Aortic valve examination has been a strength of echocardiography since its introduction into clinical practice in the early 1970s. Initially, M-modal echocardiography was shown to be reliable in excluding aortic stenosis and highly sensitive in diagnosing aortic insufficiency. With the advent of two-dimensional, and then various Doppler modes, it turned out that echocardiography diagnoses aortic valve pathology so well that it surpasses cardiac catheterization and angiography in its diagnostic value.

Normal aortic valve and aortic root

Examination of the aortic valve begins with its visualization from the parasternal approach in the position of the long axis of the left ventricle. Then, under 2D imaging guidance, usually along the parasternal short axis at the level of the base of the heart, the M-modal beam is directed to the aortic valve leaflets and the aortic root (Fig. 2.2 ). On fig. 2.6 the aortic valve is shown from the position of the parasternal short axis and its M-modal image. The right coronary and non-coronary leaflets of the aortic valve fall into the slice of the M-modal image. The line of their closure in diastole is normally located in the middle between the anterior and posterior walls of the aorta. In systole, the valves open and, diverging anteriorly and posteriorly, form a "box". In this position, the valves remain until the end of systole. Normally, mild systolic trembling of the aortic valve leaflets can be recorded on M-modal examination.

If the normal thin leaflets of the aortic valve do not open fully, this usually means a sharp decrease in stroke volume. With normal stroke volume and dilatation of the aortic root, the valve leaflets, opening, may be somewhat separated from the walls of the aorta. With low stroke volume, the M-modal movement of the aortic valve leaflets sometimes has the shape of a triangle: immediately after full opening, the leaflets begin to close. If the leaflets slam shut after their maximum opening, fixed subvalvular stenosis should be suspected. Mid-systolic closure of the aortic valve cusps (partial closure in the middle of systole, then maximum opening again) is a sign of dynamic subvalvular stenosis, i.e., hypertrophic cardiomyopathy with obstruction of the outflow tract of the left ventricle. In diastole, the closed leaflets are parallel to the walls of the aorta. Diastolic trembling of the aortic valve leaflets indicates a serious pathology and is observed when the leaflets are ruptured or detached. The eccentric location of the line of closure of the aortic valve cusps makes one suspect a congenital pathology - a bicuspid aortic valve.

Movement of the aortic root can provide valuable information about the global systolic and diastolic function of the left ventricle. Normally, the aortic root is displaced anteriorly in systole by more than 7 mm, and almost immediately returns to its place at the end of it. The movements of the aortic root reflect the processes of filling and emptying the left atrium; during atrial systole, they are normally minimal. With a decrease in the amplitude of movement of the aortic root, one should think about a low stroke volume. Note that the amplitude of movement of the aortic root does not directly depend on the ejection fraction. For example, with hypovolemia and normal contractility of the left ventricle, the amplitude of movement of the aortic root decreases. Normal or even excessive mobility of the aortic root with a reduced opening of the aortic valve cusps indicates a disproportion between the blood flow in the left atrium and in the aorta and is observed in severe mitral insufficiency.

In a two-dimensional study parasternally along the short axis, the aortic valve looks like a structure consisting of three symmetrically located, equally thin leaflets, which open completely in systole, and close in diastole and form a figure similar to an inverted emblem of a Mercedes-Benz car. The junction of all three valves may look slightly thickened. The aortic root has a larger diameter than the rest of the ascending aorta and is formed from the three sinuses of Valsalva, which are named similarly to the valve leaflets: left coronary, right coronary, non-coronary. Normally, the diameter of the aortic root does not exceed 3.5 cm. A Doppler study of blood flow through the aortic valve gives a spectrum of a triangular shape; the maximum speed of aortic blood flow is from 1.0 to 1.5 m/s. The aortic valve has a smaller diameter than the outflow tract of the left ventricle and the ascending aorta, so the velocity of blood flow is highest at the level of the valve.

Heart defects, both acquired and congenital, remain one of the topical areas of clinical cardiology. On average, they are found in approximately 1% of the population in the population, and in the vast majority these are acquired defects. Of great practical importance to this group of diseases is the fact that they often cause the formation of chronic heart failure. The peculiarity of the clinical course of heart defects also lies in the fact that the earlier and more accurately the diagnosis is made in the course of the disease, the greater the chances of timely provision of the necessary assistance, and, accordingly, the higher the likelihood of a favorable outcome of treatment. Therefore, for patients with heart defects, or with suspicion of their presence, the earliest use of highly informative diagnostic methods is optimal. The key to optimal clinical use of echocardiographic data is sufficient awareness of the attending physician about the basics and methodological possibilities of this method in relation to a particular nosology. This article aims to provide a concise, practice-oriented summary of the evaluation of echocardioscopy in mitral stenosis for physicians whose daily work includes the care of patients with heart disease and may require them to have relevant knowledge in this area.

As a rule, the following are considered as the main etiological factors in the formation of mitral valve stenosis.

1. Rheumatic carditis with predominant involvement of the valvular endocardium is still the most common cause of acquired malformations. The mitral and aortic valves are most often affected, the tricuspid valves are much less frequently affected, and rheumatic damage to the pulmonary valve is a casuistry.

2. The atherosclerotic process is the cause of the defect mainly in the elderly and affects mainly the aortic and mitral valves. The most common form of such a lesion is the so-called. senile (senile) stenosis, which can also be combined with varying degrees of valvular insufficiency.

3. Infective endocarditis, which is based on the destruction of the valves and the formation of vegetations, is rarely considered as a cause of mitral stenosis, but often becomes a source of valve insufficiency. However, a combination of rheumatic valve stenosis and secondary infective endocarditis is not excluded. With infective endocarditis, more than half of the cases occur in an isolated lesion of the aortic valve, and the mitral valve is inferior to it in this indicator.

4. Relatively infrequent etiological factors of mitral stenosis are diffuse connective tissue diseases, such as systemic lupus erythematosus and rheumatoid arthritis. At the same time, echocardioscopy in such patients is essential and may be of high diagnostic value.

5. Even more rare causes of stenotic lesions of the mitral valve are the so-called. storage diseases, the most relevant of which are amyloidosis and mucopolysaccharidosis. However, the involvement of the heart in amyloidosis itself goes far beyond valvular lesions, so echocardioscopy is important here as well.

Mitral stenosis of a rheumatic nature develops over several years. With a latent course of rheumatism, a defect can form without significant clinical symptoms preceding its occurrence, and become, in fact, its only manifestation. This defect was the first to be diagnosed by echocardioscopy, because has such a bright and specific ultrasound picture that it can be an example of the most complete and effective use of the entire visualization potential of this method. The echocardioscopic picture suggests the presence of the following changes in the valve: thickening of the leaflets (sometimes more than 3 mm) with pronounced and persistent deformation, compaction of their structure (usually uneven), shortening of their total length. Morphologically, these processes are manifested by a pattern of pronounced fibrotic changes. Specialists in ultrasound diagnostics try not to use the concepts of "density, compaction", but use the term "hyperechogenicity", which means the pronounced ability of a given structure to reflect an ultrasonic beam. These definitions are not fully synonymous, but, as a rule, in relation to acquired heart defects, they can be considered equivalent.

In addition to the leaflets themselves, adjacent elements of the valve are also involved in the pathological process: in particular, a pronounced shortening and thickening of the chords, as well as one or another degree of calcification of the mitral ring, is characteristic. In this regard, the importance of the presence of calcification of valvular structures should be noted, which has its own representation in the ultrasound picture: echo signals from calcifications continue to be visualized even at extremely low power levels of the ultrasonic beam, tk. have a very high reflectivity. The pronounced degree of calcification makes reconstructive interventions on the valve ineffective, as a result of which preference is usually given to the installation of valve prostheses.

Along with structural changes in the leaflets, there are also violations of the functional state of the valvular apparatus, which is manifested by a decrease in its elasticity, limitation of leaflet mobility, and a decrease in the amplitude of their opening. This indicator for the anterior mitral leaflet is designated as "AM" and is normally about 15 mm. The trajectory of movement of the anterior leaflet of the valve from the normal M-shaped becomes U-shaped, which is considered as one of the most significant signs of mitral stenosis (Fig. 1).

Rice. 1. B-mode (left) and M-mode (right): mitral stenosis, leaflet fibrosis (1), U-shaped (2) and in-phase (3) movement of the mitral leaflets.

If this symptom is determined, then it is usually indicated in the study protocol. The function of the valve suffers not only from anatomical changes in the structure of the leaflets, but also from the fusion of valve commissures, i.e. lateral sections of the connection of the front and rear flaps. This process leads to the fact that the multidirectional movement of both leaflets is gradually disturbed, their trajectories become in-phase, the rear leaflet begins to pull up after the front leaflet, as a result of which the full opening of the valve becomes impossible. The presence or absence of antiphase in the movement of the mitral leaflets is necessarily reflected in the study protocol, regardless of whether the patient has a mitral defect or not. The rate of covering the anterior leaflet, designated as “EF”, is also necessarily evaluated, which reflects the elastic properties and mobility of the valve and decreases with the appearance of sclerotic and fibrotic changes, averaging 12–14 cm/sec on average, and reaching 1–1 in severe stenosis. 3 cm/s (Fig. 1).

One of the most frequent and precise symptoms of stenotic valve damage is the deflection of the anterior leaflet into the cavity of the left ventricle, which in the English literature is defined by the term “doming”, and in the Russian literature as dome-shaped bulging (Fig. 2).
Rice. 2. B-mode: mitral stenosis, dome-shaped protrusion of the mitral valve (1).

The reason for its formation is that the excess pressure of blood accumulating in the cavity of the left atrium pushes through the middle part of the leaflet, not being able to open it to its full width.

In the diagnosis of mitral stenosis, the Doppler sonography method is successfully used, which consists in assessing the indicators of blood movement in real time. Measurement of blood flow parameters is performed on the affected valve and provides the following diagnostic information: flow direction, its maximum speed, peak and average pressure gradients between the left chambers, and a number of others. In addition to the speed indicators of blood flow, its turbulence is also taken into account, i.e. heterogeneity in its various parts. Normally, the filling flow of the left ventricle is mostly laminar, and its peak velocity rarely exceeds 1 m/s. On the contrary, with mitral stenosis, the flow becomes high-speed, reaching 1.5 m/s or more (Fig. 3).
Rice. 3. Dopplerography: mitral stenosis, maximum speed - 1.46 m/s (1), mitral valve area (2) - 1.2 cm2.

A high degree of its turbulence is also determined, i.e. it becomes heterogeneous, uneven, contains a large number of vortex movements and a wide spread of velocities, which, in turn, is a consequence of both a high pressure drop between the left chambers of the heart and the structural heterogeneity of the elements of the valve itself. The flow acquires the greatest acceleration at the point of maximum narrowing of the left atrioventricular orifice. Pressure gradient indicators are also in demand, in particular, the value of the average pressure gradient of the transmittal flow is more than 12 mm Hg. Art. with a high degree of certainty can be regarded as a reliable sign of severe mitral stenosis. This indicator, like many others, is automatically calculated using software and is available for analysis on all ultrasound scanners of cardiology specialization.

One of the most significant diagnostic indicators that can be obtained using echocardioscopy in such patients is the estimated area of ​​the left atrioventricular orifice, which in this case is a key parameter of the functioning of the heart, characterizes the general clinical condition of the patient, and also determines the prognosis of the course of the disease and the tactics of further treatment. To date, there are two most widely used methods for assessing this parameter - planimetric and Doppler. The first is historically earlier and at the same time simple. It consists in obtaining a still image of the most stenosed part of the valve, followed by outlining its contours on the screen and calculating the area within the boundaries of a closed perimeter. Even the simplest devices are equipped with this function, making this technique widely available and easy to perform (Fig. 4).
Rice. 4. B-mode: mitral stenosis, mitral valve area - 1.6 cm2.

Doppler characterization of stenotic flow can serve as an alternative to the planimetric method, which is based on the assessment of the dynamic change in the transmitral gradient during the process of filling the left ventricle - the so-called. pressure half-time (Fig. 3). The calculation program immediately presents the result in the form of mitral valve area. The choice of a specific method is within the competence of the researcher.

Normal values ​​of the area of ​​the left atrioventricular orifice vary widely, ranging from 4 to 6 cm 2 in adults. Currently, there are several options for classifying mitral valve stenosis according to severity - here are the two most common (Table 1, Tab. 2).

Table 1.

Classification of mitral stenosis recommended in echocardioscopy

(Shiller N., Osipov M.A.)

Table 2.

Classification of mitral stenosis recommended in clinical practice

(Okorokov A.N.)

From a practical point of view, it is important that the estimated area of ​​the mitral orifice, approaching 1 cm 2 , requires immediate consultation with cardiac surgeons to determine the indications for surgical treatment.

From the point of view of the clinician, the question of whether the stenosis in a given patient is isolated (“pure”) or whether it is combined with valvular insufficiency may also be significant. The choice of surgical treatment tactics will also depend on this - the presence of significant concomitant mitral insufficiency suggests prosthetics of a stenotic valve rather than performing a commissurotomy, even if a low degree of valvular structures calcification technically allows this intervention.

Thus, the considered echoscopic signs of mitral stenosis and their clinical significance may be useful to practitioners in evaluating protocols based on the results of ultrasound examinations of the heart in patients with mitral stenosis, and will also help them, if necessary, to make their own reasonable judgment about a particular patient and the diagnostic examination performed on him. research.

ON THE. Tsibulkin

Kazan State Medical Academy

Literature:

1. Abdullaev R.Ya., Sobolev Yu.S., Schiller N.B., Foster E. Modern echocardiography. Kharkiv. Fortune Press. 1998.

2. Diseases of the heart and blood vessels. Ed. Chazova E.A. Moscow. The medicine. 1992.

3. Clinical guide to ultrasound diagnostics. Ed. Mitkova V.A. Moscow. VIDAR. 1998.

4. Okorokov A.N. Diagnosis of diseases of internal organs. Minsk. Top school. 1998.

5. Cardiovascular surgery. Ed. IN AND. Burakovsky, L.A. Bokeria. Moscow. The medicine. 1989.

6. Schiller N., Osipov M.A. Clinical echocardiography. M. Mir. 1993.

7. Feigenbaum H. Echocardiography (4th ed.). Philadelphia. Lea & Febiger, 1986.

Aortic valve defects These are diseases that are associated with a violation of the structure and operation of the aortic valve. They manifest as incomplete closure of the leaflets (aortic insufficiency) or narrowing of the aortic orifice (aortic valve stenosis).

The structure of the aortic valve

• annulus fibrosus- the base of the valve. A ring of connective tissue that separates the left ventricle from the aorta.
• Three semilunar valves- "pockets" that close tightly, blocking the lumen into the aorta.
• Sinuses of Valsalva- sinuses of the aorta, which are located behind the semilunar valve leaflets.

The leaflets themselves look like three rounded pockets, which are located in a circle on the annulus fibrosus. Opening, they completely block the lumen of the aorta. The flaps are made up of connective tissue and a thin layer of muscle fibers. Moreover, the connective fibers of collagen and elastin are arranged in bundles. This structure allows you to redistribute the load from the valve leaflets to the walls of the aorta.

Valve mechanism

valve opening

• Elastin fibers, which are located on the side of the ventricle, help the valves to take their original position: to press against the walls of the aorta and open the passage to the aorta for blood.
• The aortic root (an extension at the very beginning of this artery) contracts and tightens the cusps.
• When the pressure in the ventricle exceeds the pressure in the artery, the blood is pushed into the aorta and presses the valves against its walls.

The lumen of the aortic valve is much narrower than that of the mitral valve. Therefore, each time during the contraction of the ventricle, it experiences a large load and gradually wears out. This leads to the appearance of acquired arterial valve defects.

Aortic valve insufficiency is the second most common heart disease, after mitral valve disease. Usually this pathology occurs in tandem with stenosis - narrowing of the aortic lumen. Men are more likely to suffer from aortic insufficiency than women.

The reasons

• develops two valve leaflets instead of three;
• one leaf is larger than the other, stretched and sagging;
• openings in the valve flaps;
• underdevelopment of one of the valves.

Acquired vices aortic valve cause such diseases.

Infectious diseases:

• syphilis
• sepsis
• angina
• pneumonia

Autoimmune diseases

• rheumatism
• lupus erythematosus

Other reasons

• aortic atherosclerosis
• calcium deposits on the valve
• hypertension
• hard blow to the chest
• age-related changes - expansion of the aortic root.

Symptoms of aortic valve insufficiency

• Feeling of increased heartbeat;
• Pulsation in the area of ​​large vessels throughout the body;
• Pain in the region of the heart;
• Dizziness;
• Noise in ears;
• Shortness of breath when doing daily activities;
• Fainting caused by impaired blood circulation in the brain;
• Heaviness and pain in the right hypochondrium associated with stagnation of blood in the liver;
• Swelling of the legs.

• Paleness of the skin - it is due to the fact that the small vessels of the skin narrow reflexively;
• Strong pulsation of the arteries, this is especially noticeable in the carotid arteries;
• Pulsation of uvula and tonsils;
• The pupils constrict during the contraction of the heart and dilate during the phase of its relaxation. These "pulsating" signs are due to the fact that the tone of small arteries is disturbed. They expand noticeably when a pulse wave passes through them, which appears after the contraction of the ventricles.
• Young people may develop a heart hump, a bulge on the chest. This is the result of an increase in the size of the heart;
• When probing the chest, the doctor hears strong blows of the left ventricle under the palm;
• When tapping, an increase in the size of the heart is revealed;
• When listening with a stethoscope, the doctor hears a heart murmur as the ventricles contract. They are caused by eddies of blood as it passes between deformed valve leaflets;
• The pulse is accelerated, the vessels are dense and well palpable;
• Significant difference between upper and lower pressure. If the normal pressure is 120/80, then with aortic insufficiency it can be 160/55. This is due to the fact that with each beat, the left ventricle ejects a large amount of blood into the vessels.

Electrocardiography- signs of enlargement of the left ventricle. In some people, unplanned ventricular contractions appear on the cardiogram, which are knocked out of the normal heart rhythm - ventricular extrasystoles.

Phonocardiography – heart murmurs are heard.

1. Systolic murmur occurs during ventricular contractions (systole). It appears when blood passes into the aorta past the modified valve leaflets. Their uneven edges create swirls, the sound of which is audible;
2. A diastolic murmur occurs when the ventricles relax (diastole) and the pressure drops. Part of the blood returns through a leaky valve from the aorta. At the same time, it passes with noise through a narrow hole.

• Violations in the leaflets of the aortic valve;
• Trembling of the mitral valve leaflets between the left atrium and the left ventricle;
• Enlargement of the left ventricle.

Diagnostics

1. Phonocardiography and listening detect heart murmurs during contraction and relaxation of the ventricles.
2. dopplerography. At dopplerography reverse flow of blood from the aorta to the left ventricle is seen.
3. x-ray reveals an enlarged heart.
4. Inspection. At inspection a strong pulsation of the arteries is noticeable.

Treatment

Calcium antagonists: Verapamil
Prevents calcium ions from entering cells. Due to this, the heart does not contract as much, needs less oxygen and has the opportunity to rest. The drug is needed if you are periodically disturbed by attacks of irregular heartbeat and pressure rises. The first days take 40-80 mg 3 times a day. Then the dose is adjusted depending on the state of health.

Diuretics: Furosemide
Diuretic drugs are prescribed for almost all people with this disease. They reduce the load on the heart, relieve swelling, remove salts and lower blood pressure. In the first days of treatment, 20-80 mg / day is prescribed. Gradually increase the dose to achieve improvement in well-being. The drug can be taken for a long time: every day or every other day, as directed by the doctor.

Beta blockers: Propranolol
You need this drug if aortic insufficiency is accompanied by aortic root dilatation, arrhythmias and high blood pressure. It blocks beta-adrenergic receptors and prevents them from interacting with adrenaline. As a result, the heart is better supplied with blood, pressure decreases. Take 1 tablet 40 mg 2 times a day. When there is no effect, the doctor may increase the dose. But if there are chronic liver diseases, then you need to take the drug in a smaller amount. Therefore, do not forget to inform the doctor about the state of health and the medicines that you are already taking.

Vasodilators: Hydralazine
This drug helps to reduce tension in the walls of blood vessels, relieve spasm in small arteries and improve blood circulation. The load on the left ventricle decreases and pressure decreases. Take Hydralazine 10-25 mg 3-4 times a day. The dose is increased gradually so that side effects do not occur. Do not use this medicine if you have a fast heart rate, mitral valve disease, atherosclerosis, or if your heart has a poor supply of blood (ischemic disease). The dose and duration of the course is determined by the doctor. Often this drug is prescribed to people who are contraindicated in surgery.

Surgery

With congenital aortic valve disease, which in most cases causes minor disturbances, the operation is done after 30 years. But if the condition is rapidly deteriorating, then it can be carried out at an earlier age.
Age at which this operation is recommended with an acquired defect depends on changes in the valve. Typically, the operation is performed on people 55-70 years old.

Indications for surgery

• violations of the left ventricle;
• the left ventricle increased to 6 cm or more;
• a large volume of blood (25%) returns from the aorta to the ventricle during its relaxation (diastole) and the person suffers from manifestations of the disease;
• the disease is asymptomatic, there are no complaints of feeling unwell, but about 50% of the blood returns to the ventricle.

• age over 70 years, but this issue is resolved individually;
• more than 60% of the blood returns from the aorta to the ventricle;
• severe chronic diseases.

1. Intra-aortic balloon counterpulsation

• minor changes in the valve leaflets;
• reverse blood flow 25-30%.

• does not require a large incision;
• allows faster recovery after surgery;
• easier to bear.

• can not be carried out if there are violations in the tissues of the aorta: atherosclerosis, aneurysm, dissection;
• there is no way to correct serious changes on the valve leaflets;
• there is a risk of re-development of aortic insufficiency for 5-10 years.

1. Artificial valve implantation

Indications for this type of operation

• reverse blood flow 25-60%, if the percentage is higher, then the risk increases that the work of the left ventricle will not improve after the operation;
• strong and numerous manifestations of the disease;
• enlargement of the left ventricle more than 6 cm.

• provides good results at any age under 70 years and with any valve lesions;
• the vast majority of people tolerate the operation well;
• health status improves significantly;
• you can simultaneously get rid of arterial insufficiency.

• requires dissection of the chest and the attachment of a heart-lung machine;
• recovery takes 2 months;
• the operation is not effective if severe circulatory failure has occurred.

Aortic valve stenosis

The reasons

birth defects

• the valve consists of two flaps instead of three
• the valve consists of one flap
• under the valve there is a membrane with a hole
• muscular fold over the aortic valve

Acquired valve defects as a result of various diseases:

infectious diseases

• sepsis
• pharyngitis
• pneumonia

Systemic diseases

• rheumatism
• systemic lupus erythematosus
• scleroderma

Age changes

• Calcification of the aortic valve - deposits of calcium salts along the edges of the valves.
• Atherosclerosis is the deposition of cholesterol plaques on the inner surface of the aorta and valve.

With minor changes, there are no symptoms. If they appear, this indicates that the valve needs to be replaced.

Symptoms

• Normal area is 2-5 cm 2
• Mild stenosis hole area greater than 1.5 cm 2
• Moderate stenosis area 1-1.5 cm 2
• Severe stenosis hole area less than 1 cm 2

well-being

• Pain and a feeling of heaviness in the chest - angina pectoris. It appears due to the fact that pressure increases in the left ventricle and blood presses on its walls;
• Fainting. This is the result of little blood entering the aorta through the narrow opening. The pressure in it drops, and the organs receive less blood and oxygen. This is primarily felt by the brain. When he experiences oxygen starvation, the person feels weak, dizzy and loses consciousness;
• Edema of the lower extremities is caused by circulatory failure and impaired outflow of venous blood;
• Signs of heart failure appear as a result of a malfunction of the left ventricle:

• Shortness of breath on exertion;
• Shortness of breath when lying down;
• Nocturnal attacks of coughing;
• Increased fatigue.

• Paleness of the skin due to insufficient blood flow to small vessels;
• The pulse is slow (bradycardia) and weak;
• A characteristic murmur is heard on auscultation of the heart. It occurs between contractions of the ventricle. Its appearance is due to the fact that the pressure in the left ventricle increases and blood rushes into the narrow opening of the aortic valve. The higher the pressure in the ventricle, the stronger the noise created by the eddies in the blood flow;
• The sound of closing the aortic valve is poorly audible. This is due to the fact that the fused valve flaps close loosely and not fast enough.

Instrumental examination data

• signs of enlargement of the left ventricle and thickening of its wall
• cardiac arrhythmias

• enlargement of the left atrium and ventricle
• the shape of the heart resembles a shoe
• accumulations of calcium on the valve or in the lower part of the aorta

• enlargement of the left ventricle and thickening of its walls
• left atrial enlargement
• membrane below the valve
• ridge above the valve in the aorta
• incomplete closing of the valves
• number of leaves
• narrowed valve opening

Doppler study – one of the types of ultrasound of the heart, which allows you to:

• see the direction of blood flow
• measure the flow rate
• determine the amount of blood that passes through the aortic valve
• see the constriction above the valve
• identify aortic valve insufficiency - incomplete closure of its valves

Cardiac catheterization- study of the state of the heart with the help of a special catheter, which is inserted into its cavity through large vessels. It is prescribed only to people over 50 years of age who do not have the same EchoCG data and the results of other examinations. Using this method, the pressure in the chambers of the heart and the features of the movement of blood through the aortic valve are determined.

After the first symptoms of aortic valve stenosis appear, surgery must be done within 3-5 years. If the disease is asymptomatic and does not cause significant disturbances in the work of the left ventricle, then the doctor will prescribe the necessary medications and the time of the next examination. Usually it is enough to undergo an ultrasound of the heart once a year.

Treatment of aortic valve stenosis

Diuretics or diuretics: Torasemide
The drug is necessary for you if the doctor has detected stagnation in the lungs. Torasemide reduces the amount of water in the body and the volume of blood circulating through the vessels. But the diuretic is prescribed carefully and in small doses. Otherwise, it can cause a decrease in pressure in the arteries, which already receive insufficient amounts of blood. The recommended dose is 2.5 mg 1 time / day. Consume in the morning, regardless of the meal.

Antianginal drugs: Sustak, Nitrong
They improve the nutrition of the heart with blood and relieve pain and heaviness behind the sternum. They reduce the heart muscle's need for oxygen and improve the heart's blood supply. Apply 2-3 times a day with a little water. Tablets should not be chewed or broken. The dose of the drug is prescribed by the doctor. Even a slight excess of it can cause deterioration and fainting due to a decrease in pressure.

Antibiotics: Bicillin-3
It is prescribed for the prevention of infective endocarditis in case of any exacerbation of chronic diseases: tonsillitis, pyelonephritis. And before various procedures that can cause bacteria to enter the bloodstream: tooth extraction, abortion. The drug is used 1 time for 1,000,000 units, unless the doctor has prescribed another regimen.

Surgery for aortic valve stenosis

• there were signs of the disease that reduce the ability to work: weakness, shortness of breath, fatigue;
• moderate and severe stenosis, the area of ​​​​the opening in the aortic valve is less than 1.5 square meters. cm;

• age over 70;
• severe comorbidities.

1. Aortic balloon valvuloplasty

Indications for surgery

• childhood;
• patients under 25 without calcium deposits on the valve;
• in adults with severe stenosis before valve replacement surgery;
• in adulthood if aortic valve replacement surgery is contraindicated.

• less traumatic method;
• high efficiency in children;
• does not require cardiac arrest and the connection of a heart-lung machine;
• allows you to recover in 7-10 days.

• over 10 years, a second operation may be required;
• there is a risk of developing aortic insufficiency due to the fact that scars will appear on the valve leaflets and they will not close tightly;
• efficiency in adults is 50%, after a year narrowing may occur again.

1. Aortic valve replacement

1. An artificial prosthesis made of durable and high-tech materials: silicone and metal.
2. Bioprostheses:

• Valve transplanted from own pulmonary artery;
• A valve taken from the heart of a deceased person;
• Animal bioprostheses: porcine or bovine.

• fainting;
• severe weakness and fatigue;
• violations of contraction of the left ventricle;
• only 50% of the blood passes through the narrowed aortic opening when the ventricle contracts.

• brings significant improvements at any age;
• low mortality rate during and after surgery;
• during the operation, it is possible to simultaneously correct shortcomings in the work of the aorta;
• eliminates all manifestations of the disease;
• life expectancy after such an operation is the same as in healthy people.

• The recovery period takes 1-2 months;
• Bioprostheses wear out, they are put on people over 60 years old
• A mechanical prosthesis increases the risk of blood clots and requires constant use of blood-thinning drugs - anticoagulants.

Usually differ in the acquired character and are shown clinically only at advanced age. Their presence can cause severe hemodynamic disorders. The severity of the pathology lies in the fact that the changes affecting the valves are irreversible.

Structure of the heart: valves

The heart is a hollow organ with 4 chambers. The left and right halves are separated by partitions, in which there are no formations, however, between the atrium and ventricle of each side there is an opening equipped with a valve. These formations allow you to regulate blood circulation, preventing regurgitation, that is, reverse reflux.

On the left there is a mitral valve, consisting of two valves, and on the right - a tricuspid valve, it has three equipped with tendon filaments, which ensures their opening only in one direction. This prevents backflow of blood into the atria. There is an aortic valve at the junction with the aorta. Its function is to ensure the one-way movement of blood into the aorta. There is also on the right side. Both formations are called "lunate", they have three valves. Any pathology, for example, calcification of the aortic valve leaflets, leads to impaired blood flow. Acquired defects are usually associated with some disease. Therefore, people with so-called risk factors should undergo regular examinations: mainly an echocardiogram.

The mechanism of the aortic valve

The aortic valve plays an important role in blood circulation. The valves are compacted or shortened - this is one of the main pathologies. It causes hemodynamic disturbances. The function of this part of the organ is to ensure the movement of blood from the left atrium to the ventricle, preventing regurgitation. The leaflets are open during atrial systole, at which time blood is directed through the aortic valve into the ventricle. Further, the flaps are closed to prevent backcasting.

Heart defects: classification

According to the time of occurrence, congenital heart defects (aortic valve and other formations) and acquired ones can be distinguished. Changes affect not only the valves, but also the septa of the heart. Congenital pathologies are often combined, which complicates diagnosis and treatment.

Aortic valve stenosis

Pathology implies a narrowing of the transition of the left ventricle into the aorta - the valve leaflets and surrounding tissues are affected. This disease, according to statistical indicators, is more common in men. Hardening of the aortic wall and aortic valve cusps is commonly associated with rheumatic and degenerative lesions. Also, endocarditis, rheumatoid arthritis can act as an etiological factor. These diseases lead to fusion of the valves, as a result of which their mobility decreases, and the valve cannot fully open during left ventricular systole. In the elderly, the cause of the lesion is often atherosclerosis and calcification of the aortic valve cusps.

As a result of the narrowing of the aortic orifice, significant changes in hemodynamics occur. They are observed when the stenosis has a pronounced degree - a decrease in the tract by more than 50%. This leads to the fact that the pressure gradient of the aortic valve changes - in the aorta, the pressure remains normal, and in the left ventricle it increases. An increased effect on the wall of the left ventricle leads to the development of compensatory hypertrophy, that is, to its thickening. Subsequently, diastolic function is also disturbed, which causes an increase in pressure in the left atrium. Hypertrophy leads to an increase in oxygen demand, however, the increased mass of the myocardium accounts for the same blood supply, and with concomitant pathologies, even reduced. This leads to the development of heart failure.

Clinic

In the early stages, the affected aortic valve may not manifest itself in any way. Clinical changes occur when the hole is narrowed by 2/3 of the norm. With severe physical exertion, patients begin to be disturbed by pain localized behind the sternum. Pain syndrome in rare cases can be combined with loss of consciousness due to systemic vasodilation. The formation of pulmonary hypertension leads to shortness of breath, which at first worries only during exercise, but then appears at rest. The protracted course of the disease becomes the cause of chronic heart failure. Pathology requires surgical treatment, as there is a risk of deterioration and sudden cardiac death.

Diagnostics

On examination, patients have a characteristic pallor associated with reduced cardiac output. The pulse on the radial arteries is palpable with difficulty - it is rare and weak. On auscultation, there is a weakening of the 2nd tone or its splitting. The ECG is not informative enough - signs of hypertrophy are determined only with a severe degree of stenosis. The most revealing echocardiography, which allows to evaluate the aortic valve. The leaflets are compacted and thickened, the opening is narrowed - these are the main diagnostic criteria that this study helps to detect. The degree of stenosis and pressure gradient effectively allows you to determine the catheterization of the cavities.

Treatment

With a mild and moderate degree of stenosis, only a lifestyle correction is required - avoidance of excessive physical exertion, treatment of concomitant pathologies. With an increased frequency of contractions, adrenergic blockers are prescribed, and for heart failure, diuretics are effective. Severe compaction of the walls of the aorta and aortic valve cusps requires surgical treatment. As a rule, prosthetics are performed or

Aortic valve insufficiency

This name was given to a pathology characterized by non-closure of the valves. This phenomenon leads to the reverse reflux of blood into the left ventricle, which occurs during diastole. The defect is usually a complication of infective endocarditis and rheumatic lesions. Less often, syphilis, aortic aneurysm, aortitis, arterial hypertension, systemic lupus erythematosus lead to it.

The aortic valve plays an important role in blood circulation. Incomplete closure of its valves causes regurgitation, that is, the backflow of blood into the left ventricle. As a result, there is an excessive volume of blood in its cavity, which leads to overload and stretching. Systolic function is impaired, and increased pressure leads to the development of hypertrophy. Retrograde pressure rises in the small circle - pulmonary hypertension is formed.

Clinic

As with stenosis, pathology makes itself felt only with a pronounced degree of insufficiency. Shortness of breath occurs on exertion and is associated with pulmonary hypertension. Pain disturbs only in 20% of cases. At the same time, auscultatory and external manifestations of pathology are expressed:

1. Pulsation of the carotid arteries.
2. Symptom Durozier or occurrence on the femoral artery. It occurs when it is pinched closer to the listening position.
3. Quincke's symptom - a change in the color of the lips and nails in accordance with the pulsation of the arterioles.
4. Traube's double tones, loud, cannon-like, that originate over the femoral artery.
5. Symptom de Musset, manifested by shaking the head.
6. Diastolic murmur after the 2nd tone, which occurs during auscultation of the heart, as well as the weakening of the 1st tone.

Diagnostics

Informative methods are echocardiography and catheterization of cavities. They allow you to evaluate the aortic valve, as well as track the volume of regurgitant blood. Based on these studies, the severity of the defect is determined and the question of the need for surgical intervention is decided.

Treatment

Severe insufficiency with a large volume of regurgitation, intense clinical manifestations requires surgical treatment. The optimal solution is artificial aortic valves, which allow to restore the work of the heart. If necessary, symptomatic drug therapy is prescribed.

Stenosis and insufficiency of the aortic valve are the most common heart defects, which, as a rule, are the outcome of any local or systemic disease. Pathology progresses slowly enough, which allows it to be diagnosed in time. Modern methods of treatment help restore valve function and improve the patient's condition.