Acquired heart defects: symptoms, diagnosis and treatment. Classification of acquired heart defects

If changes in the structure of the valve, orifice, septum of the heart and large vessels occur not during embryonic development, but after infections, injuries or against the background of atherosclerosis, connective tissue diseases, then such defects are classified as acquired. Clinical manifestations with compensated defects they may be absent; if hemodynamics worsen, shortness of breath, heart pain, and weakness increase; in such cases, surgical treatment is prescribed.

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Classification of acquired heart defects

Depending on the location, disturbances in the structure of the valves and blood circulation, there may be different types of classifications of these diseases. These options are used when making a diagnosis.

According to the location of the defect

Between the atria and ventricles there are the mitral (in the left half) and tricuspid (right) valves, therefore, taking into account the large vessels that are connected to the heart, the following defects are distinguished:

mitral (most common);
tricuspid;
aortic;
pulmonary artery defects.

Anatomy of the heart

By type of valve or hole defect

A structural defect may manifest as a narrowed (stenotic) foramen due to inflammatory process, deformed valves and their non-closure (insufficiency). Therefore, the following types of defects are distinguished:

foraminal stenosis;
valvular insufficiency;
combined (insufficiency and stenosis);
combined (several valves and holes).

As a result of damage to the valve, parts of it can evert into the cavity of the heart; this pathology is called valve prolapse.

According to the degree of hemodynamic disturbance

Blood flow is disrupted inside the heart and throughout the cardiovascular system. Therefore, depending on the effect on hemodynamics, the defects are divided into:

does not interfere with blood circulation inside the heart, moderate, with pronounced disturbances.
according to general hemodynamic parameters - (no insufficiency), subcompensated (decompensation under increased stress), decompensated (severe hemodynamic insufficiency).

Increased stress means intense physical activity, elevated body temperature, and unfavorable climatic conditions.

Causes of acquired heart defects

Most often, defects develop against the background of inflammatory and sclerotic processes in the endocardium (the inner lining of the heart). For adults and children, there are differences in the importance of these factors.

In adults

The structure of morbidity varies depending on age. After 60 years, atherosclerosis and concomitant ischemic disease predominate, and in more at a young age the occurrence of valve pathology is associated with endocarditis. It is divided into the following groups:

after rheumatism;
against the background of a bacterial infection;
traumatic (including post-operative);
tuberculosis;
syphilitic;
autoimmune;
post-infarction.

Infective endocarditis of a) aortic valve and b) tricuspid valve

In children

In childhood, defects most often occur between the ages of 3 and 10 years. The most common reason– rheumatic endocarditis, in second place is bacterial inflammatory processes of the inner lining of the heart. The role of other factors is insignificant. Difficulties in diagnosis occur when identifying the time of development - congenital or acquired structural anomaly.

Symptoms of acquired heart defects

The clinical picture is determined by the type and degree of hemodynamic disturbances. Typical signs depending on the location and variant of the defect:

Mitral regurgitation– no symptoms for a long period of time, then cyanotic coloration of the skin, difficulty breathing, rapid pulse, swelling in the legs, pain and heaviness in the liver area, swelling of the neck veins.
Mitral stenosis– cyanosis of fingers and toes, lips, blush of the cheeks (butterfly type), children are lagging behind in development, the pulse in the left hand is weak, atrial fibrillation.

Aortic insufficiency– headaches and heart pain, pulsation in the neck and head, fainting, pale skin, a large difference between the indicators (upper and lower) of blood pressure.
Aortic stenosis– attacks of pain in the heart, behind the sternum, dizziness, fainting due to psycho-emotional or physical stress, rare and weak pulse.
Tricuspid insufficiency– difficulty breathing, arrhythmia, pain in the right hypochondrium, heaviness in the abdominal area.
Stenosis of the right atrioventricular orifice– swelling in the legs, yellowing of the skin, no shortness of breath, arrhythmia.
Pulmonary artery insufficiency– constant dry cough, hemoptysis, fingers like drumsticks, difficulty breathing.
Pulmonary stenosis– swelling, pain in the liver area, rapid pulse, weakness.

The symptoms of acquired heart defects in the combined variant depend on the predominance of stenosis or insufficiency in the place where the disorders are more pronounced. In such cases, the diagnosis can be made only on the basis of instrumental research methods.

Diagnosis of acquired heart defects

An approximate examination algorithm for suspected acquired heart disease is as follows:

Survey: complaints, their connection with physical activity, previous infectious diseases, injuries, operations.
Inspection: presence of cyanosis or yellowing of the skin, pulsation of the veins of the neck, lower extremities, swelling.
Palpation: liver size.
Percussion: borders of the heart and liver.
Auscultation: weakening or intensification of sounds, the presence of an additional tone in mitral insufficiency, noise and its appearance in systole or diastole, where it is better heard and where it is carried out.
ECG with monitoring - arrhythmias, signs of myocardial hypertrophy and ischemia, conduction disorders.
The phonocardiogram confirms the listening data.
X-ray chest cavity in 4 projections – congestion in the lungs, thickening of the myocardium, configuration of the heart.

ECG monitoring

The main method of detecting a defect is echocardiography, which shows the size of the valves, holes, disturbances in blood flow, pressure in the vessels and chambers of the heart. If doubts remain after the diagnosis, a computed tomography may be prescribed.

Using blood tests, the degree of inflammation, the presence of rheumatism, atherosclerosis, and the consequences of heart failure are determined. For this purpose, cholesterol tests, rheumatoid and liver tests are carried out.

For information about echocardiography data for various acquired heart defects, watch this video:

Treatment of acquired heart defects

The choice of treatment method depends on the degree of circulatory impairment. All patients are referred for consultation to a cardiac surgeon to determine the urgency of surgical treatment.

Drug therapy

It is of secondary importance, since it cannot eliminate the cause of hemodynamic disturbances. Therefore, it is used to prepare for surgery or temporarily alleviate the condition of patients.

Drugs are prescribed to prevent recurrence of infections, rheumatism, cardiac glycosides, and medications to lower blood cholesterol (for atherosclerosis).

Surgical intervention

The extent of the operation depends on the type of acquired heart defect. In the presence of stenosis, the parts of the valve () are separated and the hole to which the valve is attached is widened. If significant mitral stenosis is detected, then surgical intervention held in urgently. Typically, this type of treatment does not require a device cardiopulmonary bypass, and the operation itself is considered safe.

In case of predominant insufficiency, artificial valves are installed. This is much more difficult than eliminating stenosis. Therefore, the indication is low tolerance physical activity, they are prescribed with caution to elderly people. In the presence of combined defects, the valve is dissected with prosthetics at the same time.

Heart valve prostheses: A and B - bioprostheses; C - mechanical valve

How long do patients with acquired heart disease live?

Heart defects are heterogeneous diseases in terms of clinical manifestations. In some patients they are diagnosed during examination for other
diseases. Such variants of the pathology may not affect well-being and life expectancy and do not require treatment.

If decompensation occurs, circulatory failure progresses, which can result in the death of the patient.

This can occur during exacerbations of the rheumatic process, severe poisoning and infections, or concomitant diseases, nervous or physical overload, in women during pregnancy or childbirth.

The most unfavorable for patients are defects with a predominance of mitral stenosis, since the heart muscle of the left atrium cannot withstand the increased load for a long time.

Prevention

The main directions for preventing the development of defects include:

Treatment of rheumatism, tuberculosis, syphilis,.
Reducing blood cholesterol - eliminating saturated animal fats, medications.
After severe infectious diseases, a cardiac examination is indicated.
Lifestyle modification - hardening, physical activity, good nutrition with salt restriction and sufficient quantity protein, quitting smoking, alcohol.

If there is a defect, it is necessary to abandon intense sports activities, sudden changes climatic conditions. Observation by a cardiologist and timely surgical treatment are indicated.

Thus, acquired heart defects may have an erased clinical picture or lead to severe circulatory failure with a fatal outcome. This depends on the type and location of the structural disorder of the valve apparatus. For radical treatment valve dissection or replacement is used. Preventive measures are aimed at eliminating infection, reducing blood cholesterol, and eliminating bad habits.

Types of defects:

valve insufficiency;
combined defects;
prolapse;
stenosis;
combined defects.

In the majority clinical situations The bicuspid valve is damaged, and, a little less frequently, the semilunar valve. The insufficiency progresses due to deformation of the valves, after which their inadequate closure occurs.

A defect such as stenosis appears as a result of narrowing of the atrioventricular opening. This condition can develop after cicatricial fusion of the valves.

Very often there are cases when narrowing of the atrioventricular orifice and valve insufficiency occur simultaneously in a single valve. This is a heart defect in a combined form. When a combined defect occurs, problems arise in several valves at once. If the walls of the valve are everted, then this disease is called prolapse.

Etiology

Diseases after which acquired heart defects may occur:

(a common cause of progression of defects);
injuries;
endocarditis of infectious nature;
connective tissue damage.

Kinds

When this defect progresses, a backflow of blood into the atrium occurs, because the bicuspid valve partially closes the left atrioventricular orifice. Relative insufficiency often begins to progress after myocarditis and myocardial dystrophy.

During these diseases, the muscle fibers around the atrioventricular opening weaken. The defect is expressed not in the deformation of the valve itself, but in the fact that the hole that it closes enlarges. As organic failure progresses, the mitral valve leaflets become smaller and shrink. This happens during rheumatic endocarditis. Functional impairment contributes to the deterioration of the muscular apparatus, which is responsible for closing the mitral valve.

If people have minor or moderate levels of valve insufficiency, then they do not have any special complaints about the functioning of the heart. This stage is called “compensated mitral valve disease.” Next comes the decompensated stage. Shortness of breath and pain intensify, limbs swell, veins in the neck swell, and the liver enlarges.

Mitral stenosis

Mitral stenosis is a narrowing of the left atrioventricular orifice. This defect often progresses after infective endocarditis. The narrowing occurs due to compaction and thickening of the valve walls or their fusion. The valve becomes funnel-like in shape and has a hole in the center.

The cause of this disease is scar-inflammatory narrowing of the valve ring. When the disease first begins to develop, no symptoms occur. During decompensation, coughing up blood and interruptions in heart rate appear, coughing, shortness of breath and heart pain.

Aortic valve insufficiency

Occurs when the semilunar valves do not close properly. From the aorta, blood enters the ventricle again. Initially discomfort and painful sensations the patient does not have. But due to the increased functioning of the ventricle, pain develops, and the first shocks of pain occur. This occurs due to myocardial hypertrophy. This condition is accompanied by severe headaches. The skin turns pale and the color of the nails changes.

Narrowing of the aortic mouth

Stenosis aortic orifice interferes with the pumping of blood into the aorta during contraction of the left ventricle. As this type of defect progresses, the flaps of the semilunar valve fuse. Scarring may also form at the opening of the aorta.

When stenosis actively progresses, blood circulation is significantly impaired and systematic painful sensations. In turn, headaches, fainting and dizziness occur. And the symptoms are most pronounced when active work and emotional experiences. The pulse becomes rare, the skin turns pale.

Tricuspid insufficiency

Tricuspid regurgitation is insufficiency of the right atrioventricular valve. Isolated form The disease is quite rare and is often combined with other defects.

With this disease, stagnation of blood circulation occurs, accompanied by periodic pain in the area of the heart. The skin takes on a blue tint, and the veins in the neck enlarge. In this case, blood flows from the ventricle into the atrium. The pressure in the atrium increases and therefore the flow of blood through the veins slows down significantly. There is a change in pressure. Since congestion occurs in the veins and blood circulation deteriorates, there is a huge risk of severe heart failure. Other complications include problems with the kidneys and gastrointestinal system, as well as the liver.

Combined defects

Combined defects are a combination of two problems at the same time: insufficiency and stenosis.

Combined lesion

Combined damage is the occurrence of diseases in two or three valves. It is necessary to treat the most damaged area first.

Symptoms

The problem is that acquired heart defects manifest themselves only slightly, especially in early stages progression. Mainly manifested general symptoms, and specific ones arise when the disease enters a more severe stage.

Acquired heart defects in children are also distinguished by the color of the skin: cyanotic color - blue defects, and white defects - pale skin. As a result of blue defects, mixing of blood occurs, and with white defects, deoxygenated blood does not enter the left ventricle. Cyanosis of the skin indicates that the child has several heart defects at once.

General symptoms: cardiopalmus and muscle weakness, dizziness and blood pressure changes. There may also be shortness of breath and fainting, and a change in the color of the skin on the head. Since these are symptoms that accompany many diseases, it is necessary to conduct a thorough examination and differential diagnosis.

During mitral stenosis, a peculiar “cat’s purring” appears. The pulse in the left hand also slows down, acrocyanosis, heart hump and cyanosis on the face (triangle of lips and nose) appear.

During the progressive stages, difficulty breathing and a dry cough with sputum production occur white. Next, serious swelling occurs on certain parts body, especially in the lungs. At severe forms shortness of breath and irregular heartbeat occur, the pulse weakens significantly and the heart hump increases. Veins may also dilate and difficulty functioning of the liver may occur.

Diagnosis and treatment

If a person discovers several of these symptoms, he should immediately make an appointment with a cardiologist. He will conduct inspection, palpation, auscultation and percussion. Doctor determines heartbeat and listens for heart murmurs. The presence of edema and cyanosis is established. Also at the appointment, auscultation of the lungs is performed, and the size of the liver is determined.

Next, an electrocardiogram, echocardioscopy and dopplerography are prescribed. These examination methods make it possible to assess the heart rhythm, identify blockages, the type of arrhythmia and signs of ischemia. To identify aortic insufficiency, diagnostics with stress should be performed. But this procedure must be done under the supervision of a cardiologist-resuscitator, since such actions can cause unexpected harmful consequences.

It is also important to take an x-ray of the heart to diagnose pulmonary congestion. This type examinations can confirm myocardial hypertrophy.

Accurate data on the condition of the heart can be obtained after performing MSCT or MRI of the heart. You also need to conduct rheumatoid tests and test: general, sugar, cholesterol.

Making a diagnosis is an extremely responsible matter. In the future, the treatment method and prognosis depend on this.

Treatment of acquired heart defects should only be carried out by a highly qualified specialist. The patient should give up physical activity and follow a daily routine, consume healthy eating and accept medications. This is the most common treatment method.

There is another way - surgery, which is prescribed at the progressive stage of development of the disease. During surgery, a heart defect is corrected.

For mitral stenosis, a mitral commissurotomy is performed to separate the fused valve leaflets. If successful, the narrowing is completely eliminated. Then rehabilitation and drug treatment are needed.

When a patient is diagnosed with aortic stenosis, surgery is needed - aortic commissurotomy. It should only be performed by a qualified surgeon, since the operation is quite complex and requires certain skills and knowledge.

In case of combined defects, it is necessary to replace the collapsing valve and install an artificial one. Sometimes doctors perform both prosthetics and commissurotomy at the same time.

Prevention

Acquired heart defects are terrible and dangerous diseases. To prevent the occurrence of such ailments, preventive measures can be taken. Since these diseases most often occur after rheumatism, syphilis or septic conditions, it is recommended, first of all, to take measures to prevent them.

Hardening and physical activity (sports exercises, running, exercise, swimming) have a positive effect on the body’s condition. In this case, you should control the rhythm and dynamics of movements: hiking and jogging at a speed at which your body feels comfortable. You cannot suddenly start active sports activities; all loads should be gradual. The diet should contain proteins and less salt should be consumed.

And of course, you need to pass on time preventive examinations at the therapist and narrow specialists, including a cardiologist.

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Diseases with similar symptoms:

A disease that is characterized by the formation pulmonary failure, presented in the form of a massive release of transudate from the capillaries into the pulmonary cavity and ultimately promoting infiltration of the alveoli, is called pulmonary edema. Speaking in simple words, pulmonary edema is a situation where fluid stagnates in the lungs, leaking through blood vessels. The disease is characterized as an independent symptom and can develop on the basis of other serious ailments of the body.

Heart failure defines a clinical syndrome in which the pumping function of the heart is disrupted. Heart failure, the symptoms of which can manifest itself most in various ways, is also characterized by the fact that it is characterized by constant progression, against the background of which patients gradually lose adequate ability to work, and also face a significant deterioration in the quality of their life.

Defect or anatomical abnormality of the heart and vascular system, which occur mainly during intrauterine development or at the birth of a child, are called birth defect heart or congenital heart disease. The name congenital heart defect is a diagnosis that doctors diagnose in almost 1.7% of newborns. Types of congenital heart disease Causes Symptoms Diagnosis Treatment The disease itself is an anomaly in the development of the heart and the structure of its blood vessels. The danger of the disease lies in the fact that in almost 90% of cases newborns do not live to see one month. Statistics also show that in 5% of cases, children with congenital heart disease die before the age of 15 years. Congenital heart defects have many types of cardiac abnormalities that lead to changes in intracardiac and systemic hemodynamics. With the development of congenital heart disease, disturbances in the blood flow of the greater and lesser circles, as well as blood circulation in the myocardium, are observed. The disease occupies one of the leading positions found in children. Due to the fact that congenital heart disease is dangerous and fatal for children, it is worth examining the disease in more detail and finding out everything important points, which is what this material will tell you about.

BASICS OF DIAGNOSIS AND SURGICAL TREATMENT OF CONGENITAL HEART DEFECTS

This dictates the need for early surgical treatment of patients with ASD.

For uncomplicated postoperative period After 1.5 - 2 months, children can attend children's groups (school, kindergarten) with an exemption from physical education lessons and sports competitions for a year, they can receive all age-related vaccinations. Children should be observed by a local pediatrician for a year ( pediatric cardiologist) or family doctor and 6 months and 1 year after surgery should be consulted with a cardiac surgeon. If the course of this period is smooth, patients can be removed from dispensary observation. In cases of persistent subjective and objective data on incomplete rehabilitation, observation of them should be continued at the place of residence with periodic consultations with a cardiac surgeon.

Adult patients with favorable course postoperative period, they can begin work not related to physical labor 2-3 months after discharge from the hospital. In cases of heavy physical labor, the patient is employed through a medical control commission.

In cases of transient or persistent circulatory failure, the patient should be referred to MSEC to determine the disability group for a year, followed by re-examination.

It is necessary to highlight a special group of patients who require observation for a long time after surgery: 1. patients with initial pulmonary hypertension, 2. patients with a complicated postoperative period (postoperative endocarditis, cardiac arrhythmias, etc.). In all these cases, the solution to issues of rehabilitation and work ability must be strictly individual, taking into account initial state the patient, the extent of the operation performed, the presence of certain complications in the postoperative period, the age of the patient.

Methodological manual for senior students

Kazan, 2009

Methods for diagnosing heart defects…………………………………………….4

Pulmonary arterial hypertension...…………………..………………….……...10

Patent ductus arteriosus…………………………………..…….…………13

Atrial septal defect…………………………………..………18

Ventricular septal defect……………………………………………………...24

Coarctation of the aorta…………………………………………………………………………………..31

Congenital aortic stenosis……………………………………………………………......36

Pulmonary artery stenosis…………………………………………………………………41

Tetralogy of Fallot…………………………………………………………………………………………46

Transposition great vessels…………………………….........................51

Open atrioventricular canal (OAVC)………………………………………………………54

Classification critical conditions for congenital heart defects in newborns………………………………………………………………………………………...59

Providing open heart surgery……………………………………….63

List of references………………………………………………………………67

1. Visual inspection

Heart defects are divided according to changes in the color of the skin and mucous membranes into pale (without cyanosis) and blue type (with cyanosis) defects. For vices pale type of pathological discharge between arterial and venous systems no (for example, with mitral stenosis), or the discharge occurs from the left chambers of the heart to the right (for example, with defects of the interatrial or interventricular septum). For vices blue type of blood discharge is directed from right to left. This group includes complex combined defects: tetralogy of Fallot, transposition of the great vessels, common truncus arteriosus, etc. As a rule, the condition of patients with blue type defects is critical from birth: without surgery, most of them die in infancy.

2. Auscultation of the heart(Fig. 1)

To listen sounds produced by the operation of the heart valves, the stethoscope should be positioned along the flow of blood passing through the valve.

The tricuspid valve is heard to the left of the lower part of the sternum near the fifth intercostal space.
The mitral valve is heard above the apex of the heart - on the left, in the fifth intercostal space along the midclavicular line.
The pulmonary valve is heard in the second intercostal space to the left of the sternal border.
The aortic valve is heard in the second intercostal space to the right of the sternal border.

It should be borne in mind that the intensity of pathological heart murmurs depends on the size of the hole through which blood flows and on the pressure gradient between the chambers of the heart connecting to this hole. For example, the systolic murmur of an atrial septal defect may be very weak because the pressure gradient between the atria is 3-4 mmHg. Art., and the size of the defect reaches 1-1.5 cm. Moreover, this noise does not occur in the area of the septal defect, but in the area of the mouth of the pulmonary artery, through which excess blood flows. At the same time, a ventricular septal defect produces a very strong systolic murmur, since the pressure gradient between the ventricles is 80-90 mmHg. Art., and the size of the defect is on average 0.5-0.7 cm. Therefore, the severity of a heart defect can never be judged by the intensity of the noise.

Besides, the so-called should be differentiated “cardiac” and “vascular” murmurs.” The latter include murmurs due to aortic valve disease and coarctation of the aorta. These noises, although audible in the projection of the heart, always extend to a great distance from it along the course of large vessels (to the neck, into the interscapular space).

The heart should be listened to especially carefully in patients with

suspected mitral stenosis with atrial fibrillation. Heart rhythm disturbances lead to a weakening of the diastolic murmur of blood expulsion from the atria. It is recommended to listen to such patients while they are lying in bed with a slight turn on their left side.

Rice. 1. Projections of heart valves onto the chest wall and places of their auscultation.

3. Electrocardiography allows you to identify overload of the heart, myocardial ischemia, rhythm and conduction disturbances. At right ventricular hypertrophy in the first standard lead the S wave is deep, significantly larger than the R wave. The T wave is positive. The R wave is low, wide, split. In the third standard lead, the R wave is high, the S-T segment is shifted downward. The T wave is low, biphasic, sometimes with a predominant negative phase. With hypertrophy left ventricle in the first standard lead the R wave is high, the S-T segment is shifted down. The T wave is low, biphasic, usually with the first negative phase. In the third standard lead there is a deep S wave. In case of overload both ventricles there may be a deviation of the electrical axis of the heart to the right, a displacement S-T segment down in all leads, low biphasic T wave in standard leads and negative in the precordial leads. ABOUT overload with overstretching of the left atrium may indicate atrial fibrillation (replacement of P waves by F waves). Ventricular overload may lead to ventricular extrasystoles. Overload of one ventricle may manifest itself as signs of incomplete blockade of the His bundle (splitting of the ventricular complex), which does not actually exist.

The illusion of such a blockade is created by a delay in the contraction of the more loaded ventricle.

4. General radiography of the heart in three projections(Fig. 2) allows you to obtain data on the size of the heart chambers, overload of the pulmonary and systemic circulation. This study is especially valuable when echocardiography is not available.

Rice. 2. General radiography of the heart: A - second oblique projection; B - contours of the heart in direct projection; B - first oblique projection. Designations: Ao - aorta, LA - pulmonary artery, Rp - right atrium, Lp - left atrium, LV - left ventricle, RV - right ventricle.

Direct projection allows us to identify a) congestion of the vessels of the pulmonary circulation: expansion of the roots of the lungs, strengthening of the pulmonary pattern and increase in the contour of the pulmonary artery (2nd arch); b) expansion of the contour of the ascending aorta (1 arch), which occurs when hypertension, aortic defect, aneurysm of the ascending aorta.

Second oblique projection allows you to differentiate enlarged ventricles. As the right ventricle dilates, the space between the shadow of the sternum and the anterior border of the shadow of the heart decreases. As the left ventricle dilates, the posterior contour of the heart approaches the spine.

First oblique projection allows you to differentiate enlarged atria. The study is carried out simultaneously with contrasting the esophagus with barium sulfate. The enlarged left atrium, in contact with the esophagus, displaces it backwards. When the right atrium expands, the heart shadow also moves posteriorly, but the position of the esophagus does not change.

X-rays of the heart sometimes reveal accurate diagnosis. Examples: 1. Signs of pulmonary hypertension in combination with dilatation of the left atrium and enlargement of the right ventricle are characteristic of mitral stenosis; 2. An increase in the “2nd arch” in combination with an expansion of the right atrium and right ventricle are observed with an atrial septal defect; 3 Signs of pulmonary hypertension and enlargement of the left chambers of the heart are characteristic of a patent ductus arteriosus.

5. Echocardiography

The following are normal echocardiogram readings for an adult.

Aorta - width up to 3.7 cm. Aortic valve - tricuspid, opening amplitude of the valves 1.5 - 2.6 cm, fibrous ring 2.5 cm. Left atrium - 2.3-3.7 cm, volume 41-58 ml . Left ventricle: end-diastolic size (EDD) = 3.7-5.6 cm, end-diastolic volume (EDV) = 60-120 ml, end-systolic size (ESD) = 2.3-3.6 cm, end-systolic volume (KSO) = 40-60 ml. Teicholtz left ventricular ejection fraction = 54%. Interventricular septum 0.6-1.1 cm. Thickness of the posterior wall of the left ventricle = 0.6-1.1 cm. Mitral orifice area = 4.0 cm 2. The movements of the mitral valve leaflets are multidirectional. Right ventricle (antero-posterior size) 2.5-3.0 cm. Right atrium(volume) 41-50 ml. Systolic pressure in the pulmonary artery (according to tricuspid regurgitation) is 25-30 mm Hg. Art.

ECHO-CG indicators in children vary depending on the surface area of the child’s body (see below).

Normal values in children (M-mode ECHO-CG) depending on body surface area, mm
Body surface area 0.7 m2
pancreas	10,8	5,1-16,4
LV (CDR)	34,8	25,2-41,8
LP	21,6	15,2-27,8
JSC	19,3	15,3-23,3
MZhP	6,6	4,3-8,8
ZSLZH	5,7	3,5-7,8
Body surface area 0.8 m2
pancreas	11,6	5,9-17,1
LV (CDR)	36,1	26,8-42,5
LP	22,3	16-28,5
JSC	20,0	16,1-24
MZhP	6,9	4,6-9,1
ZSLZH	6,0	3,8-8,2
Body surface area 0.9 m2
pancreas	12,3	6,7-17,9
LV (CDR)	37,8	28,5-45
LP	23,1	16,9-29,3
JSC	20,9	17-24,9
MZhP	7,2	5-9,4
ZSLZH	6,3	4,2-8,5

Body surface area 1.0 m2
pancreas	13,0	7,4-18,9
LV (CDR)	39,5	30-46,5
LP	24,0	17,8-30,1
JSC	21,8	17,9-25,8
MZhP	7,5	5,3-9,7
ZSLZH	6,6	4,5-8,8
Body surface area 1.1m2
pancreas	13,7	8,1-19,3
LV (CDR)	41,0	31,6-48,4
LP	24,8	18,5-30,9
JSC	22,7	18,8-26,7
MZhP	7,8	5,6-10
ZSLZH	7,0	4,8-9,2
Body surface area 1.2 m2
pancreas	14,3	8,8-20
LV (CDR)	42,8	33,2-50
LP	25,6	19,3-31,8
JSC	23,6	19,6-27,6
MZhP	8,1	5,8-10,2
ZSLZH	7,3	5,2-9,5

Abbreviations: RV - right ventricle; LV (LV) – left ventricle, end diastolic size; LA – left atrium; AO – aorta; IVS – thickness of the interventricular septum; LVDS – thickness of the posterior wall of the left ventricle. Body surface area can be calculated using the Kosteff formula:

Where S- surface of the human body, m2; P- body weight, kg.

6. Probing of the heart cavities and angiocardiography(Fig. 3).

Previously, this research method was the main one in the diagnosis of congenital heart defects. Nowadays, equivalent information is obtained from echocardiography. Therefore, cardiac probing and angiocardiography are performed only in complex diagnostic cases, for example, with congenital heart defects of the “blue” type. In particular, without angiopulmonography it is impossible to assess the development of the branches of the pulmonary artery in patients with tetralogy of Fallot, and the possibility of immediate radical correction of the defect depends on this parameter.

When probing the cavities of the heart, x-ray surgeons are given the following tasks: 1) “feeling” the septum of the heart in order to search for defects in them (however, in this way, as a rule, it is possible to find only defects of the interatrial septum, since interventricular defects

usually hidden under the tricuspid valve leaflet or between muscle trabeculae); 2) determination of oxygenation (blood oxygen saturation). A sharp increase in blood oxygenation inside the right chambers of the heart indicates left-to-right shunting with septal defects. Similarly, an increase in blood oxygenation in the pulmonary artery is characteristic of a PDA; 3) measurement of pressure in the cavities of the heart; increased pressure in the right chambers of the heart can also be a sign of a septal defect or pulmonary valve stenosis.

Over the past decade, cardiac probing has evolved from a diagnostic to a therapeutic measure. In particular, during probing, occluders are installed in defects of the interatrial and interventricular septa, and endoprosthetic stents are installed for dissecting aneurysms of the abdominal aorta.

Rice. 3. Normal indicators pressure and oxygenation of blood in the cavities of the heart.

Separate view angiocardiography – coronary angiography is used to evaluate anatomy coronary vessels heart and localization of atherosclerotic plaques causing coronary heart disease. In some cases, balloon angioplasty may be performed during angiocardiography. coronary vessels(expansion of stenotic areas of the artery with a special balloon catheter) and installation of stents - frames that hold the vessels in an expanded state - into the arteries dilated in this way (Fig. 4). In other cases, based on coronary angiograms, mammary or coronary artery bypass grafting operations can be developed.

Rice. 4. Stenosis of a branch of the left coronary artery before and after angioplasty with stenting.

7. X-ray computed tomography (XCT)

CT with angiocontrast is widely used to diagnose pulmonary artery thrombi dissecting aortic aneurysms. Below is a scan showing a thrombus in the right branch of the pulmonary artery and its size.

A special type of CT – multislice computed tomography (MSCT) – allows you to create three-dimensional reconstructions of the heart (Fig. 5).

Rice. 5. Computer tomograms: on the left – RCT, on the right – MSCT.

On MSCT, the arrow indicates stenosis of the anterior interventricular branch left coronary artery

It turns out that our heart is very fragile and the diseases you have suffered can cause acquired heart defects. This disease is dangerous because in the early stages it can proceed for a long time without any signs, and in the future it can cause serious complications.

Many of us want to save time and money and self-medicate, which is extremely dangerous in this case. After all, many deaths in the world are caused by heart disease. Identified pathology in the early stages will avoid surgical intervention.

Experts recommend monitoring your health, treating all infectious diseases, and undergoing a medical examination on time. This publication is useful for anyone who wants to know what acquired heart defects are, their causes and preventive measures.

Acquired heart defects - characteristics

Acquired heart defects

In addition to congenital heart disease, acquired heart disease is also common. Acquired heart disease develops after birth and is the result of damage to the valves or septa of the heart chambers due to various diseases, most often as a result of rheumatism.

Acquired heart disease may take the form of a change in the shape of the valve, wrinkling of its leaflets. As a result of this change, the heart valves are unable to completely close the openings between the chambers of the heart. Due to this incomplete closure, some of the blood flows back to the parts of the heart from which it came.

This creates additional stress on the heart, increases its mass, and leads to heart fatigue. This type of acquired heart disease is called valve insufficiency. Another form of acquired heart disease is damage to the heart valve with fusion of its leaflets.

This leads to a narrowing of the opening between the chambers of the heart, which also interferes with normal blood flow, partially blocking it. This heart defect is called stenosis. If two types of acquired heart disease—valve insufficiency and stenosis—affect cardiovascular system at the same time, they talk about combined heart disease.

A patient with heart disease may practically not notice his disease, since the reserve capacity of the heart is truly enormous, and compensates for the work of the affected part due to the increased work of other parts of the heart. In these cases, which are called compensated heart disease, signs of the disease can only be identified by a cardiologist: these are characteristic heart murmurs, changes in heart sounds and its size.

But the capabilities of the human heart are not limitless, and the progression of the disease leads to depletion of reserves and the development of heart failure. In this case, the heart defect is called decompensated; the state of decompensation can be aggravated by exacerbations of cardiovascular diseases, excessive physical exertion, psychological stress, infectious diseases, pregnancy and childbirth.

But the violation of compensation, as a rule, is reversible: the cardiologist prescribes treatment to the patient depending on the type of heart defect and its severity. The patient’s lifestyle is also important, especially during the period of decompensation, it should be gentle, but it is reasonable to completely refuse physical activity only in an extremely serious condition.

It is important to follow the cardiologist's recommendations regarding diet, sometimes quite strict. If conservative treatment does not produce results, the cardiologist may refer the patient for surgery. Surgery for heart disease often gives excellent results, relieving the patient not only of the consequences of the heart defect, but also eliminating the defect itself.

Acquired heart defects are formed as a result of the influence of various etiological (causal) factors that lead to disruption of the anatomical integrity of the heart valves. Valves are connective tissue structures in the form of leaflets and petals.

With their help, during contraction (systole) and relaxation (diastole) of the heart, the blood in its cavities moves only in the required direction without reverse flow (regurgitation).

There are 2 main mechanisms for the development of defects, which include:

A disorder leading to incomplete closure of the valve leaflets - during diastole, blood partially returns back (for example, from the ventricle to the atrium or large arterial trunks, represented by the aorta and pulmonary trunk, to the ventricles).
Changes in which the diameter of the valve decreases (stenosis) - in this case, the passage of blood is difficult.

The myocardium (heart muscle) has to do more work to push the required volume of blood through the stenotic valve.

This first leads to hypertrophy (thickening) of the myocardium, followed by thinning and dilatation (widening) of the cavities of the heart. Such changes cause gradual expansion of the valves with insufficient closure of their valves and regurgitation of blood.

Regardless of the mechanism of development (insufficiency or stenosis) of valve defects, heart failure develops, in which insufficient blood enters the vascular bed.

Classification

Today in practical cardiology, all acquired defects are divided into several main types according to various criteria:

The number of affected valves is single defects (only one valve is changed - mitral, tricuspid, aortic) and combined defects (2 or more heart valves are affected).
Functional form - includes stenosis and insufficiency of the leaflets, as well as deflection of the leaflets, which is usually a harbinger of their insufficiency (the most common option is mitral valve prolapse).
Blood circulation – compensated (blood circulation or hemodynamics are practically unchanged), subcompensated (develops slight decrease hemodynamics) and decompensated (severe heart failure).

Such clinical classification acquired heart defects is necessary to establish a diagnosis and select the most adequate and effective treatment.

Acquired heart defects can be different and they are divided according to different criteria. Let's talk about the main ones.

Depending on the type of lesion:

Insufficiency is a pathology when the valve leaflets do not close completely, resulting in blood flowing back from the ventricle into the atrium during contraction.
Narrowing (stenosis) - due to scars, the valve leaflets grow together and do not open completely, which is why not all the blood flows from the atrium to the ventricle.

Depending on the affected valve:

Mitral valve disease.
Tricuspid valve defect.
Aortic valve disease.
Pulmonary valve disease.

By the number of affected valves:

Monovalvular defect - one valve is affected.
A simple defect is insufficiency or narrowing of one valve.
Combined defects include insufficiency and narrowing of one valve.
Combined defects - two or more valves are affected.

According to the state of blood circulation:

Compensated defect – no circulatory failure.
Decompensated – there are signs of circulatory disorders.

Causes

Violation of the anatomical integrity of the heart structures develops due to various changes in the connective tissue at the base of the valves under the influence of several main reasons, which include:

Endocarditis – inflammatory reaction the inner layer of the heart wall, which gradually spreads to the valves and leads to a change in their properties and structure.
Rheumatism is a systemic autoimmune pathology characterized by the fact that the immune system begins to produce autoantibodies that affect its own connective tissue, primarily the areas of the heart valves and joints.
Injuries suffered chest(bruises, fractures of the ribs or sternum), which are varying degrees affected the heart and led to a gradual disruption of its anatomical structure.
Atherosclerosis is damage to the arteries due to the deposition of cholesterol in their walls with the formation of atherosclerotic plaques and changes in the properties of the vessel walls. The development of such a pathological process can take place in the valve apparatus, which leads to its defects.
Tertiary syphilis - long course this infectious disease with sexual transmission, in which pathogenic (disease-causing) microorganisms spread throughout the body, partially settle in the heart valves, leading to the formation of specific foci of inflammation and tissue destruction (gum) with a violation of integrity.
Sepsis – purulent process, which is a consequence of the development of bacterial infectious process in the blood with frequent damage to heart structures.

The simultaneous impact of several causes leads to a more rapid formation of acquired heart disease, as well as its severe course with severe heart failure.

The most common and main cause of the development of the disease is rheumatism, accounting for about 60-70% of all cases of acquired heart defects.

Symptoms of the disease depend on the valve or combination of valves affected. The patient may be bothered by rapid heartbeat, shortness of breath, swelling and other manifestations of heart failure, episodes of dizziness and loss of consciousness, chest pain during physical activity, and interruptions in heart function.

Clinical manifestations of the most common defects:

Mitral valve insufficiency.

In the compensation stage there are no complaints; with a decrease in the contractile function of the left ventricle and an increase in pressure in the pulmonary circulation, complaints appear about:

shortness of breath, first during physical activity, and then at rest;
heartbeat;
pain in the heart area of an ischemic nature (due to delayed development of coronary collaterals with myocardial hypertrophy);
dry cough;
swelling in the legs, pain in the right hypochondrium (due to enlargement of the liver and stretching of its capsule).

Mitral valve stenosis.

shortness of breath, first during physical activity, then at rest;
cough is dry or with a small amount of mucous sputum;
hoarseness of voice (Ortner's symptom);
hemoptysis (siderophages appear in the sputum - “cells of heart defects”);
pain in the heart area, palpitations, interruptions; atrial fibrillation often develops;
weakness, increased fatigue(since fixation is typical minute volume- lack of adequate increase in cardiac output during physical activity).

Aortic valve insufficiency.

In the stage of compensation of the defect general health satisfactory, only sometimes patients notice heartbeat and pulsation behind the sternum. With decompensation, complaints appear about:

pain in the heart area of an anginal nature, poorly or not relieved by nitroglycerin (due to relative coronary insufficiency due to myocardial hypertrophy, deterioration of blood supply to the coronary arteries with low diastolic pressure in the aorta and due to compression of the subendocardial layers by excess blood volume);
dizziness, tendency to faint (associated with impaired brain nutrition);
shortness of breath, first during physical activity, and then at rest (appears when the contractile function of the left ventricle decreases);
swelling, heaviness and pain in the right hypochondrium (with the development of right ventricular failure).

Aortic valve stenosis.

It is asymptomatic for a long time, the main complaints appear when the aortic opening is narrowed by more than 2/3 (less than 0.75 cm2):

compressive pain behind the sternum during physical activity (decreased coronary circulation);
dizziness, fainting (deterioration of cerebral circulation).

Subsequently, with a decrease in the contractile function of the left ventricle, the following appear: attacks of cardiac asthma; shortness of breath at rest; increased fatigue, swelling of the lower extremities.

It manifests itself as compaction or fusion of the leaflets, a decrease in the area of the mitral valve opening. As a result, the flow of blood from the left atrium to the left ventricle is obstructed, and the left atrium begins to work with increased load.

This leads to enlargement of the left atrium. The left ventricle receives less blood. Due to the decrease in the area of the mitral orifice, the pressure in the left atrium increases, and then in the pulmonary veins, through which oxygenated blood flows from the lungs to the heart.

Typically, the pressure in the pulmonary arteries begins to increase when the diameter of the opening becomes less than 1 cm, compared to the normal 4-6 cm, and a spasm occurs in the arterioles of the lungs, which aggravates the process. Thus, the so-called pulmonary hypertension, the long-term existence of which leads to sclerosis of arterioles with their obliteration, which cannot be eliminated even after eliminating the stenosis.

With this defect, first of all, the left atrium hypertrophies and expands, and then the right parts of the heart. At the beginning of the formation of this defect, the symptoms are little noticeable. Subsequently, shortness of breath, cough during physical activity, and then at rest come first.

Hemoptysis, persistent pain in the heart, and rhythm disturbances (tachycardia, atrial fibrillation) may occur. If the process goes far, then pulmonary edema may develop during physical activity.

There are physical signs of mitral stenosis: diastolic murmur in the heart, a trembling of the chest corresponding to this noise is felt (“cat purring”), and the boundaries of the heart change. Experienced specialist can often make a diagnosis after a careful examination of the patient.

Valve insufficiency is expressed in the ability of blood to return back into the atrium during contraction of the left ventricle, since a message remains between the left atrium and the ventricle, which is not closed by the valve leaflets at the time of contraction. Such insufficiency is caused either by deformation of the valve as a result of a tissue-changing process, or by its sagging (prolapse), due to stretching of the chambers of the heart when they are overloaded.

Compensated mitral regurgitation usually lasts for several years; in the affected heart, the work of the left atrium and left ventricle increases, first hypertrophy of the muscles of these parts develops, and then the cavities begin to expand (dilatation).

Then, due to a decrease in stroke volume, the minute ejection of blood from the heart begins to decrease, and the amount of blood returning (regurgitation) to the left atrium increases. Blood stagnation begins in the pulmonary circulation (pulmonary), the pressure in it increases, the load on the right ventricle increases, it hypertrophies and expands.

This leads to rapid decompensation of cardiac activity and the development of right ventricular failure. If compensatory mechanisms do not have time to develop in acute mitral valve insufficiency, the disease can begin with pulmonary edema and lead to death.

Clinical manifestations of mitral regurgitation in the compensated stage are minimal and may not be noticed by the patient. Beginning decompensation is characterized by shortness of breath, poor tolerance physical activity, then, when stagnation in the pulmonary circulation increases, attacks of cardiac asthma appear.

In addition, pain in the heart area, palpitations, and interruptions in heart function may bother you. Right ventricular heart failure leads to stagnation of blood in the systemic circulation. The liver becomes enlarged, cyanosis of the lips and limbs appears, swelling in the legs, fluid in the abdomen, heart rhythm disturbances (50% of patients have atrial fibrillation).

Make a diagnosis of mitral regurgitation now, given the existing instrumental methods Research: ECG, ECHO-CG, radiation diagnostic methods, ventriculography and others - not difficult.

However, an examination by an attentive cardiologist based on anamnesis, auscultation, percussion, palpation will allow you to draw up the correct examination algorithm and timely take measures to prevent further development the process of defect formation.

Aortic stenosis

This defect among PPS is detected quite often, in 80-85% of cases it is formed as a result of rheumatism, in 10-15% of cases it is acquired against the background of an atherosclerotic process, with subsequent deposition of calcium in atherosclerotic plaques(calcinosis).

There is a narrowing of the aortic orifice at the site of the semilunar valve of the aorta. For many years, the left ventricle works with increasing tension, however, when the reserves are depleted, the left atrium, the pulmonary circle, and then the right parts of the heart begin to suffer. The pressure gradient between the left ventricle and the aorta increases, which is directly related to the degree of narrowing of the opening.

The ejection of blood from the left ventricle becomes less, the blood supply to the heart deteriorates, which is manifested by angina pectoris, low blood pressure and weakness of the pulse, cerebrovascular insufficiency with neurological symptoms, including dizziness, headache, loss of consciousness.

The appearance of complaints in patients begins when the area of the aortic mouth decreases by more than half. When complaints appear, this indicates an advanced process, a high degree of stenosis and a high pressure gradient between the left ventricle and the aorta. In this case, treatment should be discussed taking into account surgical correction of the defect.

This is a valve pathology in which the outlet from the aorta is not completely blocked; blood has the ability to flow back into the left ventricle during its relaxation phase. The walls of the ventricle thicken (hypertrophy) as more blood has to be pumped.

With ventricular hypertrophy, insufficiency of its nutrition gradually manifests itself. More muscle mass requires more blood flow and oxygen supply. At the same time, due to the fact that part of the blood in diastole returns to the left ventricle, the aortic-left ventricular gradient decreases (it is what determines the coronary blood flow) and, as a result, less blood enters the arteries of the heart.

Angina occurs. There are sensations of pulsation in the head and neck. Neurological manifestations such as lightheadedness, dizziness, sudden fainting, especially during physical activity, when changing body position. The hemodynamics of the systemic circulation with this defect are characterized by: high systolic pressure, low diastolic pressure, compensatory tachycardia, increased pulsation of large arteries, including the aorta.

During the decompensation stage, dilatation (expansion) of the left ventricle develops, the efficiency of systole decreases, the pressure in it increases, then in the left atrium and pulmonary circulation. Clinical signs of stagnation in the pulmonary circulation appear: shortness of breath, cardiac asthma.

A thorough examination by a cardiologist may allow the doctor to suspect or even diagnose aortic insufficiency.

So known symptoms, like “carotid dance” - increased pulsation carotid arteries, “capillary pulse”, which is detected when pressing on nail phalanx, de Musset's symptom - when the patient's head sways in time with the phases cardiac cycle, pulsation of the pupils and others are detected already at the stage of an advanced process.

But palpation, percussion, auscultation and careful history taking will help identify the disease at earlier stages and prevent the progression of the disease.

This defect rarely occurs as an isolated pathology. It is expressed in the narrowing of the existing opening between the right ventricle and the right atrium, which are separated by the tricuspid valve.

Most often it occurs with rheumatism, infective endocarditis and other systemic connective tissue diseases; sometimes there is a narrowing of the opening as a result of the formation of a myxoma-tumor formed in the right atrium, less often there are other reasons.

Gamodynamics are disrupted as a result of the fact that not all the blood from the atrium can enter the right ventricle, which normally should occur after atrial systole. The atrium becomes overloaded, stretched, blood stagnates in the systemic circulation, the liver enlarges, swelling of the lower extremities and fluid appear in the abdominal cavity.

Less blood flows from the right ventricle to the lungs, which causes shortness of breath. IN initial stage There may be no symptoms, these hemodynamic disorders occur later - heart failure, atrial fibrillation, thrombosis, cyanosis of nails, lips, yellowness of the skin.

This pathology most often accompanies other defects and manifests itself in the form of tricuspid valve insufficiency. Because of venous stagnation ascites gradually develops, the liver and spleen increase in size, high venous pressure is noted, liver fibrosis develops and a decrease in its function.

The most common combination is mitral stenosis and mitral insufficiency. With this pathological combination, cyanosis and shortness of breath are noted already in the early stages. Aortic defect characterized by stenosis and valve insufficiency at the same time, usually has mild signs of two conditions.

With combined defects, several valves are affected, and each of them can have either isolated pathologies or a combination of them.

Acquired heart defects are diagnosed by a cardiologist, and treatment is prescribed by him. Diagnostics proceed as follows:

Held visual inspection, the doctor listens to the patient’s complaints, performs percussion (tapping) and auscultation (listening) of the heart. If there are characteristic symptoms, for example, murmurs in the heart area, displacement of the heart muscle and others, the doctor may suspect a defect and prescribe further diagnosis of the disease.
An ECG (electrocardiography) is performed; if necessary, daily monitoring Holter ECG, which allows you to monitor your heart rhythm throughout the day.
Echocardiography with Dopplerography.
A chest x-ray is ordered.
Computed and magnetic resonance imaging of the chest area, which allows a more detailed study of the area of the heart muscle.
Laboratory research, which include blood tests of various types.

Treatment

Used to treat heart defects medicinal methods and surgery. Heart defects can be completely compensated, which means that the patient will forget about his disease. But in order for this to happen, it is necessary to diagnose heart disease in time and properly treat it.

Treatment with medications should be used to relieve the inflammatory process in the heart, after which surgery should be performed to eliminate the heart defect.

Conservative treatment is only effective for early stages development of heart disease and requires mandatory dynamic monitoring by a cardiologist. PPS should be treated surgically when:

Heart failure progresses.
Pathological changes in the valve significantly affect hemodynamics.
The ongoing conservative therapy does not have the desired effect.
And there are fears of serious complications.

Regardless of what abnormalities in the functioning of the heart are detected in patients: congenital or acquired heart defects, treatment should be prescribed by a qualified cardiologist who will select individual methods for treating heart defects for each case, be it anti-inflammatory treatment or surgery for congenital heart defects.

The doctor will also prescribe a complex preventive measures that can prevent cardiac rheumatism. Heart disease, if it occurs in utero, is difficult to prevent, because too many factors beyond our control cause its occurrence. But heart disease acquired in children and adults is often a consequence of improper treatment or lack thereof.

We don't think about what is untreated infection can cause heart disease, the consequences of which can be very serious: from disability to death. Therefore, the closest attention should be paid to the prevention, diagnosis and treatment of the disease!

Treatment depends on the type of pathology:

Aortic heart defects.

Surgical treatment of patients with aortic regurgitation is indicated for all symptomatic patients who are in NYHA functional class II or higher, as well as with an ejection fraction less than 20-30% or with an end-systolic diameter greater than 55 mm.

An additional indication is also the end-diastolic diameter, approaching 70 mm. Patients with more serious damage contractile function of the left ventricle have significantly more high risk operations and postoperative mortality.

Aortic valve replacement is indicated for all patients with aortic stenosis who have symptoms of the disease, as well as for asymptomatic patients with a high transvalvular pressure gradient (more than 60 mmHg), an orifice area ≤ 0.6 cm2, coronary or other valvular pathology, up to how left ventricular decompensation develops.

Surgical correction of aortic disease is carried out using its prosthetics with mechanical, biological frame and frameless prostheses or cryopreserved allografts.

In some patients, aortic valve reconstruction may be possible. In cases of narrow aortic rings, to achieve optimal hemodynamics, plastic surgery of the aortic root with biological material is performed. Operations are performed using both standard and minimally invasive approaches.

Mitral heart defects.

Indications for surgery for mitral stenosis are determined by the area of the left atrioventricular orifice.

Mitral stenosis with a MV area of less than 1 cm2 is considered critical. In physically active patients or patients with large body weight, a narrowing of the opening of 1.2 cm2 may also be critical. Thus, the indication for surgery in patients with mitral stenosis is a decrease in the MV area to less than 1.5 cm2 and NYHA functional class II or more.

Indications for surgery for mitral regurgitation are the area of the effective regurgitation opening of more than 20 mm2, degree II or more of regurgitation, and NYHA functional class II-III. Surgical treatment of mitral regurgitation should be carried out before the ESI reaches 40-50 ml/m2, since its increase to more than 60 ml/m2 suggests an unfavorable prognosis. Surgical correction of mitral disease is carried out using its prosthetics with artificial mechanical and biological prostheses.

When implanting prostheses in patients with severe heart failure, it is necessary to preserve the natural chordal apparatus or implantation of artificial chordae made of polytetrafluoroethylene.

In 30-40% of patients it is possible to perform reconstructive operations on mitral valve. For this purpose, various reconstruction methods are used: annuloplasty with hard and soft rings, resection of valves, implantation of artificial chordae, edge-to-edge plastic surgery. Restoration of normal mitral valve function in most patients subsequently does not require lifelong anticoagulant therapy.

Surgeries on the mitral valve are performed both from a standard sternotomy and from a right-sided minithoracotomy.

Tricuspid valve defects.

The indication for surgery for tricuspid valve stenosis is an effective orifice area of 50 mm Hg, RV wall thickness > 7 mm, LA diameter > 55 mm, RV EF. The main method for correcting relative tricuspid valve insufficiency is annuloplasty. Methods for reducing the diameter of the tricuspid valve ring include purse-string plasty and the use of rigid or flexible correction rings.

In some cases, if it is impossible to perform corrective surgery, bioprosthetic valve replacement is used.

Infectious and prosthetic endocarditis.

The etiology of infective endocarditis has changed significantly due to active use antibiotics all over the world. Currently, the main role is given to staphylococci and gram-negative flora, as well as fungal infections.

From the point of view of surgery in the pathogenesis of infective endocarditis highest value has the fact of rapid destruction of the valvular apparatus of the heart. This leads to a catastrophic increase in heart failure, since the myocardium does not have time to adapt to drastic violation hemodynamics.

The decision on the need for surgical treatment arises, as a rule, with the development of “complicated infective endocarditis”: changes in hemodynamic status; persistence and prevalence of infection; development of metastatic foci of infection; systemic embolisms. In these cases, surgical treatment is more successful than a therapeutic approach.

The main problem of surgical treatment is to prevent recurrence of infection and the development of prosthetic endocarditis. The basis for choosing tactics is the anatomical changes identified on operating table: the degree of damage to the fibrous ring and surrounding tissues, as well as the presence of vegetations, abscesses, fistulas, prosthetic ruptures.

In recent years, particular importance has been given to reconstructive operations, especially when the mitral or tricuspid valves are affected by endocarditis. To replace valve defects after surgical treatment, plastic surgery with one’s own tissue, auto- or xenopericardium is used.

Currently, the clinic uses mechanical, biological artificial valves, as well as allografts:

Mechanical prostheses.

At the Republican Scientific and Practical Center, two modifications of bicuspid artificial heart valves have been developed and are used in the clinic: PLANIX-T and PLANIX-E.

The difference in the design of the latest version of the domestic double-leaf artificial valve hearts from the previous model are that the body of the prosthesis is coated with titanium oxide, which provides high wear resistance and biological inertness.

The high height of the rotating mechanism prevents jamming of the valves by heart tissue and made it possible to increase the opening angle of the valves to 900.

Biological prostheses.

The prosthetic valves are formed from biological tissues: xenoaortic valve, pericardial valve. Two types of bioprostheses are used: framed (biological tissue is fixed on a rigid or flexible frame) and frameless.

Allografts.

A modern trend in the surgical treatment of lesions of the valve apparatus is the use of cryopreserved allografts.

The emergence in recent years of modern cryogenic technology has made it possible to create conditions for long-term preservation viability biological objects, which provides them normal function in the body after implantation.

Surgery to correct the defect is usually performed on an open heart, and the success rate of such an operation is higher the earlier the surgery is performed. Without surgical treatment, only complications of the defect can be eliminated: circulatory failure or cardiac arrhythmia.

Currently in progress the following types surgical treatment of acquired heart defects:

plastic;
valve-sparing operations;
heart valve replacement with mechanical and biological prostheses;
reconstruction of the aortic root;
valve replacement with preservation of subvalvular structures;
recovery operation sinus rhythm hearts;
left atrium atrioplasty surgery;
bioprosthetics for defects with infective endocarditis;
heart valve replacement combined with coronary artery bypass surgery for coronary disease hearts.

Surgery for heart disease often gives very good results, relieving the patient not only from the consequences of heart disease, but also eliminating the defect itself.

Gymnastics will help improve the condition of a patient with heart defects, but we must not forget about certain limitations. Excessive activity can only worsen the condition. Therefore, it is recommended to perform sets of exercises under the supervision of a doctor (at least at the first stage) and stop at the first discomfort.

Physical therapy may include the following exercises (following the sequence):

walking;
warming up the trunk muscles;
warming up the lower extremities;
breathing exercises;
exercises for the lower extremities;
warming up the trunk muscles;
breathing exercises;
exercises for the upper limbs and shoulder girdle;
walking;
breathing exercises.

Walking is a basic exercise that should be included in every workout. It allows you to activate the work of the whole body, preparing it for subsequent loads. At first, walking is performed at a slow pace, then it is necessary to gradually accelerate.

At the end of the lesson, they also perform slow walking - this helps normalize blood circulation. When performing exercises on the torso muscles, the main thing is not to overdo it and also do everything at a calm pace. These exercises are performed no more than 2 times.

Exercises for upper limbs and shoulder girdle are designed for skill development correct breathing and strengthening the muscles of these areas. Exercises on the lower extremities are necessary to dilate blood vessels that are distant from the heart, thus eliminating congestion.

Breathing exercises are of great importance, as they stimulate blood flow to the lungs and heart muscle, feeding it with oxygen, ensuring normal nutrition of the brain.

There are no preventive measures that would protect one hundred percent from acquired heart disease. But there are a number of measures that will reduce the risk of developing heart defects. This means the following:

timely treatment of infections caused by streptococcus (in particular tonsillitis);
bicillin prophylaxis in the event of a rheumatic attack;
taking antibiotics before surgical and dental procedures if there is a risk of infective endocarditis;
prevention of syphilis, sepsis, rheumatism: sanitation of infectious foci, proper nutrition, work and rest schedule;
rejection of bad habits;
presence of moderate physical activity, accessible physical exercises;
hardening.

The prognosis for the life and ability to work of people with heart defects depends on the general condition, fitness of the person, and physical endurance. If there are no symptoms of decompensation, a person can live and work as usual.

If circulatory failure develops, work should either be lightened or stopped; sanatorium treatment at specialized resorts is indicated.

It is necessary to be observed by a cardiologist in order to monitor the dynamics of the process and, as the disease progresses, to promptly determine the indications for cardiac surgical treatment of heart disease.