Sagging heart valve. Mitral valve prolapse - degrees, regurgitation, danger and treatment. Is it a heart defect or not?

Today, mitral valve prolapse is a fairly common pathology, in which the valve begins to sag due to the pressure of the blood flow. This disease occurs mainly at a young age and is most often diagnosed in the fair sex.

The pathology may be discovered by chance during a regular examination by a doctor. It often occurs without any symptoms. Diagnosing the disease is a great success, as many serious complications can be prevented.

In this article we will try to look in more detail at what mitral valve prolapse is, what the symptoms may be, possible consequences, and preventive measures.

Mitral valve prolapse (MVP) is a clinical and anatomical phenomenon characterized by protrusion of the mitral valve leaflets into the cavity of the left atrium. Mitral valve prolapse is diagnosed in approximately 10-15% of patients during echocardiography.

Between the left ventricle and the left atrium is the mitral valve, consisting of two leaflets. When the heart relaxes, the valve leaflets are open, blood flows freely from the atrium into the ventricle.

At the moment the heart contracts, the mitral valve leaflets close tightly so that all the blood from the ventricle enters the aorta. With prolapse, there is a bulging (sagging) of one of the mitral valve leaflets into the cavity of the left atrium at the time of heart contraction.

Prolapse can cause incomplete closure of the mitral valve leaflets, then when the heart contracts, conditions are created for the return of part of the blood to the left atrium (this process is called mitral regurgitation).

If the degree of mitral valve prolapse is small, then the blood flow returning to the left atrium is small (grade 1-2 regurgitation). In this case, the prolapse does not interfere with the functioning of the heart and is considered insignificant.

Mitral valve prolapse can be primary (congenital) or secondary (arising from other heart diseases).
The detection of primary mitral valve prolapse in young people by echocardiography is not a diagnosis.

It is important to find out whether prolapse is an isolated feature of the heart, or whether its presence is due to connective tissue dysplasia syndrome (congenital weakness of connective tissue), whether there are disturbances in heart rhythm and conduction).

In persons with mitral valve prolapse, paroxysms of supraventricular tachycardia, sinus node dysfunction, and prolongation of the QT interval are significantly more common. In the presence of myxomatous degeneration of the leaflets, the risk of bacterial endocarditis and thromboembolism increases.

Therefore, when mitral valve prolapse is diagnosed for the first time, it is recommended to visit a cardiology center. The cardiologist will determine whether additional examination and special treatment is required and recommend the necessary frequency of observation. Source: » www.stomed.ru »

Mitral valve prolapse (left valve prolapse, bicuspid valve prolapse, Barlow's syndrome) is a disease accompanied by dysfunction of the valve located between the left atrium and ventricle.

This disease is not usually a cause for concern, but occurs quite frequently (affecting one in ten people).

In the case of mitral valve prolapse (MVP), the valves protrude like a parachute into the left atrium as the heart contracts. They may not close tightly in the future, which will be accompanied by the appearance of a reverse flow of blood into the atrium from the ventricle.

MVP is often called “click syndrome” because the doctor hears an extra click that occurs from the protrusion of the valves and the noise of the blood flowing back. Experts believe that some specialists are overly keen on identifying this pathology. Source: "med36.com"

Currently, a distinction is made between primary (idiopathic) and secondary MVP. The causes of secondary MVP are rheumatism, chest trauma, acute myocardial infarction and some other diseases.

In all these cases, the mitral valve chords are separated, as a result of which the leaflet begins to sag into the atrium cavity. In patients with rheumatism, due to inflammatory changes affecting not only the valves, but also the chords attached to them, separation of small chords of the 2nd and 3rd order is most often noted.

According to modern views, in order to convincingly confirm the rheumatic etiology of MVP, it is necessary to show that the patient did not have this phenomenon before the onset of rheumatism and arose during the course of the disease.

However, in clinical practice this is very difficult to do. At the same time, in patients with mitral valve insufficiency referred for cardiac surgery, even without a clear indication of a history of rheumatism, in approximately half of the cases, morphological examination of the mitral valve leaflets reveals inflammatory changes in both the leaflets themselves and the chordae. Source: "rmj.ru"

When we hear the phrase “heart pathology,” we immediately imagine something terrifying and incompatible with life, or at least with a normal quality of life.

Therefore, when patients learn the diagnosis of Mitral Valve Prolapse, and many recognize it, since MVP is a very common pathological phenomenon today, they perceive it almost as a death sentence.

However, is everything so scary? Is prolapse a dangerous disease, does it require treatment and any life restrictions? Let's try to figure it out.

In fact, left (mitral) valve prolapse is a dysfunction of the valve, characterized by sagging of its leaflets into the atrium.

That is, in a normal state, after blood from the atrium enters the ventricle, the valve closes, and the only possible path for blood is into the aorta. With pathological deviations, the valves bend and part of the blood returns to the atrium.

As a rule, mitral valve prolapse is detected by chance in early childhood, or during a comprehensive examination of a patient with complaints of various vegetative manifestations, dizziness, and perceived interruptions in the functioning of the heart.

Moreover, an ECG does not allow one to recognize MVP; drying and echocardiography are effective detection methods.

The latter technique is good because it makes it possible to determine the volume of blood returned to the atrium, the presence of certain changes in the valves; assign a degree to the pathology, of which, depending on the depth of valve sagging, there are three:

• 1st (2-5 mm) is characterized by slight sagging of the valve, a small amount of blood returning to the atrium, often the absence of clinical manifestations and does not require any treatment;
• 2nd (6-8 mm) more often exhibits symptoms requiring appropriate therapy;
• 3rd (9 mm or more) in some cases may require surgical intervention.

In most cases, valve dysfunction occurs in adolescents or people aged 35-40 years. As for gender differentiation, it is more often observed in women.

Many people can live for many years without suspecting anything about the diagnosis, since usually the pathology does not manifest itself with any symptoms, progresses extremely slowly, so that a person feels absolutely cheerful, healthy all his life and does not complain about heart problems. Source: » antibiotic.ru »

Mitral valve prolapse, the treatment of which involves a drug method of restoring the functions of the heart valves, largely owes its appearance to connective tissue dysplasia that has arisen in the structures of the heart.

Primary forms of pathology in children are marked by the presence of microscopic valve abnormalities. Continuing development of dysplasia can disrupt metabolic processes.

Often the cause of the development of valve group anomalies are:

• infections suffered by a pregnant woman during pregnancy;
• poor environmental conditions during pregnancy;
• negative heredity.

Secondary mitral valve prolapse has a wider range of causes that provoke the development of pathology. Typically, heart valve disease develops against the background of other diseases and pathologies of the heart, complicating their course.

Mitral valve prolapse, which is treated according to the prescribed schedule, disappears in some cases. However, the lack of treatment for heart valve pathology can lead to irreversible degenerative changes in the structure and structure of the heart valves.

According to the degree of severity, it is customary to distinguish three degrees of pathology:

• I degree corresponds to filling in the range of 3-6 mm;
• II degree corresponds to prolapse in the range of 6-9 mm;
• III degree corresponds to prolapse of more than 9 mm.

Depending on the time of occurrence, prolapse can be early, late or holosystolic. Source: "schneider-hospital.ru"

Classification

Echocardiography allows you to monitor the dynamics of the disease.

Cardiac prolapse has several degrees of severity, namely:

• 1st degree mitral valve prolapse. This degree of severity of the pathology is characterized by bending of the valve by 3-6 mm. There is slight reverse blood flow. Violations do not lead to the development of unpleasant symptoms.

All clinical parameters are within normal limits. Diagnosis of pathology at the initial stage is possible only through a random examination carried out in connection with another disease. A patient with stage 1 prolapse should visit a cardiologist, limit sports activities, and take measures to strengthen the heart muscle.

It is important to exclude heavy training, which can provoke further progression of the disease, namely, heavy lifting, strength training on exercise machines. The training of a patient with prolapse should have a limited load and include skating or skiing, swimming and race walking;

• mitral valve prolapse 2nd degree. Deviations of 6-9 mm can be recorded. The patient begins to be bothered by the initial manifestations of heart disease. After consultation with the patient, the cardiologist may allow minor sports training;
• mitral valve prolapse 3rd degree. The magnitude of valve deviations in the area of ​​the left atrium exceeds 9 mm.

Significant changes occur in the structure of the heart. The doctor diagnoses enlargement of the walls of the left atrium and thickening of the ventricles.

There is an abnormal change in the normal functioning of the circulatory system. Pathology leads to valve insufficiency and heart rhythm disturbances.

For patients with severe prolapse, surgical treatment is indicated to replace or suturing the mitral valve leaflets. After recovery, the patient is sent to physical therapy classes.

Depending on the etymological sign, mitral valve prolapse is divided into:

1. Primary. It occurs due to congenital defects that appear in the area of ​​the connective tissue of the heart. Deformation of the supporting and protective tissue leads to high sensitivity of the valve and susceptibility of the mitral leaflets to pathological changes. This form of the disease has a fairly favorable medical prognosis and is successfully treated.
2. Secondary. Develops against the background of other diseases. It is often a complication after disorders of the heart and blood vessels, for example, myocarditis (an inflammatory process in the area of ​​the heart muscles). The pathology may be associated with disorders of the ligaments or muscle tissue designed to hold the mitral valve. The disease does not cause atypical changes in the structure of the valve.

Regurgitation is the rapid movement of fluids or gases in the opposite direction to the normal direction.

The process develops in a hollow muscular organ after contraction of its walls.

Mitral regurgitation occurs due to complete closure or reduction of the opening to the left ventricle. This causes the blood flow to move backwards, that is, it goes from the left ventricle to the left atrium.

Regurgitation can occur:

• at the level of the heart valve leaflets;
• to the middle of the atrium;
• to the opposite side of the atrium. Source: "medinfa.ru"

There is also a distinction between congenital and acquired prolapse.

Congenital prolapse is divided into:

• Associated with congenital heart defects.
• Developed in utero as a result of an anomaly in the structure of the mitral valve leaflets.
• Arising as a result of hereditary connective tissue diseases.

Acquired prolapse occurs:

• rheumatic origin,
• due to calcification of the base in the posterior leaflet of the mitral valve,
• various dysfunctions and properties of the papillary muscle,
• chronic valvulitis, especially with CTD,
• due to infective endocarditis,
• when the integrity of the valve chords is violated,
• against the background of subaortic or aortic stenosis. Source: "medluki.ru"

Mitral valve prolapse of the primary form is characterized by signs of vegetative-vascular dystonia: headaches, dizziness, feeling of lack of air, fainting.

Weather dependence, poor tolerance to physical activity, low-grade fever, and panic attacks are also observed.

There may be complaints about interruptions in the functioning of the heart that are not relieved by medications, and painful sensations in the area of ​​the heart that are aching or stabbing in nature.

An indirect sign of primary prolapse is a tendency to the formation of hematomas, heavy menstruation in women and recurrent nosebleeds.

In the secondary form, there are complaints of severe chest pain, shortness of breath, interruptions in heart function, dizziness, cough with the release of pink foam due to blood impurities.

These symptoms are typical for myocardial infarction and other heart diseases, as well as injuries.

In diseases accompanied by changes in the structure of connective tissue, symptoms such as increased fatigue, shortness of breath even with slight exertion, and slowing or speeding up of the heart are observed. Source: “serdcemed.ru”

As mentioned above, mitral valve prolapse in the vast majority of cases is practically asymptomatic and is diagnosed accidentally during a routine medical examination.

The most common symptoms of mitral valve prolapse include:

• Cardialgia (pain in the heart area). This sign occurs in approximately 50% of MVP cases.

The pain is usually localized in the left half of the chest. They can be either short-term or last for several hours.

Pain can also occur at rest or during severe emotional stress. However, it is often not possible to associate the occurrence of a cardialgic symptom with any provoking factor.

It is important to note that the pain is not relieved by taking nitroglycerin, which happens with coronary heart disease.

• Feeling short of air. Patients have an irresistible desire to take a deep, “full” breath.
• A feeling of interruptions in the functioning of the heart (either a very rare heartbeat, or, on the contrary, a rapid heartbeat (tachycardia).
• Dizziness and fainting. They are caused by heart rhythm disturbances (with a short-term decrease in blood flow to the brain).
• Headaches in the morning and at night.
• Increase in temperature, without any reason. Source: "ztema.ru"

Pathological changes in the structure of the mitral valve manifest themselves in children in different ways. Most of the symptoms of the disease are determined by the severity of connective tissue dysplasia and vegetative changes occurring in the structures of the heart.

Many children with existing pathology usually complain of general weakness and increased fatigue at the slightest physical exertion.

Children experience frequent dizziness, periodic headaches, and shortness of breath during movement. At night there is restless and anxious sleep.

Mitral valve prolapse, the treatment of which involves a complex of therapeutic measures and is accompanied by other heart diseases, can cause the development of cardialgia and tachycardia in a child.

During the development of mitral valve prolapse, children often experience mental and autonomic disorders. A feeling of fear arises, asthenia and excessive psychomotor excitability develop.

The muscles in children with mitral valve prolapse have weak tone and development, there is joint hypermobility and changes in posture. Children with a similar diagnosis have severe scoliosis and an altered, dystrophic structure of the chest.

Children with this pathology more often usually suffer from flat feet and have pronounced pterygoid scapular bones. A distinctive feature of the pathology of the valve group is changes in the structure of many external organs characteristic of this disease.

The disease is characterized by the presence of connective tissue dysplasia, accompanied by various manifestations and is expressed in an asthenic physique, reduced body weight of the child, increased elasticity of the skin and high growth.

Mitral valve prolapse, the treatment of which is determined during the diagnostic process, is best manifested in dynamics
work of the heart.

Combinations and alternations of noises of different intensity and tonality allow cardiologists to determine whether a child has this pathology even during a medical examination. Source: "schneider-hospital.ru"

Diagnosis of mitral valve prolapse is based on listening to the myocardium, electrocardiographic (ECG), echocardiographic (EchoCG) and other methods.

The ECG of many patients shows various heart rhythm disturbances: supraventricular and ventricular extrasystoles, paroxysmal tachycardias, bradyarrhythmias and atrioventricular conduction disturbances.

Quite often, especially in children and adolescents, moderate sinus tachycardia and partial (incomplete) blockade of the right bundle branch are encountered.

Patients may exhibit nonspecific ECG changes in the form of a downward or oblique upward shift of the ST interval from the isoline and changes in the repolarization phase: the T wave is flattened or negative, but usually not symmetrical.

In an upright position, the frequency of noted electrocardiographic abnormalities doubles. It must be emphasized that in most asymptomatic patients with mitral valve prolapse there may be no ECG changes at all.

Early diagnosis of the disease is possible with the help of a Cardiovisor, which allows you to record even the slightest changes that are prerequisites for cardiovascular pathology, while a conventional ECG analysis can be “silent” about impending trouble.

Phonocardiography for primary prolapse shows that the amplitude of the I and II sounds is not changed. A mid- or late-systolic click and a mid- or late-systolic murmur adjacent to the second sound are recorded.

Typically, the systolic murmur has a medium amplitude. A holosystolic murmur with the greatest amplitude in the last third of systole is much less common.

EchoCG is the main method for diagnosing the disease, allowing one to identify the maneuvering of the valves, their structure, as well as the functional characteristics of the heart muscle.

The study is carried out in one-dimensional and two-dimensional modes using all accesses. In this case, the main echocardiographic signs of pathology are:

• thickening of the anterior, posterior or both leaflets by more than 5 mm relative to the plane of the mitral annulus;
• enlargement of the left atrium and ventricle;
• sagging of the valve leaflets into the atrium cavity at the time of left ventricular systole;
• expansion of the mitral ring;
• lengthening of tendon threads;

In the presence of diastolic movement of the posterior valve leaflet and systolic flutter of the leaflets, chord rupture can be allowed.

Additional echocardiographic signs of mitral valve prolapse include dilatation of the aortic root and aneurysm of the interatrial septum.

On chest x-ray, the configuration of the patient’s myocardium resembles a “hanging” heart, its size appears reduced, moderate bulging of the pulmonary artery arch is detected along the left contour of the myocardium, the pulmonary pattern is not changed.

An X-ray of the spine may show in a small number of patients the disappearance of lordosis (straight back syndrome). Source: "kardi.ru"

Examination of cardiovascular disease involves passing:

• examination by a cardiologist;
• blood and urine tests;
• electrocardiography;
• chest radiography;
• echocardiography. Source: "medinfa.ru"

The most important thing is to differentiate mitral valve prolapse from insufficiency of this valve, as well as from dysfunction of the myocardial valvular apparatus and from various minor anomalies of heart development. In this regard, listening to noise alone is not enough.

The ECG is not always indicative, and sometimes there are no changes at all.

X-ray of the heart will also give practically nothing, since the myocardium does not enlarge or sometimes has a slight bulging of the pulmonary arch (pulmonary artery arch) due to inferior connective tissue, but is not a definitive indicator of the presence of mitral valve prolapse.

The most informative and revealing is EchoCG, according to which the final diagnosis is made. Source: "medluki.ru"

Management tactics vary depending on the degree of leaflet prolapse, the nature of autonomic and cardiovascular changes.

It is mandatory to normalize work, rest, daily routine, adherence to the correct regime with sufficient sleep.

The issue of physical education and sports is decided individually after the doctor evaluates the indicators of physical performance and adaptability to physical activity. Most, in the absence of MR, severe disturbances in the repolarization process and VA, tolerate physical activity satisfactorily.

If they have medical supervision, they can lead an active lifestyle without any restrictions on physical activity. Recommend swimming, skiing, skating, cycling. Sports activities associated with jerky movements (jumping, karate wrestling, etc.) are not recommended.

Detection of MR, VA, changes in metabolic processes in the myocardium, prolongation of the QT interval on the electrocardiogram dictates the need to limit physical activity and sports.

Based on the fact that MVP is a particular manifestation of VSD in combination with STD, treatment is based on the principle of general restorative and vegetotropic therapy.

The entire complex of therapeutic measures should be built taking into account the individual characteristics of the patient and the functional state of the autonomic nervous system.

An important part of the complex treatment of MVP is non-drug therapy. For this purpose, psychotherapy, auto-training, physiotherapy (electrophoresis with magnesium, bromine in the upper cervical spine), water procedures, IRT, and spinal massage are prescribed.

Much attention should be paid to the treatment of chronic foci of infection; tonsillectomy is performed if indicated.

Drug therapy should be aimed at:

1. treatment of vegetative-vascular dystonia;
2. prevention of myocardial neurodystrophy;
3. psychotherapy;
4. antibacterial prophylaxis of infective endocarditis.

For moderate manifestations of sympathicotonia, herbal medicine with sedative herbs, tincture of valerian, motherwort, herbal collection (sage, wild rosemary, St. John's wort, motherwort, valerian, hawthorn), which simultaneously has a slight dehydration effect, is prescribed.

In recent years, an increasing number of studies have been devoted to studying the effectiveness of oral magnesium supplements. High clinical effectiveness of treatment for 6 months with Magnerot, containing 500 mg of magnesium orotate (32.5 mg of elemental magnesium) at a dose of 3000 mg/day for 3 doses, has been shown.

If there are changes in the repolarization process on the ECG, courses of treatment are carried out with drugs that improve metabolic processes in the myocardium (panangin, riboxin, vitamin therapy, carnitine). Carnitine (domestic drug carnitine hydrochloride or foreign analogues - L-Carnitine, Tison, Carnitor, Vitaline) is prescribed at a dose of 50-75 mg/kg per day for 2-3 months.

Carnitine plays a central role in lipid and energy metabolism. As a cofactor for beta-oxidation of fatty acids, it transports acyl compounds (fatty acids) across mitochondrial membranes, prevents the development of myocardial neurodystrophy, and improves its energy metabolism.

A beneficial effect has been noted from the use of the drug coenzyme Q-10, which significantly improves bioenergetic processes in the myocardium, and is especially effective in secondary mitochondrial failure.

Indications for the use of β-blockers are frequent, group, early PVCs, especially against the background of prolongation of the QT interval and persistent repolarization disorders; The daily dose of obzidan is 0.5-1.0 mg/kg body weight, treatment is carried out for 2-3 months or more, after which the drug is gradually withdrawn.

Rare supraventricular and PVCs, if not combined with long QT syndrome, usually do not require any drug interventions.

In case of pronounced morphological changes in the valve apparatus, it is necessary to carry out AB prevention of IE during various surgical interventions associated with the danger of bacteremia (tooth extraction, tonsillectomy, etc.). Recommendations of the American Heart Association for AB prevention of IE in children.

Treatment should include psychopharmacotherapy with explanatory and rational psychotherapy aimed at developing an adequate attitude towards the condition and treatment.

Psychopharmacotherapy is usually carried out using a combination of psychotropic drugs. Of the antidepressants, drugs with a balanced or sedative effect are most often used (azafen - 25 - 75 mg per day, amitriptyline - 6.25 - 25 mg per day).

Of the neuroleptics, preference is given to sonapax with its thymoleptic effect and phenothiazine drugs (triftazine - 5 - 10 mg per day, etapazine - 10 - 15 mg per day), given their activating effect with a selective effect on thinking disorders.

In combination with antidepressants or neuroleptics, tranquilizers that have a sedative effect (phenazepam, elenium, seduxen, frizium) are used. When using tranquilizers in isolation, “daytime” tranquilizers are preferred - trioxazine, rudotel, uxepam, grandaxin.

When the vegetative tone is sympathicotonic, certain dietary measures are recommended - limiting sodium salts, increasing the intake of potassium and magnesium salts (buckwheat, oatmeal, millet porridge, soybeans, beans, peas, apricots, peaches, rose hips, dried apricots, raisins, zucchini; from medications - panangin).

Vitamin therapy (multivitamins, B1) and collection of sedative herbs are indicated. To improve microcirculation, Vincopan, Cavinton, Trental are prescribed.

With the development of MN, traditional treatment is carried out with cardiac glycosides, diuretics, potassium supplements, and vasodilators.

MR is in a state of compensation for a long time, however, in the presence of functional (borderline) pulmonary hypertension and myocardial instability, NC phenomena may occur, usually against the background of intercurrent diseases, less often after prolonged psycho-emotional stress.

It has been established that ACE inhibitors have a so-called “cardioprotective” effect and are recommended for patients at high risk of developing CHF, reduce the incidence of pulmonary and systemic hypertension, and also limit the viral inflammatory process in the myocardium.

Non-hypotensive doses of captopril (less than 1 mg/kg, on average 0.5 mg/kg per day) with long-term use, along with improving LV function, have a normalizing effect on pulmonary circulation. It is based on the effect of captopril on the local angiotensin system of the pulmonary vessels.

In severe MN refractory to drug therapy, surgical correction of the defect is performed. Clinical indications for surgical treatment of MVP complicated by severe MN are:

• circulatory failure II B, refractory to therapy;
• addition of atrial fibrillation;
• addition of pulmonary hypertension (no more than stage 2);
• the addition of IE that is not curable with antibacterial drugs.

Hemodynamic indications for surgical treatment of MN are:

• increase in pressure in the PA (more than 25 mm Hg);
• decreased ejection fraction (less than 40%);
• regurgitation fraction more than 50%;
• LV end-diastolic volume exceeded by 2 times.

In recent years, radical surgical correction of MVP syndrome has been used, including various surgical options depending on the prevailing morphological abnormalities (mitral leaflet plication; creation of artificial chordae using polytetrafluoroethylene sutures; shortening of the chordae tendineae; suturing of the commissures).

It is advisable to supplement the described restoration operations on the MV by suturing the Carpanier support ring. If it is impossible to carry out a reconstructive operation, the valve is replaced with an artificial prosthesis.

Since the possibility of progression of changes in the urinary system with age cannot be excluded, as well as the likelihood of severe complications, dictate the need for clinical observation. They must be re-examined by a cardiologist and undergo follow-up studies at least 2 times a year.

In a clinic setting, during medical examination, anamnesis is collected: the course of pregnancy and childbirth, the presence of signs of dysplastic development in the first years of life (congenital dislocation and subluxation of the hip joints, hernia) is established.

Complaints are identified, including those of an asthenoneurotic nature: headaches, cardialgia, palpitations, etc. An examination is carried out with an assessment of constitutional features and minor developmental anomalies, auscultation in the supine position, left side, sitting, standing, after jumping and when straining, recorded electrocardiogram in a lying and standing position, it is advisable to do an echocardiogram.

The follow-up notes the dynamics of auscultatory manifestations, electrocardiogram and echocardiogram indicators, and monitors the implementation of the prescribed recommendations.

The prognosis of MVP depends on the cause of prolapse and the state of left ventricular function. However, in general, the prognosis for primary MVP is favorable. The degree of primary MVP, as a rule, does not change. The course of MVP is asymptomatic in most patients.

They have a high tolerance to physical activity. In this regard, acrobats, dancers and ballet dancers with joint hypermobility, among whom there are persons with MVP, are quite demonstrative. Pregnancy with MVP is not contraindicated.

What it is

Mitral valve prolapse (MVP) is the protrusion of one or both leaflets of the heart's mitral valve (separating the left atrium from the left ventricle) into the left atrium during contraction of the left ventricle. It is a fairly common disease, affecting 15-25 percent of people. In women it is 9-10 times more common than in men. It is usually detected at a young age (15-30 years).

Currently, a distinction is made between primary and secondary MVP. The causes of primary mitral valve prolapse are heredity or congenital connective tissue diseases.

The causes of secondary MVP are rheumatism, heart inflammation, chest trauma and some other diseases.

How does it manifest itself?

Most people are unaware of the presence of prolapse - their disease is asymptomatic. Complaints of painful sensations in the heart area are possible, usually arising against the background of emotional experiences, not associated with physical activity and not relieved by nitroglycerin. The pain is usually mild, but long-lasting, accompanied by anxiety and palpitations. There may be sensations of interruptions in the functioning of the heart.

In most cases, mitral valve prolapse proceeds favorably and does not have any effect on life or ability to work.

Diagnosis

Mitral valve prolapse sometimes causes a soft systolic murmur heard upon auscultation (listening) over the apex of the heart and in the projection of the mitral valve. But more often the presence of MVP is discovered accidentally during echocardiography. This method also makes it possible to identify the degree of prolapse and its effect on normal blood flow.

Treatment

If the degree of mitral valve prolapse is low and there are no rhythm disturbances, active treatment is not required. For severe prolapse, accompanied by pain and rhythm disturbances, beta-blockers are used. In extremely rare cases, surgical treatment is required.

The treatment method is selected depending on the degree of mitral valve prolapse and its effect on blood flow. The condition is monitored using echocardiography, usually performed once a year.

Mitral valve prolapse

Mitral valve prolapse is one of the congenital structural features of the heart. To make it easier to understand what exactly this feature is, let’s briefly consider some of the nuances of the anatomy and physiology of the heart.

So, the heart is a muscular organ whose function is to pump blood throughout the body. The heart consists of two atria and two ventricles. Between the atria and ventricles are the heart valves, the tricuspid (tricuspid) on the right and the mitral (bicuspid) on the left. The valves consist of connective tissue and are similar to peculiar doors that close the openings between the atria and ventricles so that the blood moves in the right direction - normally, blood moves from the atria to the ventricles; there should be no backflow into the atria. At the moment of expulsion of blood from the atrium into the ventricle (atrial systole), the valve is open, but as soon as all the blood has entered the ventricle, the valve leaflets close, and then the blood is expelled from the ventricles into the pulmonary artery and aorta (ventricular systole).

From left to right: 1. General diastole of the heart - the atria and ventricles are relaxed; 2. Atrial systole - the atria are contracted, the ventricles are relaxed; 3. Ventricular systole - the atria are relaxed, the ventricles are contracted.

If the mitral valve leaflets do not completely close during the period of expulsion of blood from the ventricle into the aorta, then they speak of its prolapse (sagging) into the cavity of the left atrium at the time of systole (contraction of the left ventricle).

Mitral valve prolapse- this is a violation of its connective tissue structure, leading to incomplete closure of the valves, as a result of which blood may be refluxed back into the atrium (regurgitation). There are congenital (primary) prolapse and those developed against the background of endocarditis, myocarditis, chest injuries with chordal rupture, heart defects, myocardial infarction (secondary). Primary prolapse occurs in approximately 20 - 40% of healthy people and in most cases does not have a significant effect on the functions of the cardiovascular system.

In modern medicine, primary mitral valve prolapse is considered to be a congenital structural feature of the heart rather than a serious pathology, provided that it is not combined with gross malformations and does not cause significant hemodynamic disturbances (functions of the cardiovascular system).

Causes of mitral valve prolapse

Below we will talk about primary mitral valve prolapse, which refers to minor anomalies in the development of the heart. What could cause this anomaly? The main cause of the development of the disease is genetically determined disorders in the synthesis of type 111 collagen. This is a protein that takes part in the formation of connective tissue in all organs, including the heart. If its formation is impaired, the connective tissue “skeleton” of the valve loses its strength, the valve becomes loose, softer, and therefore cannot provide sufficient resistance to blood pressure in the cavity of the left ventricle, which leads to sagging of its leaflets into the left atrium.

It is also necessary to take into account harmful factors that affect the development of the fetus and connective tissue during pregnancy - smoking, alcohol, narcotic and toxic substances, occupational hazards, poor nutrition, stress.

Symptoms and signs of mitral valve prolapse

As a rule, the diagnosis is established during a routine examination of newborns, including echocardiography (ultrasound of the heart).

Mitral valve prolapse is classified according to the degree of regurgitation (backflow of blood), determined using Doppler ultrasound of the heart. The following degrees are distinguished:

— 1st degree– the reverse flow of blood in the left atrium remains at the level of the valve leaflets;

— 2nd degree– the blood stream returns to half of the atrium;

— 3rd degree– the backflow of blood fills the entire atrium.

If the patient has congenital prolapse, then, as a rule, regurgitation is insignificant (grade 1), or there is no regurgitation at all. If valve prolapse is secondary, then hemodynamically significant regurgitation may develop, since the return of blood to the atrium has a negative effect on the functions of the heart and lungs.

With prolapse without regurgitation, there are no clinical symptoms. Like other minor anomalies of heart development (accessory chord, patent foramen ovale), this disease can only be suspected on the basis of a routine examination of the child and an ECHO-CG, which in recent years has been a mandatory method of examining all children aged 1 month.

If the disease is accompanied by regurgitation, then with psycho-emotional or physical stress there may be complaints of diffuse pain in the heart area, sensations of interruptions in the functioning of the heart, a feeling of “fading” of the heart, shortness of breath, and a feeling of lack of air. Since the activity of the heart and the autonomic nervous system (the part of the nervous system responsible for the functions of internal organs) is inextricably linked, the patient may experience dizziness, fainting, nausea, “lump in the throat,” fatigue, unmotivated weakness, increased sweating, tachycardia (rapid heartbeat). ), a slight increase in temperature. All these are symptoms of vegetative crises, which are especially pronounced in a child with prolapse during adolescence, when rapid growth and hormonal changes in the body are observed.

In rare cases, when grade 3 regurgitation is observed, the above-described complaints are accompanied by manifestations characteristic of hemodynamic disturbances in the functioning of the heart and lungs - pain in the heart and shortness of breath during normal household activities, walking, climbing stairs, caused by stagnation of blood in these organs. Also rarely, cardiac arrhythmias can occur - sinus tachycardia, atrial fibrillation and flutter, atrial and ventricular extrasystole, shortened PQ syndrome. It must be remembered that sometimes regurgitation can progress, that is, the degree of prolapse can increase.

Diagnosis of mitral valve prolapse

What is the diagnosis based on? Mitral valve prolapse can be suspected during a clinical examination of the child. In young children, prolapse may be accompanied by umbilical and inguinal hernias, hip dysplasia (congenital subluxation and dislocation of the hip). When examining children and adolescents, attention is paid to the patient’s appearance - tall stature, long fingers, long limbs, pathological joint mobility, curvature of the spine, deformation of the chest.

During auscultation (listening), either isolated systolic murmurs and clicks are heard (caused by the tension of the chordae tendineae when the valve prolapses at the moment of its closure), or a combination of them.

The main diagnostic method is echocardiography (ultrasound of the heart) with Doppler study (allows you to display an echo - a signal from moving blood structures). Direct ultrasound allows one to assess the presence of valve prolapse and the degree of its sagging, and Doppler reveals the presence and degree of regurgitation.

In addition, an ECG and daily ECG monitoring are required to determine rhythm and conduction disturbances (cardiac arrhythmias).

X-rays of the chest organs are also indicated to determine whether the heart shadow is widened in diameter and whether there is stagnation of blood in the vessels of the lungs, which may indicate the development of heart failure.

If necessary, load tests are prescribed (treadmill test - walking on a treadmill, bicycle ergometry).

Treatment of mitral valve prolapse

If mitral valve prolapse is not accompanied by clinical symptoms, the patient is not prescribed drug therapy. There is also no need for hospitalization. A number of general strengthening measures and observation by a cardiologist with an annual ECHO-CG are indicated.

General strengthening measures include: good nutrition, a rational regime of work and rest with sufficient sleep, walks in the fresh air, general hardening of the body, moderate exercise (approved by a doctor).

In case of manifestations of vegetative-vascular dystonia (vegetative crises), spinal massage, physical therapy, electrophoresis with magnesium preparations on the collar area are prescribed. Herbal sedatives are indicated (motherwort, valerian, sage, hawthorn, wild rosemary), as well as drugs that improve the nutrition of the heart muscle (magnerot, carnitine, riboxin, panangin) and vitamins.

If there are pronounced sensations of interruptions in the heart, and even more so with rhythm disturbances confirmed by ECG, adrenergic blockers are prescribed (carvedilol, bisoprolol, atenolol, anaprilin, etc.)

In rare cases (with the development of heart failure, arrhythmias, progressive mitral valve insufficiency), surgical correction of prolapse can be performed. Surgical treatment methods include reconstructive operations on the valve (suturing its sagging leaflet, shortening the stretched chord) or valve prosthetics and replacing it with an artificial one. Surgical treatment of isolated congenital prolapse is used extremely rarely due to the favorable course of this pathology.

Complications of mitral valve prolapse

Are there any complications? Despite the fact that in most cases there is mitral valve prolapse with minor regurgitation, which does not require special therapy, there is still a risk of complications. Complications are quite rare (only 2-4%) and include the following life-threatening conditions that require treatment in a specialized hospital:

— acute mitral regurgitation- a condition that usually occurs as a result of separation of the chordae tendineae due to chest injuries. It is characterized by the formation of a “dangling” valve, that is, the valve is not held by the chords, and its valves are in free movement, not performing their functions. Clinically, a picture of pulmonary edema appears - severe shortness of breath at rest, especially in the lying position; forced sitting position (orthopnea), bubbling breathing; congestive wheezing in the lungs.

— bacterial endocarditis– a disease in which microorganisms that have broken into the blood from the source of infection in the human body settle on the inner wall of the heart. Most often, endocarditis with damage to the heart valves develops after a sore throat in children, and the presence of initially altered valves can serve as an additional factor in the development of this disease. Two to three weeks after the infection, the patient develops repeated fever, chills, there may be a rash, an enlarged spleen, cyanosis (blue coloration of the skin). This is a serious disease that leads to the development of heart defects, gross deformation of the heart valves with dysfunction of the cardiovascular system. Prevention of bacterial endocarditis is timely sanitation of acute and chronic foci of infection (carious teeth, diseases of the ENT organs - adenoids, chronic inflammation of the tonsils), as well as prophylactic use of antibiotics during procedures such as tooth extraction, removal of tonsils.

— sudden cardiac death- a formidable complication, apparently characterized by the occurrence of idiopathic (sudden, causeless) ventricular fibrillation, which is a fatal rhythm disorder.

Prognosis for mitral valve prolapse

The prognosis for life is favorable. Complications rarely develop, and the patient’s quality of life does not suffer. However, the patient is contraindicated from engaging in certain sports (jumping, karate), as well as professions that overload the cardiovascular system (divers, pilots).

Regarding military service, we can say that, according to orders, suitability for military service is decided individually for each patient by a military medical commission. So, if a young man has mitral valve prolapse without regurgitation or with regurgitation of the 1st degree, then the patient is fit for service. If there is regurgitation of the 2nd degree, then the patient is conditionally fit (in peacetime he will not be called up). If there is grade 3 regurgitation, arrhythmias or heart failure of functional class 11 or higher, military service is contraindicated. Thus, most often a patient with mitral valve prolapse with a favorable course and in the absence of complications can serve in the army.

General practitioner Sazykina O.Yu.

Mitral valve prolapse. Heart disease. Diagnosis of prolapse

Mitral valve prolapse- symptoms and detection of the disease.

One of the heart defects is called mitral valve prolapse in medicine.. Behind this terrible name lies an equally terrible disease. And, like many heart diseases, mitral valve prolapse may not make itself felt for several years. The patient learns about the terrible diagnosis only at an appointment with a cardiologist based on the results of electrocardiography (ECG) and blood tests.

What kind of disease is this? mitral valve prolapse

The human heart consists of four chambers - two ventricles and two atria. During atrial contraction, the mitral valve (the septum between the left atrium and the left ventricle) allows blood to flow into the ventricle. Normally, after this it closes tightly, but with prolapse the valve bends, which causes a small amount of blood to flow back into the atrium. In some cases, the amount of blood outflow is so high that the patient requires surgical correction of the defect.

Women aged fourteen to thirty years are most susceptible to the development of mitral valve prolapse. Cardiologists still cannot say for sure what exactly is the cause of this heart defect. .

The symptoms accompanying the disease are similar to other heart diseases:

• sharp or aching pain in the left side of the chest, which is not relieved by traditional medications and is not associated with heavy physical activity, usually observed in the morning or at night,
• feeling of lack of air, unable to take a deep breath,
• feeling of rapid heartbeat,
• pre-fainting (ringing in the ears, darkening of the eyes, dizziness, loss of consciousness),
• rare slight increase in temperature.

There are two main methods of instrumental diagnostics. which allow you to accurately diagnose mitral valve prolapse - ECG and EchoCG. To monitor the health of their body, cardiologists at the “Your Doctor” medical center recommend that patients undergo examination by medical specialists at least once a year. If the disease regularly manifests itself in the form of pain, arrhythmias, and heart problems, a course of active drug treatment may be required. Most of the treatment can be completed under medical supervision in the day hospital of the “Your Doctor” medical center. In rare, protracted cases, it may be necessary to perform plastic surgery and valve replacement.

Mitral valve prolapse is the sagging of one or both mitral valve leaflets into the cavity of the left atrium during systole - contraction of the ventricles of the heart. The mitral valve is a formation located between the left atrium and the left ventricle and consists of a valve ring, two leaflets and a subvalvular apparatus that supports the leaflets - chords and papillary muscles. During atrial systole (contraction), the valve is open and blood flows freely into the ventricle. Then it closes, and during ventricular systole, when blood is directed to the aorta, it prevents the reverse flow of blood - regurgitation - from the ventricle to the atrium. Normally, the mitral valve leaflets should close completely. If this does not happen, then some of the blood is thrown into the left atrium.

A doctor can suspect mitral valve prolapse by listening with a phonendoscope to a patient, usually a child or young man, with a systolic murmur. This noise differs in its characteristics from the noise heard with heart defects, it is softer and inconsistent, but, nevertheless, earlier, when there was no echocardiography, such patients were often diagnosed with rheumatism with damage to the heart valves.

Prolapse is a serious disease that can lead to complications.- the appearance of fainting, heart rhythm disturbances, the formation of blood clots on the altered valve, which can lead to the development of ischemic stroke at a young age. Changes in the structure of the valve also lead to an increased risk of infection with the development of infective endocarditis, so such patients require antibiotic prophylaxis before any upcoming operations and even tooth extraction.

Causes and manifestations.

Mitral valve prolapse can be primary (idiopathic) or secondary. Secondary prolapse is a manifestation of various diseases leading to destruction of the valves, rupture of chords and papillary muscles: coronary heart disease, myocardial infarction, defects, inflammatory and degenerative diseases.

The causes of primary, or idiopathic, prolapse can be- hereditary weakness of connective tissue (the tissue that makes up the heart valves, as well as ligaments, tendons, supporting apparatus of various organs, components of the vascular wall, etc.). Such patients, as a rule, have other manifestations of this congenital anomaly.

Treatment of prolapse.

Mild prolapse, that is, less than 10 mm, does not require special treatment. It is detected, as a rule, in childhood and young age, and then, with an increase in the density of connective tissue, it can disappear. The accompanying conditions listed above associated with connective tissue weakness may require treatment. To improve its structure, as well as to normalize the functional state of the cardiovascular system, potassium, magnesium, copper, vitamins and other drugs are often prescribed, depending on numerous symptoms.

With severe prolapse, sports are contraindicated, since dizziness and fainting in patients can no longer occur due to improper redistribution of vascular tone, but due to low-output syndrome, associated with the fact that during intense physical activity significant regurgitation occurs, and most of the blood from the left ventricle does not go to the aorta, but returns to the cavity of the left atrium.

Due to the risk of thrombus formation on the myxomatous valve, such patients may require specific antithrombotic therapy to prevent ischemic stroke. They are also recommended to prescribe prophylactic antibiotics in advance of any surgeries and dental procedures. Sometimes surgical treatment is necessary to correct severe prolapse.

Complications of mitral valve prolapse include mitral regurgitation, infective endocarditis, atrial fibrillation. Visit your cardiologist and other doctors at the “Your Doctor” medical center in a timely manner. In this case, the development of complications can be avoided .

Heart defects- these are changes in the structure of the heart that cause disturbances in its functioning. These include defects in the wall of the heart, ventricles and atria, valves or outflow vessels. Heart defects are dangerous because they can lead to impaired blood 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 defects
• Acquired heart defects

It is believed that 1% of children are born with the defect. In Russia this amounts to 20,000 people annually. But to these statistics we need to add those cases where congenital defects are discovered many years later. The most common problem is ventricular septal defect, 14% of all cases. It happens that several defects are detected simultaneously in the heart of a newborn, which usually occur together. For example, tetralogy of Fallot accounts for 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 a fairly common phenomenon. Do not think that they appear only in old age. A large proportion occurs between the ages 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 illnesses, heart valve disorders mainly appear, which ensure the movement of blood in the right direction and prevent it from returning back. Most often, problems arise with the mitral valve, which is located between the left atrium and the left ventricle - 50-75%. The second highest risk group is the aortic valve, located between the left ventricle and the aorta – 20%. The pulmonary and tricuspid valves account for 5% of cases of the disease.

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 get rid of the cause of the disorders.

Anatomy of the heart

Heart- a tireless pump that pumps blood throughout our body without stopping. This organ is the size of a fist, has the shape of a cone 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 part by the ventricles. Thus, the heart consists of four chambers.
Oxygen-poor blood comes from the organs to 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 pulmonary 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 there it goes through the arteries to the organs. This is the beginning systemic circulation: left ventricle, organs, right atrium.

First and main condition proper functioning of the heart: blood waste from organs without oxygen and blood enriched with oxygen in the lungs should not mix. For this purpose, the right and left halves are normally tightly separated.

Second prerequisite: Blood should only flow in one direction. This is ensured by valves that prevent the blood from taking “a single step back.”

What is the heart made of?

The function of the heart is to contract and pump out 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 consists of three layers.

1. Pericardium – outer two-layer bag made of connective tissue. There is a small amount of liquid between the outer and inner layers, which helps 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 fraction of a second between blows. The thickness of the heart muscle is not the same in different areas.
3. Endocard – the inner layer that lines the chambers of the heart and forms the septum. Valves are folds of endocardium along the edges of the openings. This layer consists of strong and elastic connective tissue.

Anatomy of valves

There are 4 valves in the heart:

1. Mitral valve- between the left atrium and the left ventricle. It consists of two valves, papillary or papillary muscles and tendinous threads - chords, which connect the muscles and valves. When blood fills the ventricle, it presses on the valves. The valve closes under blood pressure. The chordae tendineae prevent the valves from opening towards the atrium.
2. Tricuspid, or tricuspid valve - between the right atrium and the right ventricle. Consists of three valves, papillary muscles and chordae tendineae. The principle of its operation is the same.
3. Aortic valve- between the aorta and left ventricle. It consists of three petals that have a crescent shape and resemble pockets. As 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.

Structure of the aorta

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

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

While the fetus is developing inside the uterus, there is a duct between the aorta and the pulmonary trunk - a vessel that connects them. While the child's lungs are not working, this window is vital. It protects the right ventricle from overfilling.

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 during the first two months after birth.

If this does not happen, then one of the heart defects develops - patent ductus arteriosus.

Oval hole

The foramen ovale is the door between the left and right atria. The baby needs it while he is in the womb. During this period, the lungs do not work, but they need to be fed with blood. Therefore, the left atrium transfers part of its blood through the foramen ovale 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 completely overgrown. This happens during the first year of life. If this does not happen, then the oval window may remain open throughout life.

Interventricular septum

Between the right and left ventricles there is a septum, which consists 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 septum. Through it, the blood of the right and left ventricles is mixed. This defect is considered a heart defect.

Mitral valve

• 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 basis of the valve. There is a hole in the center of the ring; its circumference is 6-7 cm.
• Valve flaps. The doors resemble two doors covering a hole in a ring. The front valve is deeper and resembles a tongue, while the rear valve is attached around the circumference and is considered the main one. In 35% of people it splits, and additional valves appear.
• Tendon chords. These are dense fibers of connective tissue that resemble threads. In total, 30-70 chords 1-2 cm long can be attached to the valve flaps. They are fixed not only to the free edge of the valve flaps, but also along 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 contraction of the ventricle and prevent the valve from opening and releasing blood into the atrium.
• Papillary or papillary muscles. It is an extension of the heart muscle. They look like 2 small papilla-shaped outgrowths on the walls of the ventricle. It is to these papillae that the chordae are attached. The length of these muscles in adults is 2-3 cm. They contract together with the myocardium and stretch the tendon threads. And they hold the valve flaps tightly and do not allow it to open.

Mitral valve stenosis

Causes

The causes of mitral valve stenosis can be congenital abnormalities of the heart and past diseases.

Birth defects:

• valve leaflet fusion
• supravalvular membrane
• reduced annulus fibrosus

Infectious diseases:

• sepsis
• brucellosis
• syphilis
• angina
• pneumonia

• rheumatism
• scleroderma
• systemic lupus erythematosus
• dermatopolymyositis

Regardless of what reason caused the narrowing of the mitral valve, the symptoms of the disease will be the same.

Symptoms

Normally, the area of ​​the opening between the left atrium and the ventricle is 4-5 cm 2. For minor changes to the valve well-being remains normal. But the smaller the gap between the chambers of the heart, the worse the person’s condition.

When the lumen narrows by half to 2 cm2, the following symptoms appear:

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

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

Manifestations of mitral valve stenosis:

• the skin is pale, but a blush appears on the cheeks;
• bluish areas (cyanosis) appear on the tip of the nose, ears and chin;
• attacks of atrial fibrillation; with severe narrowing of the lumen, the arrhythmia can become permanent;
• swelling of the limbs;
• “heart hump” - protrusion of the chest in the area of ​​the heart;
• strong blows of the right ventricle against the chest wall are heard;
• “cat purring” occurs after squats, in a position on the left side. The doctor places his hand on the patient's chest and feels how the blood oscillates through the narrow opening of the valve.

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

Electrocardiogram (ECG). Reveals enlargement of 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, the following appears on the graphic recording of heart sounds:

• characteristic noises that are heard before contraction of the ventricles. It is created by the sound of blood passing through a narrow opening;
• “click” of the mitral valve closing.
• the jerky “pop” that the ventricle makes as it pushes blood into the aorta.

• left atrium enlargement;
• sealing valve flaps;
• The valve leaflets close more slowly than in a healthy person.

Diagnostics

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

• the sound of blood while it fills the ventricles;
• a “click” that is heard when the mitral valve opens;
• trembling of the chest, which is caused by the passage of blood through the narrow opening of the valve and the vibration of its valves - “cat purring”.

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

Treatment

• Cardiac glycosides: Digoxin, Celanide
These medications help the heart pump faster and slow down its beat rate. You especially need them if your heart cannot cope with the load and begins to hurt. 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 remove excess water from the body, reducing pressure in the vessels of the lungs and 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 take a break. Along with water, useful minerals and vitamins are removed from the body, so it is advisable to take a vitamin-mineral complex, for example, Multi-Tabs.
• Beta blockers: Atenolol, Propranolol
They help return the heart rhythm to normal if atrial fibrillation or other rhythm disturbances appear. They reduce left atrial pressure during exercise. Take 1 tablet before meals, without chewing. The minimum course is 15 days, but usually the doctor prescribes long-term treatment. The drug should be discontinued gradually so as not to cause worsening.
• Anticoagulants: Warfarin, Nadroparin
You need them if a heart defect has caused enlargement of the left atrium, atrial fibrillation, which increases the risk of blood clots forming in the atrium. These medications thin the blood and prevent the formation of blood clots. Take 1 tablet 1 time per day at the same time. For the first 4-5 days, a double dose of 5 mg is prescribed, and then 2.5 mg. Treatment lasts 6-12 months.
• Anti-inflammatory and antirheumatic drugs: Diclofenac, Ibuprofen
  These non-steroidal anti-inflammatory drugs relieve pain, inflammation, swelling, and lower temperature. 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 medicine has its own contraindications and can cause serious side effects. Therefore, do not self-medicate and do not take medications that helped your friends. Only an experienced doctor can decide which medications you need. At the same time, it takes into account whether the drugs you are taking will be combined.

Types of operations for mitral valve stenosis

Whether surgery is necessary for congenital mitral valve stenosis is decided by the doctor depending on the child’s condition. If the cardiologist determines that it is impossible to do without urgently eliminating 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. This treatment will allow the baby to develop normally and not lag behind his peers in any way.

Mitral valve repair.
If the changes are small, the surgeon will cut the fused sections of the valves and expand the lumen of the valve.

Mitral valve replacement. If the valve is severely damaged or there are developmental anomalies, the surgeon will put a silicone prosthesis in its place. 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 ​​the 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 (pulmonary circulation);
• deterioration of health, despite constant use of medications.

• severe heart failure;
• thrombosis of the left atrium (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.

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 sharply inflates it. The operation is carried out under X-ray and ultrasound control.

• the area of ​​the mitral valve opening is less than 1.5 cm2;
• mild deformation of the valve leaflets;
• the valves retain their mobility;
• there is no significant thickening or calcification of the valves.

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

• cannot eliminate serious changes in the valve (calcification, deformation of the valves);
• cannot be performed in case of severe damage to several heart valves and thrombosis of the left atrium;
• The risk of needing further surgery is up to 40%.

Transthoracic commissurotomy. This is an operation that allows you to cut the adhesions on the valve leaflets, 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 is to make a small incision in the chest and insert a surgical instrument into the mitral valve through the interatrial groove to widen the valve opening. This operation is performed without a heart-lung machine.

Indications for this type of operation

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

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

The operation is ineffective if there is a thrombus in the left atrium, mitral valve calcification or the lumen is narrowed too much. In this case, you will have to make an incision between the ribs, connect artificial blood circulation and carry out 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 insufficiency;
• calcification and low mobility of the valve.

• gives good treatment results;
• helps reduce pressure in the atrium and pulmonary veins;
• the doctor sees what changes have occurred in the valve structures;
• if during the operation it is discovered that the valve is severely damaged, then an artificial one can be immediately installed;
• can be carried out if there is a thrombus in the left atrium or several valves are affected;
• effective when Balloon valvuloplasty and transthoracic commissurotomy were unsuccessful.

• the need for artificial circulation;
• a large incision on the chest takes longer to heal;
• 50% of people develop stenosis again within 10 years after surgery.

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

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

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

• 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 the valves and tendon threads;
• a thick layer of connective tissue (fibrosis) has formed on the valve leaflets and they do not close well;
• There are large calcium deposits on the valve leaflets.

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

• it is necessary to exclude the heart from the circulatory system and immobilize it.
• it takes about 6 months for full recovery.

Mitral valve prolapse

2.5-5% of people have this disease and most of them don’t even know about it. If changes in the valve are minor, then no symptoms of the disease occur. In this case, doctors consider mitral valve prolapse to be a normal variant - a feature of heart development. Most often it is found in young people under 30 years of age, 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 been diagnosed with mitral valve prolapse, then you need to 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 PMC

Congenital

• impaired structure of the mitral valve leaflets;
• weakness of the connective tissue that makes up the valve;
• chordae tendineae are too long;
• disturbances in the structure of the papillary muscles to which the chordae fixing the valve are attached.

Infectious diseases

• angina
• scarlet fever
• sepsis

Autoimmune pathologies

• rheumatism
• scleroderma
• systemic lupus erythematosus

Other reasons

• Severe blows to the chest can cause chordae rupture. In this case, the valve flaps will also not close tightly.
• consequences of myocardial infarction. When the work of the papillary muscles responsible for closing the valves is disrupted.

Symptoms

20-40% of people diagnosed with mitral valve prolapse have no symptoms of the disease. This means that little or no blood leaks into the atrium.

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

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

• pain in the heart area;
• strong heartbeat;
• weakness and faintness;
• attacks of dizziness;
• increased fatigue;
• attacks of fear and anxiety;
• heavy sweating;
• shortness of breath and feeling of lack of air;
• fever not associated with infectious diseases.

• tachycardia - the heart beats faster than 90 beats per minute;
• arrhythmia - the appearance of extraordinary “unplanned” heart contractions against the background of a normal rhythm;
• rapid breathing;
• systolic trembling - trembling of the chest, which the doctor feels under his hand during palpation. It is created by vibrating valve flaps 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 returns through small defects in the valves to the atrium;
• tapping (percussion) may reveal that the heart is narrowed.
  Listening to the heart with a stethoscope allows the doctor to identify the following abnormalities:
• systolic murmur. It is produced by blood leaking through the valve back into the atrium during ventricular contraction;
• Instead of two tones when the heart contracts (I - the sound from the contraction of the ventricles, II - the sound from the closure of the aortic valves 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 valve petals at the moment of closure;

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

Instrumental examination data

Two-dimensional echocardiography or ultrasound of the heart. Reveals that one or both valve leaflets bulge, bend towards the left atrium and during contraction they move back. It is also possible to determine what volume of blood returns from the ventricle to the atrium (what is the degree of regurgitation) and whether there are changes in the valve leaflets themselves.

Chest X-ray. It may show that the heart is of normal or reduced size; sometimes there is an enlargement of the initial part of the pulmonary artery.

Diagnostics

In order to make a correct diagnosis, the doctor listens to the heart. Characteristic signs of mitral valve prolapse:

• clicking of the valve leaflets when the heart contracts;
• the sound of blood passing through the narrow gap between the valve leaflets in the direction of the atrium.

• bulging of the mitral valve leaflets, they look like rounded baths;
• outflow of blood from the ventricle into the atrium, the more blood returns, the worse the state of health;
• thickening of the valve leaflets.

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

Drug treatment is prescribed if your health worsens.

• 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 medications help get rid of the manifestations of vegetative-vascular dystonia, which affects all those who have mitral valve prolapse. Tinctures can be taken for a long time, 25-50 drops 2-3 times a day.

Combined drugs: Corvalol, Valoserdin will help reduce the heart rate and make attacks of the disease more rare. These medications are taken daily 2-3 times a day. Usually the course is 2 weeks. After 7 days of rest, treatment can be repeated. You should not abuse these drugs, as addiction and nervous system disorders may occur. Therefore, always follow the dose exactly.

• Tranquilizers: Diazepam
Helps relieve anxiety, fear and irritability. It improves sleep and slows down the heart rate. Take half a tablet or a whole tablet 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 the heart. 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 blood 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
The magnesium in its composition improves the production of collagen and thereby strengthens the connective tissue that makes up the valve. The ratio of potassium, calcium and sodium also improves, and this normalizes the heart rate. Take 1 g daily for a week. Then the dose is halved to 0.5 g and continued to be taken for 4-5 weeks. Not suitable for people with kidney disease and children under 18 years of age.
• Means for lowering blood pressure: Prestarium, Captopril
  They inhibit the action of a special enzyme that causes an increase in blood pressure. Restores the elasticity of large vessels. The atria and ventricles are prevented from stretching due to increased blood pressure. Improves the condition of the connective tissue of the heart and blood vessels. Prestarium is taken 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 can continue for years if necessary.

Surgery for mitral valve prolapse

Balloon valvuloplasty

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

Indications for this type of operation

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

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

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

This operation to replace a damaged heart valve with an artificial one is performed very rarely, because MVP is considered a relatively mild pathology. But in exceptional cases, the doctor will recommend installing a mitral valve prosthesis. It can be biological (human, pig, horse) or artificial, created from silicone and graphite.

Indications for this type of operation

• sharp deterioration in condition;
• heart failure;
• rupture of the chord that holds the valve leaflets.

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

• valve replacement may be required after 6-8 years, especially with a biological prosthesis;
• the risk of blood clots forming in the heart increases;
• Open heart surgery (incision between the ribs) will require up to 1-1.5 months for recovery.

Degrees 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 bulge by 6-8 mm;
• III degree - the sashes bend by more than 9 mm.

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

It is advisable that before echocardiography you did 10-20 squats. This will make abnormalities in the heart more noticeable.

Basic diagnostic criteria

• echocardiography reveals protrusion of the mitral valve leaflets into the atrium;
• Doppler echocardiography determines how much blood leaks through the resulting gap back into the atrium - the volume of regurgitation.

results listening to the heart (auscultation) help to distinguish the disease from aneurysm of the interatrial septum or myocarditis. PMC is characterized by:

• clicks that are heard when the mitral valve closes;
• the noise that blood creates as it rushes under pressure through the narrow gap between the valve leaflets.

Mitral valve insufficiency

What happens in the heart? The volume of blood in the left atrium increases, and it swells and thickens. The annulus fibrosus, the backbone of the mitral valve, stretches and weakens. As a result, the condition of the valve gradually deteriorates. The left ventricle is also stretched, into which too much blood enters after the atrium contracts. Increased pressure and congestion occurs in the vessels leading from the lungs to the heart.

Mitral valve insufficiency is the most common defect, especially in men - 10% of all acquired defects. It rarely occurs on its own, and is often accompanied by mitral stenosis or aortic valve defects.

Causes

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

• underdevelopment of the left half of the heart;
• mitral valve leaflets are too small;
• bifurcation of the valves;
• The chordae tendineae are too short and prevent the valve from closing completely.

Infectious diseases

• pharyngitis
• bronchitis
• pneumonia
• periodontal disease

Autoimmune pathologies

• rheumatism
• systemic lupus erythematosus
• multiple sclerosis

These systemic diseases cause changes in the structure of connective tissue. Cells with collagen fibers multiply quickly. The valve flaps shorten and appear wrinkled. Compression and thickening of the petals leads to mitral valve insufficiency and stenosis.

Other reasons

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

Symptoms

1. how large a gap remains between the valve flaps at the moment of closure;
2. what volume of blood returns to the left atrium during ventricular contraction.

• shortness of breath during exercise and at rest;
• weakness, fatigue;
• cough that gets worse in a horizontal position;
• sometimes blood appears in the sputum;
• aching and pressing pain in the heart area;
• swelling of the legs;
• heaviness in the abdomen under the right rib caused by an enlarged liver;
• accumulation of fluid in the abdomen - ascites.

• bluish skin on the fingers, toes, and tip of the nose (acrocyanosis);
• swelling of the neck veins;
• “heart hump” is an elevation to the left of the sternum;
• when tapping, the doctor notices an increase in the size of the heart;
• during palpation after squats, the doctor feels the chest trembling in the area of ​​the heart. These vibrations are created by the blood that passes through the hole in the valve, forming turbulence and waves.
• atrial fibrillation – small irregular contractions of the atria.

• the sound from the contraction of the ventricles is weakened or not heard at all;
• you can hear the mitral valve closing;
• the most characteristic sign 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 loosely closed valve leaflets during contraction of the ventricles.

Chest X-ray. The picture shows:

• enlargement of the left atrium and left ventricle;
• esophagus shifted 4-6 cm to the right;
• the right ventricle may be enlarged;
• the arteries and veins in the lungs are dilated, their contours are unclear and blurred.

Phonocardiogram. The most informative study that allows you to study heart sounds and murmurs:

• The sound from the contraction of the ventricles is faintly audible. This is due to the fact that the ventricles hardly close;
• the sound of blood rushing from the left stomach into the left atrium. The louder the murmur, the more severe the mitral regurgitation;
• An additional click is heard when the valve closes. This sound is created by the papillary muscles, valve leaflets and chords that hold them.

• increase in the size of the left atrium;
• left ventricular distension;
• incomplete closure of the valve flaps.

Diagnostics

1. Echocardiography– reveals weakening of the sound from contraction of the ventricles and the noise that creates the reverse flow of blood. Changes in the valve leaflets are also visible.
2. Electrocardiogram shows enlargement of the left atrium, left and right ventricles.
3. X-ray. On x-ray dilated vessels are visible throughout the surface of the lungs with a fuzzy edge and expansion of the heart to the left.

Treatment

• Diuretics: Indapamide
This is a diuretic drug that is prescribed to relieve blood congestion in the lungs. It speeds up urine production and helps 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 minerals potassium, sodium, and calcium necessary for the proper functioning of the heart are excreted in the urine. Therefore, it is necessary to take mineral supplements with the approval of a doctor.
• ACE inhibitors: Captopril
Reduces the load on the heart and pressure in the blood vessels of the lungs, improves blood circulation. In addition, it reduces the size of the heart and allows it to pump blood into the arteries more efficiently. Helps to better bear loads. Take 1 tablet 2 times a day an 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 heart rate. Reduces the impact of the sympathetic nervous system, which is what makes the heart beat faster. Atenolol reduces the contractility of the heart muscle, makes the heart beat evenly, in the desired 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, and for the third week it is increased to 100 mg/day. This medicine also needs to be discontinued gradually, otherwise your health may deteriorate sharply and a myocardial infarction may 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. The 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 1 mg/day. The dose is divided into 2 parts and drunk in the morning and evening. After a few days, switch to a maintenance dose of 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 stomach lining, you can take aspirin with meals or take the tablet with milk.

Types of operations

1st degree – backflow of blood into the left atrium of no more than 15% of the blood volume in the left ventricle.
2nd degree - 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 - reverse blood flow is more than 50%, the left atrium is enlarged, but its walls are no thicker than in other chambers of the heart.

In case of stage 1 mitral valve insufficiency, surgery is not performed. At stage 2, they may suggest clipping; at stages 2 and 3, they try to perform valve repair. Stages 3-4, which are accompanied by serious changes in the valves, chords and papillary muscles, require valve replacement. The higher the stage, the greater the risk of complications and recurrence of the disease.

Clipping method

A special clip is delivered through an artery in the thigh using a flexible cable to the heart. This device is attached to the middle of the mitral valve. Thanks to its special design, it allows blood to pass 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 sensor placed in the esophagus. The procedure takes place under general anesthesia.

Indications for this type of operation

• Stage 2 mitral insufficiency;
• blood reflux into the left atrium reaches 30%;
• there are no serious changes in the chordae tendineae and papillary muscles.

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

• not suitable for severe valve damage.

Modern doctors try to preserve the valve whenever possible: if there is no severe deformation of the valves or significant calcium deposits on them. Reconstructive mitral valve repair is performed on milder patients at any age. To correct valve deficiencies, the doctor dissects the chest and, using a scalpel, corrects damage to the valves and aligns them. Sometimes a rigid support ring is inserted into the valve to narrow it or the chordae tendineae 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

• Stages 2 and 3 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.

• preserves the “original” valve and improves its operation;
• heart failure occurs less frequently;
• lower mortality after surgery;
• complications occur less frequently.

• not suitable for significant calcium deposits on the valve leaflets;
• cannot be done if other heart valves are affected;
• There is a risk that mitral regurgitation will reoccur within 10 years.

Mitral valve replacement

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 blood volume in the ventricle;
• the operation is performed even if there are no noticeable 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.

• 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;
• allows you to help patients with grade 4 mitral regurgitation, when other methods are no longer effective.

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

After any open heart surgery, you will have to spend the first day in intensive care and another 7-10 days in the cardiology department. After this, 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 for the body to fully recover. Proper nutrition, proper rest and physical therapy will allow you to regain full health and live a long and happy life.

One of the common pathologies of the heart is disturbances in the structure of the valves. The bending of the valve leaflets into the cavity of the left atrium is called the heart.

The heart is an organ consisting almost exclusively of muscle fibers. It contains two ventricles and atria, which are separated by valves. The tricuspid valve separates the right parts of the heart, and the bicuspid valve separates the left parts of the heart. The bicuspid valve in the heart is also called the mitral valve.

When the heart valve leaflets are open, they allow blood to flow from the left atrium into the ventricle. By contracting, the left ventricle promotes tight closure of the valves and blood does not flow back into the atrium. In this case, the heart valve experiences significant blood pressure, which normally should not prolapse the valves.

Classification of mitral valve prolapse

For the reason:

• Primary;
• Secondary.

According to the location of the valves:

• front flap;
• rear flap;
• both doors.

By severity:

• I degree;
• II degree;
• III degree.

According to clinical manifestations:

• asymptomatic;
• low-symptomatic - weak or moderate displacement of the valves along the valve, no regurgitation;
• clinically significant – pronounced clinical manifestations, clear systolic murmur and characteristic changes in echocardiography;
• significant morphologically - the above is accompanied by significant dysfunction of the prolapsed mitral valve and the presence of complications.

Causes

Primary heart valve prolapse develops independently and is not associated with other diseases. Genetic predisposition contributes to the development of the disease. It is very rare and refers to connective tissue dysplasia or minor cardiac anomalies. The valve leaflets are affected by degenerative processes, and the structure of collagen fibers is disrupted. Changes occur in the fibrous layer, which plays the role of the skeleton of the valve leaflet.

Secondary - is a consequence of any disease, for example, Marfan syndrome, ischemic heart disease, rheumatoid arthritis, rheumatism, myocarditis, etc.

The causes of mitral valve prolapse in rheumatism are damage to the valve leaflets by an inflammatory process. Leaflet prolapse in cardiomyopathy is caused by uneven thickening of the myocardium.

With the development of regurgitation, complaints are accompanied by shortness of breath and poor tolerance of even light exercise.

Mitral valve prolapse is most often diagnosed in the following areas:

• during a planned preventive examination;
• when a systolic murmur is detected;
• in the presence of cardiac complaints;
• detection of the disease during examination for another pathology.

An examination by a doctor is of paramount importance in identifying the disease. When listening to heart sounds, systolic murmur attracts attention, the detection of which is an indication for further examination of an adult patient or child.

The presence does not necessarily mean the presence of a heart defect: in young people, the murmur can be functional in nature. Auscultation is performed standing after exercise, for example, jumping, squats, because the noise intensifies after this.

• : with primary pathology there will be no changes, with secondary pathology, changes in tests will be characteristic of the underlying disease.
• Electrocardiography.
• Phonocardiography is a method of recording heart murmurs.
• Echocardiography in this case is the most informative method.

During the study, three degrees of mitral valve prolapse are distinguished:

• I degree – sagging from 3 to 5 mm;
• II degree – from 6 to 9 mm;
• III degree – from 9 mm.

However, it has been established that MVP up to 10 mm is favorable.

• Chest X-ray.
• Differential diagnosis with congenital heart defects.

Forecast

For many patients, MVP does not threaten anything: most people do not know about the presence of this pathology in the body.

Complications

Why is mitral valve prolapse dangerous? The development of complications greatly worsens the prognosis of the disease and the patient’s quality of life.

Rhythm disturbance

Causes of heart rhythm disturbances:

• dysfunction of the autonomic nervous system;
• the prolapsed cusp can irritate cardiomyocytes (heart muscle cells) when it touches the wall of the left atrium;
• strong tension of the papillary muscles that hold the prolapsing valve;
• changes in impulse conduction.

There are such as extrasystoles, tachycardia, atrial fibrillation. Most arrhythmias that occur against the background of MVP are not life-threatening, but it is necessary to examine the patient to determine the exact cause of the arrhythmia. With exercise, the risk of developing arrhythmia increases.

Mitral regurgitation

For the development of regurgitation, grade III prolapse is necessary. In young patients, there is a separation of the chords holding the valve leaflets, which leads to the development of acute mitral and requires emergency surgical treatment. Often, separation occurs due to chest injury and is manifested by the development of symptoms of acute left ventricular failure.

Infective endocarditis

It is typical for patients with a primary disease, that is, with signs of degenerative changes in connective tissue. Changed valves are a good background for the development of infection.

Neurological complications

Microthrombi often form on the altered valves, which are carried by the blood flow into the vessels of the brain and clog them, causing an ischemic stroke.

Treatment

Mandatory consultation with a cardiologist to decide whether to prescribe medication or consult a cardiac surgeon.

How is mitral valve prolapse treated in adults and children:

• therapy for neurocirculatory dystonia;
• psychotherapy;
• preventive measures aimed at preventing the development of complications.

• Primary mitral valve prolapse does not require treatment, but if there are complaints, a consultation with a psychotherapist is recommended and symptomatic therapy is carried out: antihypertensive drugs, antiarrhythmics, sedatives, tranquilizers. Prescribing magnesium supplements significantly improves the general condition of patients.
• If secondary prolapse is detected, the underlying disease must be treated.
• If severe cardiac prolapse with regurgitation and complications is detected, it is necessary to consider surgical treatment.

Clinical examination

Preventive examinations by a cardiologist and echocardiography should be carried out at least once every six months.

During preventive examinations and ultrasound examinations of the heart for various reasons, doctors often make a verdict about the presence of MVP. Therefore, many people are beginning to worry about the question: mitral valve prolapse - what is it, why is it dangerous, is it possible to cure it and how. Let's try to figure it out.

Mitral valve prolapse: what is it, why is it dangerous?

Sagging, protrusion of two or one leaflets of the mitral valve into the left atrium during the ejection of blood into the aorta from the left ventricle. This is the essence of the pathology - mitral valve prolapse. Doctors do not define this condition as a heart defect and call it a developmental feature. As a rule, it is genetically determined and associated with connective tissue dysplasia.

The danger of prolapse is determined

• Functional disorders. Normally, during contraction (systole) of the left ventricle, the valve leaflets between it and the atrium should be tightly closed. In the case of prolapse, at this moment the blood may flow back (regurgitation) into the left atrium. This adds extra volume, and the left parts of the heart begin to suffer from overload, and their hypertrophy develops. In the future, this leads to pulmonary hypertension, overload of the right side of the heart, and heart failure.
• Heart rhythm disturbances. Patients report periods of palpitations, discomfort and pain in the chest.
• The possibility of settlement of infectious agents on the altered valve - the development of infective endocarditis with vegetations on the valves.

Types of pathology

Types of PMC are classified depending on various factors.

Origin:

• caused by congenital and genetic characteristics of the development of connective tissue - primary;
• caused by systemic diseases affecting connective tissue, neuroendocrine diseases, disrupting the autonomic regulation of valves, cardiac diseases, affecting the functions of the myocardium and endocardium - secondary.

Manifestations:

• auscultatory - when listening, systolic murmur and clicks are determined;
• mute – no pathology is detected during ausultation.

Degree of sashes sagging in mm:

• first – 3-6;
• second – 6-9;
• the third is more than 9.

Depths of blood flow back into the atrium:

• in the valve area;
• 1/3 of the atrium;
• ½ atrium;
• more than half of the cavity.

Severity of manifestations:

• asymptomatic;
• asymptomatic – when observation is necessary;
• clinically significant – subject to treatment.

Symptoms of mitral valve prolapse

Most cases of primary prolapse go unnoticed, and sagging valve leaflets are detected during examinations for other diseases. But retrograde analysis of patient complaints still reveals characteristic symptoms.

In the absence of progression or grade 1-2 regurgitation, the presence of pathology may be indicated by various minor ailments, which are usually attributed to disorders of the autonomic regulation of the tone of the vascular system:

• discomfort, pain in the chest, in the heart area, not related to physical activity;
• periodic shortness of breath or feeling of lack of air;
• irregular rhythm, “fading” of the heart, palpitations;
• a quickly onset feeling of fatigue;
• unstable mood;
• night and morning headache
• fainting states.

Mitral regurgitation of 3-4 degrees leads to significant disturbances in cardiac hemodynamics. Without correction, symptoms of heart failure gradually increase.

Diagnostics of MVP

Accurate diagnosis of prolapse allows the doctor to determine the most appropriate tactics for managing the patient: observation or active therapeutic measures.

Upon inspection and questioning:

• The nature of the patient's complaints may lead the doctor to think about the presence of MVP.
• The general appearance of such patients often indicates a congenital pathology of connective tissue. Usually these are asthenics with long, thin limbs, pathological joint mobility, often with poor eyesight and strabismus.
• When auscultating the heart, clicks and systolic murmurs are heard as blood flows into the left atrium through the unclosed valves.

With Echo-CG:

• valve deflection, changes in the leaflets and chordal apparatus, the degree of prolapse and the depth of regurgitation flow into the left atrium are reliably visualized;
• signs of pulmonary hypertension can be seen and myocardial thickness measured.

• rhythm disturbances are recorded; when monitoring the ECG throughout the day, episodes of accelerated heartbeat may be detected.

Is treatment required for MVP?

MVP, accompanied by only slight regurgitation at the valve level - up to grade 1 and not manifesting clinical symptoms, usually does not require treatment. Perhaps the doctor will recommend periodic monitoring by a cardiologist and control echocardiograms. Patients are asked to eliminate or reduce

• heavy physical activity;
• smoking;
• alcohol abuse;
• passion for strong coffee and tea.

You should establish a work and rest schedule, engage in physical therapy, take healthy walks and get a good night's sleep.

The vegetative symptoms that bother patients certainly require adequate correction. Use drug therapy

• antiarrhythmics;
• antihypertensive drugs;
• medications that improve myocardial metabolic processes;
• neuroleptics, sedatives, tranquilizers.

Also, when performing any operations (tooth extraction, tonsils, etc.), patients with mitral valve prolapse are recommended to be prescribed broad-spectrum antibiotics to avoid the development of infective endocarditis.

For severe mitral regurgitation, therapy is carried out to correct the condition

• cardiac glycosides;
• diuretics;
• ACE inhibitors.

Significant dysfunction of the valve requires surgical intervention - mitral valve repair is performed. Often operations are performed using endovascular or endoscopic techniques,

• suturing of folds;
• shortening of valve chords;
• ablation of myocardial areas in areas that trigger pathological impulses - arrhythmia.

Open valve replacement surgery is performed for severe combined pathology.

Forecast

With MVP that is not accompanied by significant regurgitation, the prognosis is favorable, especially if you follow the doctor’s recommendations and slightly change your lifestyle towards a healthy one. With such prolapse, you can engage in some sports, swimming non-professionally.

To a pressing question for young people - if a conscript has grade 1 mitral valve prolapse, is he accepted into the army - the answer is yes, he is accepted. Medical diversion requires a diagnosis of MVP with significant valve dysfunction or complications. As a rule, these are grade 2 and 3 MVP.

Mitral valve prolapse with regurgitation up to half or the entire length of the atrium requires treatment and sometimes surgical correction. In this case, the prognosis depends on the joint work of doctors and the patient. If the tandem is successful, the prognosis is also favorable. The lack of adequate treatment threatens a deterioration in overall health and irreversible consequences.

Pregnant women should be involved in the prevention of MVP as a congenital pathology - avoid colds, poor environmental conditions, correct metabolic disorders, and manifestations of toxicosis.

The progression of an existing pathology can be avoided by following the measures recommended by the doctor and regularly monitoring the condition.