE inhibitors, beta-blockers, vasodilators, cardiac glycosides, diuretics. With the development of atrial fibrillation, indirect anticoagulants are used.

For mitral regurgitation of moderate and severe severity, as well as the presence of complaints, cardio is indicated surgical intervention. The absence of calcification of the leaflets and the preserved mobility of the valve apparatus makes it possible to resort to valve-preserving interventions - mitral valve plastic, annuloplasty, shortening of the chordae, etc. Despite the low risk of development infective endocarditis and thrombosis, valve-sparing operations are often accompanied by relapse of mitral insufficiency, which limits their performance to a fairly narrow range of indications (mitral valve prolapse, ruptures of valve structures, relative valve insufficiency, dilatation of the valve ring, planned pregnancy).

In the presence of valve calcification and severe thickening of the chordae, mitral valve replacement with a biological or mechanical prosthesis is indicated. Specific postoperative complications in these cases, thromboembolism, atrioventricular block, secondary infective endocarditis of prostheses, and degenerative changes in bioprostheses may serve.

Prognosis and prevention

Progression of regurgitation with mitral regurgitation is observed in 5–10% of patients. The five-year survival rate is 80%, the ten-year survival rate is 60%. The ischemic nature of mitral regurgitation quickly leads to severe circulatory impairment and worsens prognosis and survival. Postoperative relapses of mitral insufficiency are possible.

Mitral lung failure and moderate degree is not a contraindication for pregnancy and childbirth. In case of high degree of deficiency it is necessary additional examination with a comprehensive risk assessment. Patients with mitral regurgitation should be observed by a cardiac surgeon, cardiologist and rheumatologist. Prevention of acquired mitral valve insufficiency involves preventing diseases leading to the development of the defect, mainly rheumatism.

In medicine, mitral regurgitation is understood as incomplete closure of the valve during systole, as a result, part of the blood flows back into the left atrium, while the blood volume and pressure in it increase. Blood then flows from the left atrium into the left ventricle, where its volume and pressure also increase. As a result, mitral valve insufficiency leads to increased pressure and the formation of congestion in the pulmonary vessels. The movement of blood in the opposite direction is called regurgitation.

IN pure form Mitral regurgitation is rare and accounts for only 5% of cases. It is observed less frequently in adults than in children. As a rule, the disease is combined with other heart defects, such as mitral stenosis and aortic defects.

Classification

There are three degrees of mitral regurgitation depending on how severe the rigurgitation is.

At grade 1, the blood flow into the left atrium is insignificant (about 25%) and is observed only at the valve. Due to compensation of the defect, the patient feels normal, there are no symptoms or complaints. The ECG does not show any changes; examination reveals murmurs during systole and the borders of the heart are slightly expanded to the left.
At stage 2, the reverse blood flow reaches the middle of the atrium, more blood is thrown in - from 25 to 50%. The atrium cannot pump out blood without increasing pressure. Developing pulmonary hypertension. During this period, shortness of breath appears, rapid heartbeat during exercise and at rest, cough. The ECG shows changes in the atrium; examination reveals systolic murmurs and expansion of the cardiac boundaries: to the left - up to 2 cm, up and to the right - by 0.5 cm.
At stage 3, the blood reaches back wall atrium and can account for up to 90% of systolic volume. This is the stage of decompensation. There is hypertrophy of the left atrium, which cannot push out the entire amount of blood. Swelling appears, the liver enlarges, and venous pressure increases. An ECG shows the presence of left ventricular hypertrophy and mitral wave. A pronounced systolic murmur is heard, the boundaries of the heart are significantly expanded.

Symptoms

For a long time, mitral regurgitation does not manifest itself in any way and does not cause any discomfort due to the fact that it is successfully compensated by the capabilities of the heart. Patients do not see a doctor for several years because there are no symptoms. The defect can be detected by listening to the characteristic murmurs in the heart that occur when blood flows back into the left atrium during contraction of the left ventricle.

With mitral regurgitation, the left ventricle gradually increases in size as it is forced to pump more blood. As a result, every heartbeat, and the person experiences palpitations, especially when lying on the left side.

To accommodate the extra blood coming from the left ventricle, the left atrium increases in size and begins to contract abnormally and too quickly due to atrial fibrillation. The pumping function of the heart muscle in mitral insufficiency is impaired due to an abnormal rhythm. The atria do not contract, but tremble. Impaired blood flow leads to thrombus formation. With severe regurgitation, heart failure develops.

Thus, we can name the following possible signs diseases that usually appear in the late stages of mitral valve insufficiency:

heartbeat;
a non-productive dry cough that cannot be cured;
swelling of the legs;
shortness of breath occurs during exercise, and then at rest as a result of stagnation of blood in the pulmonary vessels.

Causes

This defect may be associated with damage to the valve itself or due to pathological changes in the myocardium and papillary muscles. Relative mitral regurgitation can also develop with a normal valve that does not close the hole that has been stretched as a result of an enlarged left ventricle. The reasons may be the following:

previous infective endocarditis;
rheumatism;
mitral annulus calcification;
valve leaflet injury;
some autoimmune systemic diseases ( rheumatoid arthritis, lupus erythematosus, scleroderma);
mitral valve prolapse;
myocardial infarction;
post-infarction cardiosclerosis.
progressive arterial hypertension;
cardiac ischemia;
dilated cardiomyopathy;
myocarditis.

Diagnostics

To the main diagnostic methods Mitral insufficiency includes:

examination and conversation with the patient;
electrocardiography;
chest x-ray;
echocardiography.

By listening, the doctor can determine the presence of mitral regurgitation by the characteristic sound during contraction of the left ventricle. A chest x-ray and ECG can help detect left ventricular enlargement. Echocardiography is considered the most informative method for diagnosing mitral regurgitation and allows you to see the valve defect and assess the severity of the damage.

Treatment

Treatment of mitral regurgitation depends on the severity of the defect and the causes of its occurrence. Medicines are used for atrial fibrillation, arrhythmia, and to reduce heart rate. Mild and moderate mitral regurgitation requires limiting emotional and physical stress. A healthy lifestyle is necessary, smoking and drinking alcohol should be stopped.

In case of severe urinary tract injury, surgical treatment is prescribed. Surgery to restore the valve should be performed as early as possible, before irreversible changes in the left ventricle appear.

At surgical treatment Mitral valve insufficiency is restored. This operation indicated if changes in the heart valve are minor. This can be plastic surgery of the ring, plastic surgery of the valves, narrowing of the ring, or replacement of valves.

There is another option - removing the damaged valve and replacing it with a mechanical one. Valve-sparing surgery cannot always eliminate regurgitation, but it can reduce it and therefore alleviate symptoms. As a result, the process of further damage to the heart is stopped. More effective method is considered prosthetics. However, with an artificial valve there is a risk of blood clotting, so the patient is forced to constantly take medications that prevent rapid blood clotting. If the prosthesis is damaged, it must be replaced immediately.

Forecast

The prognosis depends on the severity of the valve damage and the condition of the myocardium. Severe deficiency and not satisfactory condition myocardium quickly lead to severe circulatory disorders. An unfavorable prognosis can be said in the case of chronic heart failure. At the same time, the mortality rate during the year is 28%. With relative insufficiency of uric acid, the outcome of the disease is determined by the severity of the circulatory disorder and the disease that led to the defect.

With mild to moderate mitral regurgitation, a person may long time maintain working capacity if you see a cardiologist and follow his advice. The disease at these stages is not a contraindication for having a child.

Aortic valve insufficiency: symptoms, diagnosis, treatment

Aortic valve insufficiency is a heart defect in which the valve leaflets cannot fully close and prevent the return of blood from the aorta to the left ventricle when the walls of the ventricles relax. As a result of constant regurgitation of blood, the left ventricle experiences constant stress, its walls stretch and thicken, and the organs and tissues of the body suffer from insufficient blood circulation.

In the compensation stage, aortic valve insufficiency may not manifest itself, but when the reserves are exhausted, the heart experiences increasing stress, and the patient’s health worsens, since changes in the structure of the heart become irreversible and total heart failure develops. Such severe manifestations of this valve defect can lead to the development of severe complications and death.

According to statistics, aortic insufficiency is found in every seventh patient with heart defects, and in 50-60% of cases it is combined with aortic stenosis and/or mitral insufficiency or stenosis. In isolated form, this defect is observed in every twentieth patient with heart defects. Aortic insufficiency occurs predominantly in men and in most cases is acquired.

Kinds

Depending on the time of formation of the defect, aortic insufficiency can be:

congenital: develops as a result hereditary causes or negative influence various factors on the body of the expectant mother;
acquired: develops due to effects on the heart various diseases, injuries and oncological pathologies appearing in a child or adult after birth.

Acquired aortic valve insufficiency can be:

organic: develops due to damage to the valve structure;
functional: develops due to expansion of the left ventricle or aorta.

Depending on the volume of blood thrown into the left ventricle from the aorta, four degrees are distinguished this vice hearts:

I degree – no more than 15%;
II degree – about 15-30%;
III degree – up to 50%;
IV degree – more than 50%.

According to the speed of development of the disease, aortic insufficiency can be:

chronic: develops over many years;
acute: the stage of decompensation occurs within a few days (with aortic dissection, severe course endocarditis or chest trauma).

Causes

Congenital aortic valve insufficiency is rarely detected. It can be called:

negative effects on the body of a pregnant infection, X-ray or radiation radiation, etc.;
congenital defects of heart structures (development of 1-2- or 4-leaf aortic valves, anomalies of the interatrial septum);
dilatations of the aorta, frolicking due to Marfan syndrome;
connective tissue dysplasia syndrome, which leads to thickening and degeneration of the valve leaflets.

Acquired organic failure aortic valve can be caused by the following diseases and pathologies:

atherosclerosis of the aorta;
rheumatic fever;
infective endocarditis;
syphilis;
systemic lupus erythematosus;
traumatic damage to the aortic valve;
Takayasu's disease.

Acquired functional aortic insufficiency develops as a result of the following pathologies:

arterial hypertension, causing an increase in the size of the left ventricle;
myocardial infarction leading to the formation of a left ventricular aneurysm;
aortic aneurysm developing against the background of sudden and significant hypertension, aortic atherosclerosis or aortic inferiority due to Marfan syndrome.

Symptoms

A constant feeling of pulsation in the head and dizziness disrupts the normal rhythm of life of patients.

During compensation of aortic valve insufficiency (with I-II degrees) in most cases, patients have no complaints. After the exhaustion of compensatory mechanisms (in grades III-IV) and a reduction in the contractility of the left ventricle, which is under constant load, the following symptoms appear in the patient:

sensations of pulsation in the vessels of the neck and head (especially when lying down);
cardialgia (pain) of a pressing and squeezing nature;
general weakness and decreased tolerance to physical activity;
increased sweating;
heartbeat;
dyspnea;
tachycardia;
arrhythmias;
noise in ears;
dizziness;
visual impairment;
fainting states.

When examining the skin, pallor is noted, and late stages acrocyanosis is observed. Patients with this defect experience Musset's symptom:

shaking the head to the rhythm of the pulse;
abnormal pulsation of general carotid arteries on the neck.

When palpating (feeling) the heart in the VI-VII intercostal space, a strong dome-shaped apical impulse is determined, and in the area xiphoid process pulsation of the aorta is felt.

When percussing (tapping) the heart, the configuration of the heart with a clearly defined waist (a “boot” or “duck” shaped heart) characteristic of aortic insufficiency is determined. Subsequently, in the later stages of the disease, the patient’s heart increases significantly in size and takes on a spherical shape (“bull heart”).

Auscultation (listening) of the heart determines:

quiet I tone;
weakening of the second tone;
protosystolic murmur in the aorta;
pathological III tone in the area of the apex of the heart.

Auscultation of the vessels determines:

double Vinogradov-Durozier noise;
Traube double tone.

The patient has an increased systolic, decreased diastolic and high pulse pressure, high and rapid pulse.

Complications

Long-term aortic insufficiency can be complicated by infective endocarditis.

With prolonged aortic insufficiency and lack of adequate treatment, the patient may develop the following complications:

left ventricular failure;
mitral valve insufficiency;
coronary circulation disorders (myocardial infarction, ischemic heart disease);
secondary infective endocarditis;
atrial fibrillation;
aortic rupture.

Diagnostics

To detect aortic valve insufficiency in the complex diagnostic studies include:

analysis of medical history and life;
fiscal examination of the patient;
clinical urine and blood tests;
biochemical blood tests (for the level of total cholesterol, LDL, triglycerides, uric acid, creatinine and total protein blood);
immunological blood test (for the content of antibodies to one’s own and foreign structures, C-reactive protein, syphilis);
phonocardiogram;
Echo-CG;
chest x-ray;
coronary angiography;
spiral CT;

If necessary surgical treatment catheterization of the cardiac cavities and ascending aortography are prescribed.

Treatment

Patients with asymptomatic aortic insufficiency are recommended to undergo an annual examination by a cardiologist with carrying out Echo-CG. When planning surgical and dental procedures, such patients are recommended to take a prophylactic course of antibiotics to prevent the development of infective endocarditis. Patients with this heart defect are advised to limit physical activity to prevent possible aortic rupture.

With moderate aortic insufficiency, patients are prescribed drug therapy, which is aimed at slowing down damage to the structure of the left ventricle. Selection medicines and their dosage is determined for each patient individually. The treatment regimen may include the following drugs:

drugs to treat the underlying cause of aortic regurgitation (for example, antibiotics to treat rheumatism);
ACE inhibitors: Captopril, Lisinopril, Enalapril;
angiotensin receptor antagonists: Valsartan, Lorista N, Naviten, Losartan;
beta blockers: Tranzikor, Anaprilin, Atenolol;
calcium antagonists: Corinfar, Nifedipine;
calcium antagonists from the Diltiazem and Verampil group;
drugs for the treatment of complications of aortic insufficiency (heart failure, arrhythmias, etc.).

In case of severe aortic insufficiency, patients are recommended surgical correction this heart defect. To perform the operation, minimally invasive techniques can be used and traditional ways in conditions of providing artificial blood circulation. The following types of interventions can be used to correct aortic valve insufficiency:

Aortic valve plastic surgery (remodeling, resuspension, reimplantation).
Transcatheter aortic valve implantation.
Aortic valve replacement with biological or mechanical prostheses.

If there is significant damage to the heart structures, a donor heart transplant operation may be recommended.

After implantation of a mechanical valve, patients must constantly take medications from the group of anticoagulants (Warfarin with Aspirin). When replacing a valve with a biological prosthesis, anticoagulants are taken in short courses (1-3 months), and when performing valve surgery, anticoagulants are not required.

Forecasts

The prognosis for aortic valve insufficiency depends on the cause of the defect, the condition of the myocardium and the severity of regurgitation from the aorta to the left ventricle:

With moderate aortic insufficiency, the patient’s satisfactory state of health and ability to work remains for several years.
When symptoms of deterioration in myocardial contractility and severe aortic valve insufficiency appear, the progression of heart failure occurs quite quickly.
When aortic valve insufficiency develops as a result of syphilis or infective endocarditis, an unfavorable course of the disease is often observed.
With aortic insufficiency, which occurs against the background of aortic atherosclerosis or rheumatism, the disease progresses more favorably.

The average survival rate of patients with severe aortic insufficiency without signs of decompensation is about 5-10 years, and in the decompensated stage and the presence of total heart failure, taking medications becomes ineffective and patients die within two years. A timely surgical operation to eliminate the aortic valve defect significantly improves the prognosis of aortic insufficiency.

In Astrakhan, they learned how to replace heart valves in a new way. Cardiac surgeons in Astrakhan, under the guidance of German specialists, mastered a fundamentally new technique for replacing the aortic valve. This operation is carried out…

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Features of tricuspid insufficiency grade 2

Tricuspid valve insufficiency is a failure of the valve apparatus, in which incomplete closure of the leaflets occurs and, as a result, regurgitation occurs. There are several degrees of severity of this pathology. When grade 2 tricuspid insufficiency occurs, characteristic symptoms diseases of cardio-vascular system.

Causes of development of tricuspid valve insufficiency 2nd degree

Tricuspid insufficiency occurs due to various diseases and exposure to damaging factors on the body. Most common reasons are:

Inflammation of a systemic nature - rheumatism.
Infectious lesion of the inner layer of the heart.
Inflammation of the muscle layer of the heart.
Myocardial infarction with predominant damage to the right ventricle.
Sclerotic changes in the vessels of the heart muscle.
Carcinoid tumors.
Chest injuries with damage to the valves.
Chronic heart failure.
VSD (ventricular septal defect).
Complications of some heart surgeries.

Classification

Tricuspid insufficiency, depending on various criteria, is divided into numerous forms. Depending on the time of occurrence, congenital and acquired deficiency differs.

Depending on which part of the valve is affected, the following forms are distinguished:

organic failure is characterized by damage to the valves themselves;
the functional (relative) form occurs due to damage to other elements of the valve apparatus.

The degrees of the defect, which depend on the severity of the reflux of blood from the ventricle back into the atrium:

Grade 1 – regurgitation is almost invisible.

Grade 2 - reverse blood flow is noticeable 20 millimeters from the valve apparatus.

Grade 3 – throw is determined more than 20 millimeters from the valve flaps.

Grade 4 – significant regurgitation over a large volume.

This classification is very important. Determining the form of the pathology will help you choose the right treatment.

Symptoms of the defect

Tricuspid insufficiency of the 2nd degree is manifested by hypertension and enlargement of the atrium (compensation of the heart muscle). When the body exhausts the ability to compensate for the heart, decompensatory phenomena develop, due to which symptoms arise.

With a first degree defect, symptoms do not appear due to compensation. The patient does not have any complaints.

Tricuspid valve insufficiency grade 2 leads to noticeable deterioration general condition human, in contrast to pathology of the 1st degree, which in some cases is a variant of the norm. This pathological condition leads to weakening of the right parts of the heart, which is why the course of the disease actually worsens and damage to organs and systems occurs. When transitioning from grade 2 to grade 3, it is necessary to correct the defect (surgery) as quickly as possible.

The clinical picture of this pathology includes the following symptoms:

A person's performance decreases. He complains of weakness and fatigue during physical work.
Patients usually note irregular heartbeat. They feel a heartbeat with irregular rhythm.
There is frequent urination at night (nocturia).
In the afternoon, swelling becomes noticeable on the lower limbs, which may subside slightly the next morning.
A person experiences discomfort due to constant freezing of his feet. They are cold to the touch even in a warm room.
Discomfort and heaviness in the liver.
Violation respiratory function(dyspnea).
Swollen vessels of the neck are revealed, which palpably pulsate.
Complaints of bloating, nausea and vomiting.

All these symptoms are characteristic of the progression of this pathological condition. If treatment is not carried out, then the person experiences complications:

PE (thromboembolism pulmonary artery). A thrombus, breaking away from its attachment site, can partially or completely block the lumen of the pulmonary vessels. This condition develops acutely, it is very life-threatening for the patient and requires emergency care.
Violations heart rate(eg, atrial fibrillation).
Secondary infection of the endocardium.

Features of the manifestation of this pathology in children

In children, as a rule, this defect does not occur in its pure form. It is combined with pathology of other valves.

If tricuspid insufficiency of the 2nd degree occurs in a newborn, then he has a rapid development of cardiac and respiratory failure. Very often this condition leads to the death of the baby.

The acquired form of the defect occurs as a complication of previous infectious diseases, injuries and malignant neoplasms.

Tricuspid insufficiency in children leads to stagnation in the pulmonary and systemic circulation. This, in turn, is manifested by a violation of the functions of organs and systems of a small organism.

The first degree of pathology is an indication for monitoring the child; in case of a more severe course of the disease, treatment is provided, both medicinal and surgical.

The sooner a pathology of the valve apparatus is detected, the easier it will be to eliminate it. In this case, the child’s chances of managing full life further.

Diagnostic signs of tricuspid valve insufficiency 2 degrees

Diagnostic measures are aimed at identifying pathology and assessing the degree of its severity. When a patient first contacts, it is necessary to collect a thorough medical history. You need to ask about previous diseases both the patient himself and his blood relatives. After which it is necessary to begin a physical examination.

You can visually assess the color of the skin. Noted yellow skin due to pathological effects on the liver. For the same reasons, an increase in the size of the abdomen (ascites) is determined. Free fluid accumulates in the abdominal cavity, which affects the internal organs. It is also necessary to measure your blood pressure level.

By palpation, you can determine liver enlargement, swelling and irregular heartbeat when palpating the pulse.

Percussion reveals changes in the boundaries of the heart and liver.

Auscultation helps to listen to the characteristic heart murmur and irregular heartbeat.

Laboratory research methods are necessary to detect concomitant pathologies and complications of this defect:

Laboratory examination of urine and blood.
Biochemical blood test.
Immunological analysis.

Instrumental research methods:

An ECG helps assess the size of the heart's chambers and its functionality. According to the results of the electrocardiogram, hypertrophy of the right chambers of the heart and signs of arrhythmia are revealed.
Phonocardiography will help identify the characteristic (systolic murmur).
Ultrasound of the heart muscle is more accurate and available method diagnostics of diseases of the cardiovascular system. Using echocardiography + Doppler, the degree of regurgitation is revealed, that is, the return of blood to the atrium at a distance of less than two centimeters from the valve apparatus. Hypertrophic changes and hypertension of the right heart are determined.
X-ray of the chest organs. By using this method research determines pathological changes heart size and position.
CT (computed tomography) helps to obtain images of the heart in different projections.
MRI (magnetic resonance imaging) allows you to evaluate the heart muscle layer by layer and identify concomitant pathology.

Diagnosis of this type of pathology is quite labor-intensive and varied due to the combination of defects and the development of complications in the organs of the systemic circulation.

Treatment of valve insufficiency

Determining the type and tactics of treatment will depend on the severity of the defect, the cause of its occurrence, accompanying pathologies and complications that arise. As a rule, for grade 2 tricuspid valve pathology, two treatment methods are combined:

conservative treatment (medication);
surgical (operative) treatment.

Conservative treatment includes diet therapy and medications. The diet consists of limiting the intake of liquid and salt. It is necessary to give up selenium, fatty, fried food and canned foods.

Drug therapy is carried out to treat the disease that caused the pathology of the valve apparatus. Apply antibacterial drugs if the cause is an infection. It is also necessary to eliminate circulatory failure and cardiac pathology (failure, arrhythmias). Groups of drugs used in treatment:

diuretics (diuretics) are used to treat arterial hypertension and elimination of edema;
nitrates help enrich the myocardium with oxygen and relieve spasm of the coronary vessels;
Angiotensin converting enzyme inhibitors are prescribed to treat heart failure;
anticoagulants, used to prevent thrombosis;
Medicines containing potassium help strengthen the heart muscle.

Tricuspid valve insufficiency of the 2nd degree also requires surgical treatment. Operations are performed on an open heart with cardiac arrest. There are 2 types of operations:

plastic surgery (helps preserve the patient’s valve apparatus);
implantation of a prosthesis (replacement of one’s own tricuspid valve with a mechanical or biological one).

Complications arising after surgical treatment:

Thromboembolism. After surgery, blood clots may form on the prosthesis. They can provoke a stroke, pulmonary embolism, kidney and myocardial infarction. For prevention this complication Indirect anticoagulants are prescribed. If the prosthesis is mechanical, then the duration of taking the drugs is up to three months. When a biological prosthesis is implanted, anticoagulants are prescribed for 1 month.
Inflammatory diseases of heart tissue.
Thrombosis of the prosthesis. This complication leads to disruption of blood flow.
Damage to a biological prosthesis.
Calcium deposition on a prosthesis made from animal tissue (biological), which leads to disruption of its functioning.

Patients with this pathology should be constantly monitored by a cardiologist to correct the basic treatment and prescribe additional therapy in case of complications.

The prognosis for patients without proper treatment is disappointing, since with increasing insufficiency of the valve apparatus, the severity of heart failure worsens, which can lead to death.

Preventive actions

Prevention is aimed at preventing the development of the disease and the occurrence of complications:

Prevention and timely treatment rheumatism and infectious diseases that can cause the development of this pathology.
Compliance with recommendations and prescribed treatment for diseases of the heart muscle and blood vessels prescribed by a cardiologist.
Treatment chronic lesions infections.
You cannot self-medicate, or change the dosage of prescribed medications yourself or stop taking them.
Follow the principles of proper and dietary nutrition.
Refusal bad habits(smoking, alcohol).
Hardening procedures.
Maintaining a sleep and rest schedule.
Sufficient exposure to fresh air.

Mitral insufficiency is a type of valvular heart disease. Pathogenesis is caused by incomplete closure of the mitral orifice, which is preceded by disturbances in the structure of the leaflets and tissues located under the valves.

The pathology is characterized by regurgitation of blood into the left atrium from the left ventricle. Let us consider in detail what it is, the nature of development and the clinical picture of the course of mitral valve insufficiency in degrees 1, 2 and 3 of the disease, methods of its treatment and the prognosis for returning to normal life.

MVR (mitral valve insufficiency) is the most common cardiac anomaly. Of all the sick 70% suffer from an isolated form of cerebrovascular accident. Typically, rheumatic endocarditis is the main underlying cause of the disease. Often a year after the first attack there is a heart condition, which is quite difficult to cure.

The highest risk group includes people with valvulitis.. This disease damages the valve leaflets, as a result of which they undergo processes of wrinkling, destruction, and gradually become shorter than their original length. If valvulitis is at an advanced stage, calcification develops.

Additionally, as a result of these diseases, the length of the chords is reduced, and dystrophic and sclerotic processes occur in the papillary muscles.

Septic endocarditis leads to the destruction of many cardiac structures, so NMC has the most strong manifestations. The valve flaps do not fit together tightly enough. When they are not completely closed through the valve, too much blood coming out, which provokes its reboot and formation stagnant processes, increase in pressure. All signs lead to increasing insufficiency of uric acid.

Causes and risk factors

NMC affects people with one or more of the following pathologies:

Congenital predisposition.
Connective tissue dysplasia syndrome.
Mitral valve prolapse, characterized by regurgitation of 2 and 3 degrees.
Destruction and breakage of the chords, rupture of the valves of the mitral valve due to injuries in the chest area.
Rupture of valves and chords during development.
Destruction of the apparatus connecting the valves in endocarditis resulting from connective tissue diseases.
Infarction of part of the mitral valve with subsequent scar formation in the subvalvular region.
Changes in the shape of the valves and tissues located under the valves when rheumatism.
Enlargement of the mitral annulus during dilatation cardiomyopathy.
Insufficiency of valve function in the development of hypertrophic cardiomyopathy.
MK insufficiency due to surgery.

Types, forms, stages

With NMC the total stroke volume of the left ventricle is estimated. Depending on its quantity, the disease is divided into 4 degrees of severity (the percentage indicates the part of the blood that is redistributed incorrectly):

I (the softest) - up to 20%.
II (moderate) - 20-40%.
III (medium form) - 40-60%.
IV (heaviest) - over 60%.

According to the forms of its course, the disease can be divided into acute and chronic:

When determining the features of movement of the mitral valves, there are 3 types of pathology classification:

1 - standard level of mobility of the leaflets (in this case, painful manifestations consist of dilatation of the fibrous ring, perforation of the leaflets).
2 - destruction of the valves (the chords take the greatest damage, as they are stretched or ruptured, and a violation of the integrity of the papillary muscles also occurs.
3 - decreased mobility of the valves (forced connection of commissures, reduction in the length of the chords, as well as their fusion).

Danger and complications

With the gradual progression of NMC, the following disorders appear:

thromboembolism due to constant stagnation of a large part of the blood.
Valve thrombosis.
Stroke. Great importance Pre-existing valve thrombosis is a risk factor for stroke.
Atrial fibrillation.
Symptoms of chronic heart failure.
Mitral regurgitation (partial failure of the mitral valve to perform functions).

Mitral valve insufficiency is a type of valvular heart disease. Pathogenesis is caused by incomplete closure of the mitral orifice, which is preceded by disturbances in the structure of the leaflets and tissues located under the valves. The pathology is characterized by regurgitation of blood into the left atrium from the left ventricle.

Symptoms and signs

The severity and severity of MCT depends on the degree of its development in the body:

Stage 1 the disease has no specific symptoms.
Stage 2 does not allow patients to exercise physical activity in an accelerated mode, since shortness of breath, tachycardia immediately manifests itself, painful sensations V chest, loss of heart rhythm, unpleasant sensations. Auscultation with mitral insufficiency determines increased tone intensity and the presence of background noise.
Stage 3 characterized by left ventricular failure and hemodynamic pathologies. Patients suffer from constant shortness of breath, orthopnea, accelerated heart rate, feel discomfort in the chest, their skin paler than in a healthy state.

Find out more about mitral regurgitation and hemodynamics with it from the video:

When to see a doctor and which one

When identifying symptoms characteristic of MCT, it is necessary contact a cardiologist immediately, to stop the disease in its early stages. In this case, you can avoid the need to consult with other doctors.

Sometimes there is suspicion of a rheumatoid etiology of the disease. Then you should visit a rheumatologist for diagnosis and proper treatment. If there is a need for surgical intervention, treatment and subsequent the problem is resolved by a cardiac surgeon.

Symptoms of mitral regurgitation may be similar to those of other acquired heart defects. We wrote more about how they manifest themselves.

Diagnostics

Common methods for detecting NMC:

Learn more about symptoms and diagnosis from the video:

It is necessary to distinguish NMC from other heart pathologies:

Myocarditis in severe form.
Congenital and acquired heart defects of related etiology.
Cardiomyopathies.
MK prolapse.

and how to cure this problem? You will find all the details in the available review.

About the symptoms of aortic valve insufficiency and the differences between this heart defect and the one described in this article in another material.

Also read the information about how Behçet's disease appears and how dangerous it is, and the methods of treating this disease.

Therapy methods

If symptoms of cervical urinary tract are severe, surgical intervention is indicated for the patient. The operation is performed urgently for the following reasons:

In the second and later stages, despite the fact that the volume of blood ejected is 40% of its total amount.
If there is no effect from antibacterial therapy and aggravation of infectious endocarditis.
Increased deformation, sclerosis of the valves and tissues located in the subvalvular space.
In the presence of signs of progressive left ventricular dysfunction together with general heart failure occurring at 3-4 degrees.
Heart failure in the early stages can also be a reason for surgery, however, to form an indication, thromboembolism of large vessels located in the systemic circulation must be detected.

The following operations are practiced:

Valve-sparing reconstructive surgeries are necessary to correct cerebrovascular accidents in childhood.
Commissuroplasty and decalcification of the leaflets are indicated for severe MV insufficiency.
Chordoplasty is intended to normalize the mobility of the valves.
Translocation of cords is indicated when they fall off.
Fixation of parts of the papillary muscle is carried out using Teflon gaskets. This is necessary when separating the head of the muscle from the remaining components.
Prosthetics of the chords is necessary when they are completely destroyed.
Valvuloplasty avoids leaflet rigidity.
Anuloplasty is intended to relieve the patient of regurgitation.
Valve replacement is carried out when it is severely deformed or when fibrosclerosis develops irreparably and interferes with normal functioning. Mechanical and biological prostheses are used.

Learn about minimally invasive operations for this disease from the video:

What to expect and preventive measures

With the development of cerebrovascular accident, the prognosis determines the severity of the disease, that is, the level of regurgitation, the occurrence of complications and irreversible changes in cardiac structures. Survival rate 10 years after diagnosis is higher than for similar severe pathologies.

If valve insufficiency manifests itself in moderate or average shape, women have the ability to bear and give birth to children. When the disease becomes chronic course, all patients should have an annual ultrasound and visit a cardiologist. If worsening occurs, you should visit the hospital more often.

If the condition worsens, surgical intervention is undertaken, so patients should always be prepared for this measure of cure for the disease.

Prevention of NMC consists in preventing or speedy treatment calling this pathology diseases. All diseases or manifestations of mitral valve insufficiency due to an abnormal or reduced valve must be quickly diagnosed and promptly treated.

NMC is dangerous pathology, leading to severe destructive processes in the heart tissue, and therefore requires proper treatment. Patients, if they follow the doctor’s recommendations, may, some time after starting treatment,

Normally, in a healthy person, the mitral valve completely closes the opening between the left ventricle and the atrium to prevent backflow of blood. If the valve is defective, the hole does not close completely and leaves a gap. During the systole phase, blood flows back into the left atrium (regurgitation phenomenon), where its volume and pressure increase. After this, blood enters the left ventricle, and volume and pressure there also increase.

Description and causes of pathology

This pathology affects adults more than children. Often mitral regurgitation is accompanied by blood vessel defects and stenoses (compression of the lumen). It is extremely rare in its pure form.

This defect is less often congenital and more often acquired. Degenerative changes in some cases affect the tissues of the leaflets and valve and the structures underneath it. In others, the chords are affected and the valve ring is overextended.

Some of the reasons acute failure mitral valve are , strong blunt trauma hearts or . With these diseases, the papillary muscles, chordae tendons are torn, and the valve leaflets are torn off.

Other causes of mitral insufficiency:

joint inflammation;
restrictive cardiomyopathy;
some autoimmune diseases.

With all these systemic diseases there is chronic failure mitral valve. Genetic diseases with chromosomal mutations, accompanied by connective tissue defects of a systemic nature, lead to mitral valve insufficiency.

Ischemic valve dysfunction occurs in 10% of cases. , tears or shortening of the mitral valve with lengthening of the chordae tendons and papillary or papillary muscles also lead to mitral regurgitation.

Relative mitral valve regurgitation can occur without its structural changes as a result of dilation of the left ventricle and the fibrous ring. This can happen when:

cardiac aortic defects;

Very rarely, mitral valve insufficiency is a consequence of calcification of the valve leaflets or hypertrophic myopathy.

Congenital mitral regurgitation is characterized by the presence of the following diseases:

parachute valve deformation;
splitting of the mitral valves;
artificial fenestration.

Symptoms of heart valve pathology

Symptoms of this pathological process increase as the deficiency develops. During a period of compensated mitral valve regurgitation, symptoms may not appear. This stage can last for a long time (up to several years) without any symptoms.

Subcompensated degree of deficiency is accompanied by:

development of shortness of breath in the patient;
appears fast fatiguability during physical and mental work;
weakness;
rapid heartbeat even at rest;
dry cough and hemoptysis.

In the process of developing stagnation in venous circle blood circulation develops, manifesting itself in the form of a night cough, the patient “does not have enough air.” Patients complain of pain behind the sternum in the region of the heart, radiating to left shoulder, forearm, scapula and hand (anginal pain).

With the further course of the pathology, failure of the right ventricle of the heart develops. Symptoms such as:

acrocyanosis - blueness of the extremities;
swelling of the legs and arms;
the veins of the neck swell;
Ascites (accumulation of fluid in the abdominal cavity) develops.

On palpation, an enlarged liver is felt. The enlarged atrium and pulmonary trunk compress the laryngeal nerve, resulting in hoarseness - Ortner's syndrome.

In the decompensated stage more patients are diagnosed.

Types of mitral valve pathologies

Depending on the course of the pathological process, acute or chronic mitral insufficiency occurs.

For reasons of occurrence, there are ischemic and non-ischemic mitral valve insufficiency.

If pathology is observed on the part of the valve structure, then they speak of organic mitral regurgitation. In this case, the lesions affect either the valve itself or the threads of the tendons that fix it.

In diseases of the heart muscle, it can occur due to hemodynamic overstrain. As a result of this, a relative or functional impairment mitral valve.

Degrees of the disease

Depending on the size of the lumen and the severity of regurgitation, the clinical degrees of manifestation of mitral regurgitation are determined:

Mitral valve insufficiency of the 1st degree - compensated - is characterized by insignificant blood flow (less than 25%) and disturbances only in the valve structure. The state of health does not change, there are no symptoms or complaints. ECG diagnostics does not reveal pathology to this extent. During auscultation, the cardiologist hears slight noises during systole when the valve leaflets close; the boundaries of the heart are slightly wider than normal.
Mitral regurgitation of the 2nd degree, subcompensated, is characterized by filling the atrium with blood to almost half (up to 25-50%). To free the atrium from blood, it develops. A person at this moment suffers from shortness of breath, even during rest, and a dry cough. ECG diagnoses changes in the atrium. During auscultation, murmurs are detected during systole, the boundaries of the heart increase, especially on the left (up to 2 cm).
Mitral valve insufficiency of the 3rd degree is accompanied by filling of the left atrium with blood up to 90%. Its walls increase in size. The decompensated stage begins, in which blood is not removed from the atrium. Symptoms such as swelling and an increase in the size of the liver upon palpation appear. An increase in venous pressure is observed. ECG signs are diagnosed: enlargement of the left ventricle, mitral wave. On auscultation - increased murmurs in systole, expansion of the cardiac boundaries, especially the left one.
Grade 4 mitral insufficiency is called dystrophic. Pathological structural changes in the valve and stagnation of blood in the pulmonary circulation occur. Symptoms of the third degree increase significantly. Surgical operations are very widely used at this stage and give favorable resolution.
5th degree – terminal. Patients have a clinical picture of the third stage cardiovascular failure. The patient's condition is very serious and does not allow surgical interventions. The prognosis for the course of the pathology is extremely unfavorable, most often it is a death due to complications.

Diagnosis of mitral valve pathology

Diagnosis of mitral regurgitation should be based on the following comprehensive measures:

conversation, examination, palpation and percussion, auscultation of the patient;
data ;
chest x-ray data;
data ;
cardiac ultrasound data;
results of probing of the cardiac cavities;
Ventriculography data.

Competent history taking during a thorough questioning, examination, palpation and percussion of the patient can coordinate the doctor for further research for precise setting diagnosis. Percussion reveals the expanded borders of the heart, especially on the left side. During auscultation, depending on the degree of mitral insufficiency, systolic murmurs of varying intensity are detected.

According to X-ray and ECG data, dilation of the left ventricle and atrium is diagnosed.

Most informative method diagnostics - echocardiography, here you can evaluate the defect and the degree of damage to the valve itself. For a more specific diagnosis in the presence of atrial fibrillation, transnutritive echocardiography is used.

Treatment of cardiac pathology

In case of mitral valve insufficiency, treatment should only be prescribed by a cardiologist. You cannot self-medicate and resort to traditional methods!

Treatment should be aimed at eliminating the cause that caused mitral regurgitation, that is, at the disease preceding the pathological process.

Depending on the degree of mitral regurgitation and severity of the condition, drug treatment, in some cases surgery is necessary.

Light and moderate degree requires an appointment medicines, whose action is aimed at reducing heart rate, vasodilators(vasodilators). It is important to lead a healthy lifestyle, not drink or smoke, and avoid states of physiological fatigue and psychological stress. Outdoor walks are shown.

In case of mitral valve insufficiency of the 2nd degree, as well as in the third, lifelong anticoagulants are prescribed to prevent vascular thrombosis.

Surgical solution to the problem

Starting from the third degree, with obvious pathological changes, they resort to surgical reconstruction valve This must be done as early as possible to prevent irreversible dystrophic changes in the left ventricle.

Exist following indications for operation:

the reverse flow of blood accounts for more than 40% of the blood ejected by the heart;
No positive effect in the treatment of infectious endocarditis;
irreversible sclerotic changes in the mitral valve;
severe dilatation of the right ventricle, systole dysfunction;
vascular thromboembolism (one or many).

Reconstructive operations are performed on the valve leaflets and its ring. If such an operation is impossible, then the valve is reconstructed - removing the damaged one and replacing it with an artificial one.

Modern medicine uses the most high-tech xenopericardial and synthetic materials for mitral valve replacement. There are also mechanical prostheses that are made from special metal alloys. Biological prostheses involve the use of animal tissue.

IN postoperative period the risk increases, so appropriate medications are prescribed. In rare cases, damage to the prosthetic valve occurs, then another operation is performed and a second synthetic valve is installed to replace it.

Prognosis and prevention

A favorable prognosis for grade 1-2 mitral regurgitation is given in almost 100% of cases. The patient can maintain his ability to work for many years. It is important to be under the supervision of specialists, undergo consultations and diagnostic examinations. During such phases of the disease, even pregnancy and bearing a child are allowed. Permission to deliver in these cases is carried out by performing a Caesarean section.

More severe pathological changes with insufficiency lead to severe disorders of the circulatory system as a whole. An unfavorable prognosis is usually assumed when associated with a defect. Mortality rates for this category are quite high.

Mitral regurgitation is a serious defect, so its identification, diagnosis, and treatment should not be delayed.

The main preventative measures for this pathology are aimed at preventing the development of complications. First of all, this:

healthy lifestyle of the patient;
moderation in food;
refusal of fatty and spicy foods;
giving up alcohol and smoking.

Primary prevention begins in childhood and includes elements such as hardening, timely treatment of infectious diseases, including dental caries and inflammatory diseases tonsils

Secondary prevention involves taking medications that dilate blood vessels (vasodilators), improve blood flow, and lower blood pressure.

Mitral regurgitation can recur even after surgery. Therefore, you need to take care of yourself, take all medications prescribed by the doctor, and follow his advice.