Regurgitation 3 degrees treatment. How to identify and treat mitral regurgitation of the heart? degree is the least

In cardiology practice, such a heart disease as mitral valve insufficiency is often encountered. The movement of blood in the cavity of the heart depends on the operation of the valves. The bicuspid valve is located in the left parts of the organ. It is located in the region of the atrioventricular orifice. When it is incompletely closed, blood rushes back into the atrium, which leads to disruption of the organ.

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Violation of the function of the valvular apparatus

Mitral insufficiency is an acquired heart disease in which the valve leaflets do not close completely, which leads to backflow (regurgitation) of blood into the atrium. This condition leads to the appearance of various clinical symptoms (shortness of breath, edema). An isolated form of such a defect is diagnosed very rarely.

It accounts for no more than 5% of all cases of this pathology. Most often, mitral insufficiency is combined with narrowing of the left mouth between the atrium and ventricle, aortic valve defects, atrial septal defect and septum between the ventricles. In preventive studies of the heart in 5% of the population, a violation of the function of the bicuspid valve is detected. In most cases, the degree of deviation is negligible. This defect is detected by ultrasound.

The severity of the disease

Mitral insufficiency can be of several types: ischemic, non-ischemic, acute and chronic, organic and functional. The ischemic form is due to a lack of oxygen in the heart muscle. Organic pathology develops as a result of damage to the valve itself or tendon cords. With the functional form of this defect, the violation of blood flow is associated with an increase in the cavity of the left ventricle.

There are 4 degrees of this pathology: mild, moderate, severe and severe. This defect includes 3 stages. In the compensation stage, the return of blood into the atrium does not exceed 20-25% of the total blood volume during the contraction of the heart. This condition is not dangerous, since compensatory mechanisms are activated (increased work of the left atrium and left ventricle).

In the stage of subcompensation, congestion is observed in the pulmonary circulation (lungs). The left side of the heart is heavily overloaded. Blood regurgitation is 30-50%. Stage 3 inevitably leads to severe heart failure. Back to the atrium returns from 50 to 90% of the blood. With this pathology, the valve begins to sag.

The degree of sagging is different (from 5 to 9 mm). When assessing the state of the mitral valve, the size of the opening between the atrium and the ventricle is also taken into account. With a mild degree, it is less than 0.2 cm², with an average degree it is 0.2-0.4 cm², and with a severe degree there is a hole larger than 0.4 cm². In the latter case, the left atrium is constantly filled with blood.

Etiological factors of the disease

There are the following reasons for the development of this acquired heart disease in children and adults:

rheumatism;
endocarditis of an infectious nature;
acute form of myocardial infarction;
deposition of calcium salts in the valve leaflets;
bulging of the valves forward due to weakness of the connective tissue;
autoimmune diseases (lupus, scleroderma);
coronary heart disease due to atherosclerosis or thrombosis of the coronary arteries;
dilated cardiomyopathy;
myocarditis;
cardiosclerosis.

The ischemic form of the defect often develops against the background of myocardial sclerosis after a heart attack. Sometimes this pathology becomes a manifestation of the Marfan and Ehlers-Danlos syndrome. The expansion of the fibrous ring and the cavity of the ventricle causes the development of relative insufficiency of the bicuspid valve of the heart. The bicuspid valve is a structure of the heart made up of connective tissue. It is located in the fibrous ring.

In a healthy person, during the contraction of the left stomach, blood rushes into the aorta. It moves in only one direction (from the left atrium to the left ventricle and aorta). If the valve is not completely closed, then blood regurgitation (backflow) occurs. The condition of the valve leaflets largely depends on the health of the tendon chords. These are the structures that provide the flexibility and movement of the valve. With inflammation or injury, the chords are damaged, which leads to a violation of the tone of the valves. They don't close all the way. A small hole is formed through which blood flows freely.

Clinical manifestations in the early stages

Signs of this pathology depend on the degree of regurgitation. In the first two stages, the following symptoms are possible:

frequent heartbeat;
violation of the heart rhythm;
fast fatiguability;
weakness;
malaise;
dyspnea;
chest pain;
cough;
small swelling of the lower extremities.

With mitral valve insufficiency of the 1st degree, complaints may be absent. The body compensates for these violations. This stage can take several years. Most often, such patients complain of chilliness of the legs and weakness. In the second stage (subcompensation), the first signs of heart failure (shortness of breath, tachycardia) appear.

Shortness of breath occurs with physical exertion. Its appearance can cause prolonged walking, lifting weights, climbing stairs. At rest, she does not care. Shortness of breath is a feeling of lack of air. The heart of such patients begins to beat more often (80 or more beats per minute). The heart rhythm is often disturbed by the type of atrial fibrillation.

With it, the atria are excited and contract randomly with a frequency of 300-600 beats per minute. Prolonged arrhythmia can cause a heart attack, ischemic stroke and vascular thrombosis. With mitral valve insufficiency of the 2nd degree, edema may appear on the feet and legs. Both limbs are affected at once symmetrically. Cardiac edema intensifies in the evening. They are bluish in color, cold to the touch and grow gradually.

Manifestations at a later stage

Symptoms of mitral valve insufficiency of the 3rd degree are most pronounced. Due to significant regurgitation, there is stagnation of venous blood in the small circle, which leads to an attack of cardiac asthma. Most often, attacks occur at night. They are characterized by shortness of breath, shortness of breath, dry cough. Symptoms are most pronounced when the person is lying down. Such people breathe through their mouths and have difficulty speaking.

At stage 3 of mitral insufficiency, complaints become permanent. The symptoms are disturbing even at rest. These people often develop pulmonary edema. Sometimes there is hemoptysis. The edematous syndrome is pronounced. Edema appears not only on the limbs, but also on the face and other parts of the body.

Violation of blood flow leads to stagnation in the liver. This is manifested by pain in the hypochondrium on the right. Depletion of the heart muscle leads to multiple organ failure. Against the background of insufficiency of the mitral ventricle, the right parts of the heart often suffer. Right ventricular failure develops. She has the following symptoms:

an increase in the volume of the abdomen (ascites);
acrocyanosis;
bulging veins in the neck.

The most formidable complication of mitral defect is atrial fibrillation.

How are patients examined?

Treatment of patients begins after the final diagnosis is made. Diagnostics includes:

collection of anamnesis of life and disease;
identification of the main complaints;
physical examination;
electrocardiography;
Ultrasound of the heart;
analysis of heart murmurs;
immunological examination of blood;
radiography of the chest cavity;
dopplerography;
general analysis of blood and urine.

If necessary, coronary cardiography (examination of the coronary arteries using a dye), as well as spiral computed tomography, is organized. In order to determine the pressure in the left side of the heart, catheterization is performed. Physical examination is very informative. With mitral insufficiency, the following changes are detected:

the presence of a heart hump;
strengthening of the apex beat;
increase in the boundaries of cardiac dullness;
weakening or absence of 1 heart sound;
systolic murmur in the apex;
splitting or accent 2 tones in the region of the pulmonary artery.

To determine the severity of mitral insufficiency allows ultrasound of the heart. This is the main method for diagnosing this defect. In the process of heart ultrasound, the condition of the valves, the size of the atrioventricular orifice, the presence of pathological inclusions in the area of the valves, the size of the heart and its individual chambers, wall thickness and other parameters are assessed.

Conservative treatment tactics

Treatment of patients with this defect is conservative and surgical. It is necessary to identify the main cause of this pathology. If the insufficiency of the bicuspid valve has developed against the background of rheumatism, then treatment involves the use of glucocorticoids, NSAIDs and immunosuppressants. Additionally, antibiotics may be prescribed. Sanitation of all foci of chronic infection is required.

In the case of coronary heart disease against the background of atherosclerosis, a change in lifestyle is required (refusal of alcohol and tobacco products, diet, restriction of load, exclusion of stress), the use of statins (Simvastatin, Lovastatin, Atorvastatin). If necessary, beta-blockers and antiplatelet agents are prescribed.

Drug treatment for bicuspid valve insufficiency includes the use of the following drugs:

reducing vascular resistance (ACE inhibitors);
antiarrhythmic drugs (Cordarone, Novocainamide);
beta-blockers (Bisoprolol);
diuretics (Veroshpiron, Indapamide);
anticoagulants (Heparin, Warfarin);
antiplatelet agents (thrombo ACC).

Diuretics reduce the volume of blood circulating in the vessels. Nitrates are essential to reduce afterload on the heart. With developed heart failure, glycosides are indicated. In the case of mild severity of the defect and the absence of symptoms, drug therapy is not required.

Therapeutic actions

In moderate to severe mitral regurgitation, surgical intervention is required.

In the terminal stage, the operation is not performed. The most commonly organized plastic surgery or prosthetics. Such treatment is aimed at preserving the valves of the heart. Plastic surgery is indicated in the following situations:

with prolapse of the bicuspid valve;
when the structures of the valve apparatus are ruptured;
when expanding the valve ring;
with relative insufficiency of the bicuspid valve.

Surgical treatment is also carried out if a woman plans to have children. Prosthetics is organized in case of ineffective plastic surgery or gross changes. After the installation of prostheses, indirect anticoagulants should be taken. Possible complications after surgery include the development of atrioventricular blockade, thromboembolism, secondary infective endocarditis.

If complications (pulmonary edema) develop in the later stages, then drug therapy is additionally carried out. With edema, oxygen supply is indicated. Diuretics and nitrates are used. At high pressure, antihypertensive drugs are prescribed. The prognosis for life and health is determined by the degree of regurgitation, the age of the person and the presence of concomitant pathology.

If all the recommendations of the doctor are followed, the five-year survival rate reaches 80%. 6 people out of 10 live 10 years or more. The worst prognosis is observed with ischemic form of mitral insufficiency. With a defect of mild and moderate severity, sick women can bear a child and give birth. Thus, dysfunction of the bicuspid heart valve is a dangerous condition that causes heart failure and early death of patients.

The term "regurgitation" is quite often found in the everyday life of doctors of various specialties - cardiologists, therapists, functional diagnosticians. Many patients have heard it more than once, but they have little idea what it means and what it threatens. Should I be afraid of the presence of regurgitation and how to treat it, what consequences to expect and how to identify? We will try to find out these and many other questions.

Regurgitation is nothing but the reverse flow of blood from one chamber of the heart to another. In other words, during the contraction of the heart muscle, a certain volume of blood, for various reasons, returns to the cavity of the heart from which it came. Regurgitation is not an independent disease and therefore is not considered a diagnosis, but it characterizes other pathological conditions and changes (for example).

Since blood is constantly moving from one part of the heart to another, coming from the vessels of the lungs and leaving for the systemic circulation, the term "regurgitation" is applicable to all four valves, on which reverse current may occur. Depending on the volume of blood that returns back, it is customary to distinguish the degrees of regurgitation that determine the clinical manifestations of this phenomenon.

A detailed description of regurgitation, the allocation of its degrees and detection in a large number of people became possible with the use of ultrasound examination of the heart (echocardiography), although the concept itself has been known for a long time. Auscultation of the heart provides subjective information, and therefore does not allow judging the severity of blood return, while the presence of regurgitation is beyond doubt, except in severe cases. The use of Doppler ultrasound makes it possible to see in real time the contraction of the heart, how the valve flaps move and where the blood stream rushes.

Briefly about anatomy ...

In order to better understand the essence of regurgitation, it is necessary to recall some moments of the structure of the heart, which most of us have safely forgotten, having once studied at school in biology lessons.

The heart is a hollow muscular organ with four chambers (two atria and two ventricles). Between the chambers of the heart and the vascular bed are valves that act as a "gate" that allows blood to flow in only one direction. This mechanism ensures adequate blood flow from one circle to another due to the rhythmic contraction of the heart muscle, which pushes blood inside the heart and into the vessels.

The mitral valve is located between the left atrium and ventricle and consists of two wings. Since the left half of the heart is the most functionally burdened, it works with a heavy load and under high pressure, various failures and pathological changes often occur here, and the mitral valve is often involved in this process.

The tricuspid or tricuspid valve lies on the path from the right atrium to the right ventricle. It is already clear from its name that anatomically it represents three interlocking valves. Most often, its defeat is secondary in the already existing pathology of the left heart.

The valves of the pulmonary artery and the aorta carry three cusps each and are located at the junctions of these vessels with the cavities of the heart. The aortic valve is located on the path of blood flow from the left ventricle to the aorta, the pulmonary artery - from the right ventricle to the pulmonary trunk.

In the normal state of the valvular apparatus and myocardium, at the moment of contraction of one or another cavity, the valve flaps close tightly, preventing the reverse flow of blood. With a variety of heart lesions, this mechanism can be disturbed.

Sometimes in the literature and in the conclusions of doctors, one can find a mention of the so-called physiological regurgitation, which means a slight change in blood flow in the valve leaflets. In fact, in this case, there is a “swirl” of blood at the valve opening, while the cusps and myocardium are quite healthy. This change does not affect the circulation in general and does not cause clinical manifestations.

Physiological can be considered regurgitation of 0-1 degree on the tricuspid valve, in the mitral cusps, which is often diagnosed in thin tall people, and according to some reports, it is present in 70% of healthy people. This feature of the blood flow in the heart in no way affects the well-being and can be detected by chance during examination for other diseases.

As a rule, the pathological reverse flow of blood through the valves occurs when their valves do not close tightly at the time of myocardial contraction. The reasons may be not only damage to the leaflets themselves, but also papillary muscles, tendon chords involved in the mechanism of valve movement, stretching of the valve ring, pathology of the myocardium itself.

mitral regurgitation

Mitral regurgitation is clearly observed with or. At the moment of contraction of the left ventricular muscle, a certain volume of blood returns to the left atrium through an insufficiently closed mitral valve (MV). At the same moment, the left atrium fills with blood flowing from the lungs through the pulmonary veins. This overfilling of the atrium with excess blood leads to overdistension and increased pressure (volume overload). During atrial contraction, excess blood enters the left ventricle, which is forced to push more blood into the aorta with greater force, as a result of which it thickens and then expands ().

For some time, violations of intracardiac hemodynamics may remain invisible to the patient, since the heart, as best it can, compensates for the blood flow due to the expansion of its cavities.

With mitral regurgitation of the 1st degree, its clinical signs are absent for many years, and with a significant amount of blood returning to the atrium, it expands, the pulmonary veins overflow with excess blood and signs appear.

Among the causes of mitral insufficiency, which is the second acquired heart disease in frequency after changes in the aortic valve, one can single out:

Prolapse;
, on sashes MK;
Some connective tissue diseases, autoimmune processes, metabolic disorders (Marfan's syndrome, rheumatoid arthritis, amyloidosis);
(especially with damage to the papillary muscles and tendon chords).

With mitral regurgitation of the 1st degree, the only sign may be the presence of noise in the region of the apex of the heart, detected by auscultation, while the patient does not complain, and there are no manifestations of circulatory disorders. Echocardiography (ultrasound) can detect a slight divergence of the valves with minimal disturbances in blood flow.

Mitral valve regurgitation of the 2nd degree accompanies a more pronounced degree of insufficiency, and the stream of blood returning back to the atrium reaches its middle. If the amount of blood return exceeds a quarter of its total amount in the cavity of the left ventricle, then signs of stagnation in a small circle and characteristic symptoms are found.

The degree of regurgitation is said to be when, in the case of significant defects in the mitral valve, the blood flowing back reaches the posterior wall of the left atrium.

When the myocardium cannot cope with the excess volume of contents in the cavities, pulmonary hypertension develops, leading, in turn, to an overload of the right half of the heart, resulting in circulatory failure in a large circle.

At grade 4 regurgitation, the characteristic symptoms of severe blood flow disorders inside the heart and increased pressure in the pulmonary circulation are shortness of breath, arrhythmias, cardiac asthma and even pulmonary edema may occur. In advanced cases, swelling, cyanosis of the skin, weakness, fatigue, a tendency to (atrial fibrillation), pain in the heart join the signs of damage to the pulmonary blood flow. In many ways, the manifestations of severe mitral regurgitation are determined by the disease that led to damage to the valve or myocardium.

Separately, it should be said about mitral valve prolapse (MVP), quite often accompanied by regurgitation of varying degrees. Prolapse in recent years began to appear in diagnoses, although earlier such a concept was quite rare. In many respects, this state of affairs is associated with the advent of imaging methods - ultrasound examination of the heart, which allows you to trace the movement of the valves of the MV during heart contractions. With the use of Doppler, it became possible to determine the exact degree of blood return to the left atrium.

MVP is typical for tall, thin people, often found in adolescents by chance during examination before being drafted into the army or passing other medical examinations. Most often, this phenomenon is not accompanied by any violations and does not affect the lifestyle and well-being in any way, so you should not be scared right away.

Mitral valve prolapse with regurgitation is far from always detected, its degree in most cases is limited to the first or even zero, but at the same time, such a feature of the functioning of the heart may be accompanied by.

In case of detection of MVP of small degrees, one can limit oneself to the observation of a cardiologist, and treatment is not required at all.

Aortic regurgitation

The reverse flow of blood on the aortic valve occurs when it is insufficient or the initial section of the aorta is damaged, when, in the presence of an inflammatory process, its lumen and the diameter of the valve ring expand. The most common reasons for these changes are:

Rheumatic affection;
Infectious with inflammation of the valves, perforation;
Congenital malformations;
Inflammatory processes of the ascending aorta (syphilis, rheumatoid arthritis, ankylosing spondylitis, etc.).

Such widespread and well-known diseases as atherosclerosis can also lead to changes in the valve leaflets, aorta, and left ventricle of the heart.

Aortic regurgitation is accompanied by a return of blood to the left ventricle, which overflows with excess volume, while the amount of blood entering the aorta and further into the systemic circulation may decrease. The heart, trying to compensate for the lack of blood flow and pushing excess blood into the aorta, increases in volume. For a long time, especially with stage 1 regurgitation, such an adaptive mechanism allows you to maintain normal hemodynamics, and symptoms of disorders do not occur for many years.

As the mass of the left ventricle increases, so does its need for oxygen and nutrients, which the coronary arteries are unable to provide. In addition, the amount of arterial blood pushed into the aorta is getting smaller, which means that it will not come to the vessels of the heart enough. All this creates the prerequisites for hypoxia and ischemia, resulting in (proliferation of connective tissue).

With the progression of aortic regurgitation, the load on the left half of the heart reaches its maximum degree, the myocardial wall cannot hypertrophy indefinitely and it is stretched. In the future, events develop in the same way as with damage to the mitral valve (pulmonary hypertension, in small and large circles, heart failure).

Patients may complain of palpitations, shortness of breath, weakness, pallor. A characteristic feature of this defect is the occurrence of angina attacks associated with inadequacy of the coronary circulation.

Tricuspid regurgitation

The defeat of the tricuspid valve (TC) in an isolated form is quite rare. As a rule, its insufficiency with regurgitation is the result of pronounced changes in the left half of the heart (relative TC insufficiency), when high pressure in the pulmonary circulation prevents adequate cardiac output into the pulmonary artery, which carries blood for oxygenation to the lungs.

Tricuspid regurgitation leads to a violation of the complete emptying of the right half of the heart, adequate venous return through the vena cava and, accordingly, a systemic circulation appears.

For insufficiency of the tricuspid valve with regurgitation, the occurrence of atrial fibrillation, cyanosis of the skin, edematous syndrome, swelling of the cervical veins, enlarged liver and other signs of chronic circulatory failure is quite characteristic.

Pulmonary valve regurgitation

Damage to the cusps of the pulmonary valve can be congenital, manifesting itself in childhood, or acquired due to atherosclerosis, syphilitic lesions, changes in the cusps in septic endocarditis. Often, damage to the pulmonary valve with insufficiency and regurgitation occurs with existing pulmonary hypertension, lung diseases, and lesions of other heart valves ().

Minimal regurgitation on the pulmonary valve does not lead to significant hemodynamic disorders, while significant return of blood to the right ventricle, and then to the atrium, cause hypertrophy and subsequent dilation(expansion) of the cavities of the right half of the heart. Such changes are manifested by severe heart failure in a large circle and venous congestion.

Pulmonary regurgitation is manifested by all kinds of arrhythmias, shortness of breath, severe edema, accumulation of fluid in the abdominal cavity, changes in the liver up to cirrhosis and other signs. With congenital valvular pathology, symptoms of circulatory disorders occur already in early childhood and are often irreversible and severe.

Features of regurgitation in children

In childhood, the proper development and functioning of the heart and circulatory system is very important, but, unfortunately, violations are not uncommon. Most often, valvular defects with insufficiency and blood return in children are due to congenital developmental anomalies (hypoplasia of the pulmonary valve, defects in the septa between the atria and ventricles, etc.).

Severe regurgitation with an abnormal structure of the heart manifests itself almost immediately after the birth of a child with symptoms of respiratory disorders, cyanosis, and right ventricular failure. Often, significant violations end fatally, so every expectant mother needs not only to take care of her health before the intended pregnancy, but also to visit an ultrasound diagnostic specialist in a timely manner during gestation.

Possibilities of modern diagnostics

Medicine does not stand still, and the diagnosis of diseases is becoming more reliable and of high quality. The use of ultrasound has made significant progress in the detection of a number of diseases. The addition of ultrasound examination of the heart (EchoCG) with Dopplerography makes it possible to assess the nature of blood flow through the vessels and cavities of the heart, the movement of the valve flaps at the time of myocardial contractions, to establish the degree of regurgitation, etc. Perhaps this is the most reliable and informative method for diagnosing cardiac pathology in real time and at the same time being affordable and inexpensive.

In addition to ultrasound, indirect signs of regurgitation can be detected on, with careful auscultation of the heart and assessment of symptoms.

It is extremely important to identify violations of the valvular apparatus of the heart with regurgitation not only in adults, but also in the period of intrauterine development. The practice of ultrasound examination of pregnant women at different times makes it possible to detect the presence of defects that are not in doubt already during the initial examination, as well as to diagnose regurgitation, which is an indirect sign of possible chromosomal abnormalities or emerging valve defects. Dynamic monitoring of women at risk makes it possible to timely establish the presence of a serious pathology in the fetus and decide whether it is advisable to maintain pregnancy.

Treatment

The tactics of treating regurgitation is determined by the cause that caused it, the severity, the presence of heart failure and concomitant pathology.

It is possible both surgical correction of violations of the structure of the valves (various types,), and medical conservative therapy aimed at normalizing blood flow in the organs, combating arrhythmia and circulatory failure. Most patients with severe regurgitation and damage to both circulations need constant monitoring by a cardiologist, the appointment of diuretics, beta-blockers, antihypertensive and antiarrhythmic drugs, which will be selected by a specialist.

With mitral prolapse of a small degree, valvular regurgitation of another localization, dynamic observation by a doctor and timely examination in case of aggravation of the condition are sufficient.

The prognosis of valvular regurgitation depends on many factors: its degree, cause, age of the patient, the presence of diseases of other organs, etc. With a caring attitude to one's health and regular visits to the doctor, minor regurgitation does not threaten with complications, and with pronounced changes, their correction, including including surgical, allows you to extend the life of patients.

Mitral valve insufficiency (MIV) is the most common cardiac anomaly. Of all patients, 70% suffer from an isolated form of NMC. Usually, rheumatic endocarditis is the main underlying cause of the development of the disease. Often a year after the first attack, the condition of the heart leads to chronic insufficiency, the cure of which is quite difficult.

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

Septic endocarditis leads to the destruction of many cardiac structures, so NMC has the most severe manifestations. The flaps of the valve adjoin each other not tightly enough. When they are not completely closed through the valve, too much blood comes out, which provokes its reboot and the formation of stagnant processes, an increase in pressure. All signs lead to the increasing insufficiency of MK.

As you know, the main work of the heart muscle is to continuously transport blood through the human body and saturate it with oxygen.

In the heart itself, blood moves in a certain order from one department to another, after which it continues its movement through the veins in the systemic circulation.

With regurgitation, a reverse movement of blood occurs in various volumes, and the severity of symptoms depends on the indicators of the latter.

Regurgitation is a pathological process that indicates the malfunction of the heart muscle due to a serious illness. This state has 5 stages of development. Each of them needs to be considered:

Regurgitation is the movement of liquids or gases in the opposite direction, that is, in the direction opposite to natural. It is observed in hollow organs during muscle contractions.

The phenomenon occurs due to a partial loss of the functionality of the pulp or a violation of the structure of the partitions.

In the article we will talk about regurgitation of the 1st degree, what it is and the reasons for their occurrence. We will touch on both 2 and other degrees of pathology.

Regurgitation means fluid movement is the opposite of normal. For the cardiovascular system, this phenomenon is associated with the movement of blood and is characteristic of both heart valves and blood vessels. The situation of blood regurgitation in the heart valves depends on which valve is affected and occurs either in the systole or diastole phase.

Valvular heart defects include a group of disorders of the heart caused by a morphological or functional lesion of the valvular apparatus. Changes can be isolated and affect one valve or become generalized and affect several valves.

Valve pathology can be manifested by valvular stenosis, insufficiency, or, in some cases, a combination of these disorders.

This is explained by the fact that the main significant manifestation of this defect will be precisely the return flow of blood into the cavity of the left ventricle during cardiac diastole, caused by incomplete closure or complete non-closure of the semilunar valves.

Regurgitation is more common in men than in women. The incidence of pathology increases with age. However, AR caused by acquired rheumatic malformations is more typical for young patients.

Aortic valve regurgitation of the 1st degree implies the presence of a minimal return wave, which is not accompanied by the formation of significant circulatory disorders and does not require specific treatment.

Such a reverse wave is detected during color Doppler sonography and is designated as a return wave that does not extend beyond the outflow tract of the left ventricle (LV).

Trivial (minimal) mitral regurgitation (RG) can be observed in three percent of healthy people and is a variant of the individual norm. Such a reverse current is not accompanied by the formation of significant hemodynamic disorders and does not lead to the development of volume overload of the left ventricular cavity.

Such PH, like minimal aortic and mitral, does not require treatment. Patients with a slight reverse wave are recommended to undergo regular preventive examinations and avoid severe physical overload.

The rate of progression of acquired heart defects in rheumatism, endocarditis, etc., has little effect on the presence of such changes.

There are many diseases associated with the cardiovascular system, all of which are life-threatening, since it is this system that delivers nutrients and oxygen to all parts of the body. One of the pathological processes associated with blood flow is regurgitation of the heart valves. Many have heard this definition, but they do not understand well what it is and how much it affects life.

Regurgitation of the heart valves determines the process of blood flow in the opposite direction. This happens for various reasons. Depending on the volume of the passing flow, the degrees of regurgitation are distinguished, for example, blood can flow back from one part of the heart to another, or it can affect the entire circulation.

The detection of such a pathology has become easier with the use of ultrasound (ultrasound examination) of the heart. The method shows how the valves close and close and where the blood flows.

Causes and mechanism of development

The human heart is a four-chamber structure, the cavities of which are separated by valves. This prevents mixing of venous and oxygenated arterial blood, which keeps the heart working smoothly.

The mitral valve leaflets (MV) are 2 folds of connective tissue located between the left ventricle and the atrium. Violation of their functioning can be caused by:

infective endocarditis.
Rheumatism.
Congenital heart defects.

The action of the causative factor leads to damage (sagging, sclerosis) of the mitral valve cusps. Blood entering the left ventricle from the pulmonary veins and ejected during systole into the aorta partially enters the left atrium, since the valve remains half open. This leads to an increase in the load on the left ventricle and left atrium, pulmonary hypertension develops, and the volume of oxygenated blood entering the aorta decreases.

Cardiologists distinguish a slight physiological regurgitation, which is possible under normal conditions. For example, 70% of tall adults have an incomplete closure of the tricuspid valve that the person is unaware of. On ultrasound, slight swirling flows are determined with complete closure of the valves. It does not affect the general blood circulation.

Pathology occurs during inflammatory processes:

rheumatism,
infective endocarditis.

The formation of scars after an acute infarction, against the background of cardiosclerosis in the area approaching the leaflets and threads of the valve, leads to a breakdown of the necessary tension mechanism, changes the shape of the leaflets. Therefore, there is no complete closure.

In the pathological process, an equally important role is played by the diameter of the outlet, which must be blocked. Significant enlargement with left ventricular dilatation or hypertrophy prevents the aortic valve cusps from tightly fitting.

infective endocarditis.
Rheumatism.
Mitral valve prolapse.
Congenital heart defects.
A history of acute myocardial infarction.
Injuries and wounds of the chest.
Diseases leading to an increase in the left side of the heart - angina pectoris, arterial hypertension (the so-called relative mitral regurgitation).
Systemic diseases (amyloidosis, rheumatoid arthritis, Marfan's syndrome, etc.).

Causes

The causes of damage to the aortic valves, the diameter of the hole between the left ventricle and the initial section of the aorta are:

rheumatic inflammation with localization along the line of valve closure - tissue infiltration at the initial stage leads to wrinkling of the valves, forms a hole in the center for the passage of blood into the systole into the cavity of the left ventricle;
bacterial sepsis with damage to the endocardium and aortic arch;
warty and ulcerative endocarditis in severe forms of infection (typhoid fever, influenza, measles, scarlet fever), pneumonia, cancer intoxication (myxoma) - the valves are completely destroyed;
congenital malformations (the formation of two valves instead of three) involving the aorta, a large ventricular septal defect;
specific autoimmune processes in the ascending aorta in chronic syphilis, ankylosing spondylitis, rheumatoid arthritis;
hypertension, atherosclerosis - the process of sealing the valves with the deposition of calcium salts, the expansion of the ring due to dilatation of the aorta;
consequences of myocardial infarction;
cardiomyopathy;
chest trauma with rupture of the muscles that reduce the valves.

The reasons include complications in the treatment of heart diseases by catheter radiofrequency ablation, as well as cases of destruction of a biological valve prosthesis.

The portion of the aortic arch closest to the heart is called the aortic root. It is its structure that affects the "health of the valves" and the width of the gate ring from the left ventricle. Root lesions include:

age-related or degenerative changes that cause dilation;
cystic necrosis of the middle layer of the aorta in Marfan's syndrome;
dissection of the aneurysm wall;
inflammation (aortitis) in syphilis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis;
giant cell arteritis;
malignant hypertension.

Among the reasons, a negative effect of drugs used to reduce appetite in obesity was found.

This pathology occurs to a small extent in absolutely healthy people. But expressed, ranging from moderate to severe, is already a rare occurrence and is provoked by the following reasons:

congenital and acquired defects of the main "motor" of the body;
mitral valve prolapse;
transferred endocarditis of an infectious nature;
transferred myocardial infarction;
injuries.

At the same time, several degrees of applied valve pathology are distinguished. Mitral regurgitation of the first degree, in which the reverse flow looks like a swirl on the valve. In medicine, it is considered practically the norm and does not require correction with medications, but only observation.

In pathology of the second degree, the flow penetrates into the atrium for a distance not exceeding half of its length. In the third degree, this distance increases by more than half, and in the fourth degree, the flow reaches the back wall, penetrates behind the ear or into the veins of the lung.

In addition, mitral valve regurgitation can be acute or chronic. Acute leads to dysfunction of the papillary muscles or their rupture, acute rheumatic fever, etc. Chronic disease develops for the same reasons. Less commonly, it is caused by atrial myxoma, calcification of the mitral ring, which is characteristic of older women, etc.

NMC affects people who have one or more of the following pathologies:

congenital predisposition.
Syndrome of connective tissue dysplasia.
Mitral valve prolapse, characterized by regurgitation of 2 and 3 degrees.
Destruction and breakage of chords, rupture of the valves of the MC due to injuries in the chest area.
The rupture of the valves and chords in the development of endocarditis is infectious in nature.
Destruction of the apparatus that unites the valves in endocarditis due to diseases of the connective tissue.
Infarction of a part of the mitral valve with subsequent scar formation in the subvalvular region.
Change in the shape of the valves and tissues under the valves, with rheumatism.
Enlargement of the mitral annulus in dilated cardiomyopathy.
Insufficiency of valve function in the development of hypertrophic cardiomyopathy.
MK insufficiency due to the operation.

Mitral insufficiency is often accompanied by another defect - mitral valve stenosis.

Sometimes regurgitation is observed in absolutely healthy people (0-1 degree), but it is insignificant and does not interfere with life. According to WHO, the incidence of this pathology is 50–70%.

The causes of more pronounced mitral regurgitation are varied:

Congenital heart disease and valvular changes.
Acquired defects of the heart muscle.
History of myocardial infarction.
Trauma to the chest and heart.
Infectious diseases of the heart (endocardium).
valve prolapse.
Rheumatoid diseases.
Violation of the integrity and work of the muscles that are the engines of the valve leaflets.
In newborns, if the valve area is filled with protein deposits.

In addition to diseases, chest injuries can lead to the development of regurgitation, in which the heart is damaged.

The chronic form is caused by:

Pathology of the aortic valve:
- rheumatism;
- bacterial endocarditis;
- autoimmune diseases: rheumatoid arthritis, lupus erythematosus;
- atherosclerosis;
- severe chest injuries;
- diseases of the gastrointestinal tract: Whipple's disease, Crohn's disease;
- valve damage that occurs as a side effect of certain medications;
- wear of the valve bioprosthesis.
Pathology of the ascending aorta and its root:
- expansion of the aortic root in the elderly;
- aortitis caused by syphilis;
- hypertension;
- psoriasis;
- imperfect osteogenesis;
- Reiter's syndrome;
- Behçet's disease;
- Marfan's syndrome;
- cystic median necrosis of the aorta.

Acute aortic valve insufficiency is also provoked by damage to the valve, root and ascending aorta. The causes of pathology include:

severe chest trauma;
infective endocarditis;
prosthetic valve dysfunction;
dissection of an aortic aneurysm;
paraprosthetic fistula.

congenital anomalies of development or genetically determined pathologies of the connective tissue;
inflammation of the endocardium of a non-infectious (rheumatism, systemic lupus erythematosus) or infectious (bacterial, fungal endocarditis) nature;
structural changes: dysfunction of the papillary muscles, tears or ruptures of the chord, expansion of the mitral ring, cardiomyopathy that occurs with left ventricular hypertrophy.

From this article, you will learn what tricuspid regurgitation is, its causes, symptoms and the choice of treatment (depending on the stage and form of the disease).

When the tricuspid valve closes incompletely. In this condition, the patient has reversed blood flow from the right ventricle to the atrium.

The human circulatory system provides one-way blood flow. The blood from the ventricle to the atrium moves in one direction thanks to valves that close tightly with each contraction of the heart. If their incomplete closure occurs, then part of the blood returns to the ventricle (regurgitation).

The disease is treated by a cardiologist. The choice of method of therapy depends on the severity of the pathology. So, 1st degree does not need specific treatment, doctors recommend simply monitoring the patient's condition. Patients with grade 2 pathology undergo conservative treatment. And at degrees 3 and 4, it is possible to restore the work of the cardiovascular system only by surgical means.

Primary, the causes of which are such diseases: rheumatism, endocarditis (acute inflammation of the inner wall of the heart), myocardial infarction, the formation of fibrous plaques in the heart tissues and genetic predisposition. Secondary. Such valve damage is observed due to its stretching in cardiomyopathy and pulmonary hypertension, which increase the functional load on the right ventricle.

KA insufficiency is divided into rheumatic and non-rheumatic (this also includes degenerative forms of HR. In young patients, HR on the aortic valve is usually associated with:

acquired rheumatic heart disease and is combined with aortic stenosis, mitral valve disease (mitral regurgitation);

In addition to rheumatic damage to the heart, arterial hypertension with frequent hypertensive crises plays an important role in the formation of the return wave. A significant increase in blood pressure contributes to the expansion of the aortic root, contributing to the development of CA insufficiency.

The main causes of WG are divided into CA dysfunctions and pathologies of its root.

Valve dysfunctions include:

congenital defects of the KA (bicuspid or quadricuspid), accompanied by incomplete closure of the semilunar valves or prolapse (folding of the valves). In children, the most common cause of congenital severe regurgitation is the tetrad of Fallot, pulmonary valve (pulmonary artery) hyperplasia, significant septal defects;

Acquired defects that are accompanied by WG include:

hemodynamic disorders after infective endocarditis and valvuvit (inflammatory lesions of the cusps and endocardium);

Pathologies of the aortic root leading to WG include:

aneurysms;
root expansion against the background of arterial hypertension;
defeat of the cardiovascular system in syphilitic aortitis;
Ehlers-Danlos syndrome (hereditary connective tissue damage caused by defective collagen synthesis);
dilatation of the CA ring in patients with Marfan syndrome;
Reiter's syndrome, which develops with gonococcal or chlamydial infection;
blunt chest trauma.

Types, forms, stages

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

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

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

1 - the standard level of leaflet mobility (in this case, painful manifestations are dilatation of the fibrous ring, perforation of the leaflets).
2 - destruction of the valves (the chords take the most damage, as they are stretched or torn, and the integrity of the papillary muscles is also impaired.
3 - decrease in the mobility of the valves (forced connection of the commissures, reduction in the length of the chords, as well as their fusion).

There are several degrees of mitral regurgitation. They differ in the amount of blood returned. There are only 4 stages:

First. The volume of reverse blood flow is less than 25%. Mitral regurgitation of the 1st degree at the beginning of its development is not characterized in any way, but on the electrocardiogram one can already detect small malfunctions in the activity of the valves.
Second. In the pathology of the second degree, there is already a more significant hemodynamic failure. The blood returns in a volume of more than 25%, but not more than 50%. This results in pulmonary hypertension. Regurgitation at this stage can cause disturbances in the work of the myocardium. The ECG reveals a malfunction of the heart.
Third. When the disease progresses to the third stage, the volume of returned blood exceeds 50%. At this stage, other diseases often join, for example, left ventricular hypertrophy. The electrocardiogram clearly shows cardiac dysfunction.
Fourth. Regurgitation of this degree refers to a severe form of pathology. Because of it, a person can completely lose his ability to work, get a disability. At this stage, only surgery can prolong the life of the patient.

Aortic insufficiency is classified based on the volume of blood flow from the aorta to the heart. There are 4 degrees of this pathology:

I degree: the jet does not go beyond the outflow tract of the left ventricle.
II degree: the jet extends to the anterior mitral valve.
III degree: reaches the level of papillary muscles.
Grade IV: may reach the wall of the left ventricle.

Aortic regurgitation is a sign of valvular insufficiency, which can be acute or chronic. The acute form of the disease provokes a rapid violation of hemodynamics, and if a person is not provided with timely medical care, the likelihood of developing cardiogenic shock increases.

Chronic aortic insufficiency is characterized by the absence of pronounced symptoms. Gradually, dysfunction of the left ventricle develops, provoked by stagnation of venous blood in the small circle. Coronary arteries are also affected and diastolic blood pressure is reduced. Chronic aortic regurgitation leads to a gradual decrease in left ventricular contractility.

Mitral regurgitation is most often observed in patients with heart disease, severe valve prolapse. Another reason is the lack of MK. This manifests itself as follows: MK, or rather its wings do not close to the end. At the same time, the atrium continues to fill with blood, which flows through the veins from the lungs.

The result of overfilling is excessive stretching and increased pressure on the ventricle. It expands and thickens. This process is called dilation.

At first, the violation of functionality will not be noticeable to the patient. The heart mechanism compensates for blood flow. Cardiac cavities are hypertrophied.

If a diagnosis of regurgitation of the 1st degree, which concerns damage to the mitral valve, is made, then its clinical manifestations and consequences will not appear for many years. If the pathology is not eliminated, then pulmonary hypertension will be a likely outcome.

The reasons for this type of regurgitation are as follows:

Prolapse MK;
Rheumatic deviations;
Deposition of calcium salts on the valve leaflets;
atherosclerotic lesions;
ischemia of the heart;
autoimmune processes.

2 degree of pathology is expressed by a greater insufficiency of MK. The flow can reach the middle of the atrium. Stagnation according to the ICC and a number of other symptoms are possible.

3 degree of damage means that the blood stream during the reverse flow penetrates to the posterior wall of the left atrium. Pulmonary hypertension may occur, but only if the myocardium cannot function normally. It leads to an excessive load on the right half. There is insufficiency in BCC.

If the 4th degree of regurgitation is diagnosed, then the symptoms will have the following character:

Changes in blood flow;
Increase in pressure according to the IWC;
shortness of breath;
Flickering type arrhythmia;
Asthma of the cardiac type;
Swelling of the lungs.

Patients often experience heart pain. There is weakness, a noticeable cyanosis of the skin. Symptoms of mitral regurgitation are due to the disease that caused the pathology.

At 1 or 2 degrees, treatment is not required. It is enough to periodically see a cardiologist.

Applied aortic pathology may be due to aortic valve insufficiency. Another option is changes in the functionality of the initial aortic section, which occurs in the presence of one of the possible inflammatory processes.

Rheumatic lesions;
Perforations of the aortic cusps;
Defects related to congenital;
Inflammation of the valves, as a result of infection.

Other causes may be arterial hypertension or atherosclerosis. With regurgitation, blood flows back into the left ventricle. The result is excess blood volume. At the same time, the blood that flows through the BCC decreases.

The mechanism will attempt to compensate for this lack of volume, and excess blood will inevitably flow into the aorta. With a 1 degree lesion, normal hemodynamics will be maintained for quite a long time. Symptoms do not appear for years.

If the pathology begins to progress, then there will be a load on the left half of the heart.

It occurs to the maximum extent, which leads to stretching of the myocardial wall, which simply cannot hypertrophy constantly and without consequences.

There is heart failure, pulmonary hypertension, stagnation of blood in the BCC and ICC

Pathology of the tricuspid valve is rare when considered as an isolated lesion. Usually subvalvular regurgitation of the tricuspid valve is the result of early changes in the structure of the left side. The characteristic of the pathology tells us that the lungs begin to enrich the blood with oxygen less.

Due to a violation of the normal flow through the vena cava, stagnation occurs in the venous part of the BCC.

With the defeat of the tricuspid valve, the following symptoms appear:

Atrial fibrillation;
Blueness on the skin;
swelling;
Swelling of the veins in the neck;
Increase in hepatic volume.

acute and chronic;
rheumatic and non-rheumatic;
associated with pathologies of the CA, root or ascending aorta.

The development of acute CA insufficiency in a short time leads to the formation of significant circulatory disorders due to the fact that the left ventricle does not have time to adapt to an increase in end-diastolic volume.

Excessive diastolic pressure in the LV cavity contributes to:

increased pressure in the pulmonary veins;
accession of diastolic mitral WG;
pulmonary congestion.

In chronic AP, there is a discharge of a part of the effective VR back into the cavity of the left ventricle and its severe volume overload. As a consequence of this process, the development of eccentric LV hypertrophy occurs compensatory.

In the future, the compensatory capabilities of the myocardium are exhausted, the walls of the left ventricle become thinner and develop:

dilatation of the LV cavity;
a sharp decrease in ejection fraction and CO (cardiac output).

In accordance with the localization of violations of the heart valves, they are divided into classifications:

Mitral regurgitation is when blood flows from the left ventricle of the heart back into the atrium. This leads to its stretching and increased work and wear. At first, this is not noticed by a person in any way, since the heart compensates for the pathology by changing its shape. Its causes include diseases of the heart and blood vessels, joints and muscles, dysfunction of valves, deposits of cholesterol and calcium on the inner walls of blood vessels and myocardium, some pathologies of the connective tissue, autoimmune processes, improper functioning of metabolic processes, a decrease in blood supply to certain parts of the body;
Aortic regurgitation is formed with incomplete closure of the valves or pathologies associated with the structure of the largest unpaired vessel, when, expanding, the valve ring also increases and the valve simply cannot close completely. Here there is a reverse flow of blood into the ventricle, which begins to fill too much, stretching, it takes more blood, and much less of it enters the vessel. In this case, the heart begins to pump blood faster and stronger. As a result, oxygen starvation, stagnation of blood in large vessels;
Tricuspid regurgitation is less common. Occurs with increased pressure in a small circle. It leads to the devastation of the right side of the heart, after which stagnation occurs in the veins of the large circle. Outwardly, this can manifest itself in the blue of the skin, an increase in the size of the liver, swelling of the veins in the neck, atrial fibrillation;
Pulmonary artery regurgitation can occur with atherosclerosis, syphilis, endocarditis, or be congenital. Not infrequently, such a pathology occurs with diseases of the pulmonary system. It is an incomplete closure of the valve in the artery of the pulmonary circulation.

Forms of mitral insufficiency

Mitral regurgitation 1 and 2 degrees

Mitral regurgitation of the 1st degree (minimal) is the most initial degree of divergence of the valves. Their deflection into the left atrium occurs by no more than 3–6 mm. This degree, as a rule, is not clinically manifested. When listening to the heart (auscultation), the doctor may hear a characteristic murmur at the apex or "click" of the mitral valve, characteristic of prolapse. Confirm regurgitation is possible only with an echocardiographic study of the heart (ultrasound).

Mitral regurgitation of the 2nd degree is the return of blood in a volume of 1/4 or more of the total amount of blood in the left ventricle. Valve prolapse in this case can be from 6 to 9 mm. At this degree, the load on the left ventricle becomes greater as the volume of blood to be pumped increases.

In addition, the pressure in the pulmonary veins and in the entire pulmonary circulation increases. All this is manifested by complaints in the form of shortness of breath, weakness and fatigue, cardiac arrhythmias, and sometimes pain in the region of the heart. The patient may experience pre-syncope and fainting. If left untreated, heart failure may develop.

Mitral regurgitation of the 3rd degree is the return of blood from the ventricle to the atrium in a volume of more than 1/2 of the volume of the ventricle. Prolapse in this case can be more than 9 mm of valve deflection. This is a severe degree that overloads not only the left sections of the heart, but also the right ones. Pulmonary insufficiency develops with severe shortness of breath, cyanosis of the skin, cough and wheezing during breathing. Heart failure manifests itself in the form of edema, portal hypertension (increased pressure in the vessels of the liver), and heart rhythm disturbances.

4 degree mitral regurgitation is an extremely serious condition, which is accompanied by heart failure and occurs when the blood of the left ventricle returns in a volume of more than 2/3.

cardioportal.ru

Minimal disturbance of blood flow, which is absolutely asymptomatic. The presence of a reverse blood stream up to 2 cm long. Regurgitation is more than 2 cm. The disease is accompanied by acute heart failure.

The term "regurgitation" is quite often found in the everyday life of doctors of various specialties - cardiologists, therapists, functional diagnosticians.

Many patients have heard it more than once, but they have little idea what it means and what it threatens. Should I be afraid of the presence of regurgitation and how to treat it, what consequences to expect and how to identify? We will try to find out these and many other questions.

Regurgitation is nothing more than the reverse flow of blood from one chamber of the heart to another. In other words, during the contraction of the heart muscle, a certain volume of blood, for various reasons, returns to the cavity of the heart from which it came. Regurgitation is not an independent disease and therefore is not considered a diagnosis, but it characterizes other pathological conditions and changes (heart defects, for example).

A detailed description of regurgitation, the allocation of its degrees and detection in a large number of people became possible with the use of ultrasound examination of the heart (echocardiography), although the concept itself has been known for a long time. Auscultation of the heart provides subjective information, and therefore does not allow judging the severity of blood return, while the presence of regurgitation is beyond doubt, except in severe cases.

Accounting for the prevalence of pathology is carried out exclusively among professional functional diagnostic specialists. The degree cannot be judged in relation to the total population. Only the degree of spread is taken into account by the number of patients who have been examined by the Doppler method.

Signs of backflow of blood through the heart, namely through the aorta, have been found to date in slightly less than 9% of women and 13% of male patients. Among all variants of pathology, the most common is aortic. It occurs in one in ten subjects.

This is a chronic disease. The effects are most noticeable in older men. The consequences of regurgitation can affect the systemic (BCC) and pulmonary circulation (ICC).

There are four degrees of blood transfusion in the opposite direction:

With grade 1 valvular regurgitation, there are no symptoms for several years. A large amount of returning blood enlarges the heart compartment, which can cause, if proper treatment is not followed when detected, a persistent increase in blood pressure. When examining the patient, a heart murmur is detected, ultrasound shows a slight discrepancy in the valve and a slight violation of blood flow.
2 degree of regurgitation of the heart valves is characterized by a greater severity of the returning flow. There is stagnation in a small circle.
3 degree of valve regurgitation is characterized by a large reverse jet, the flow of which reaches the posterior wall of the atrium. Here, an increase in blood pressure develops in the pulmonary artery, due to which there is an overload on the right side of the heart muscle. As a result of such a violation, insufficiency occurs in the systemic circulation.

At the last stage, shortness of breath, heart rhythm disturbance, asthma, and pulmonary edema appear. If you do not consult a doctor for help, swelling, blueness of the skin (skin acrocyanosis), weakness, fatigue, pain in the chest area appear.

The severity of the stages is determined by the power of the blood stream that returns to the ventricle or atrium:

does not extend beyond the anterior cusp of the valve connecting the left ventricle to the atrium;
reaches or passes the sash;
in terms of flow, it approaches half the length of the ventricle;
the jet touches its top.

They also distinguish prolapse of the bicuspid heart valve, due to which there is a reverse flow of body fluid of varying degrees. Previously, this diagnosis was not often made. This is due to newer ways to detect the disease. The use of the Doppler method helped to establish the exact amount of the returning jet.

Heart valve prolapse is found in thin, tall people, teenagers. In most cases, the disease does not cause any ailments in the patient and is detected in young people by chance, passing through various medical examinations, for example, when entering an institute, or before being drafted into the army.

If the degree is first or even zero, then there is no need for treatment. The main thing is not to miss the transition, the formation of complications, for this it is necessary to be examined by a doctor.

What happens in the heart during the development of regurgitation

Doctors identify the following most common causes of the development of this disease:

Usually, tetralogy of Fallot is diagnosed in early childhood due to severe symptoms in a child who is immediately operated on. The disease in question often causes thickening of the walls of the right heart ventricle. This, in turn, can lead to the development of heart failure. In another case, an existing pathology can provoke the occurrence of this disease.

In medicine, there is the concept of physiological regurgitation. This state is called physiological only if the changes that have arisen due to pathology are insignificant. That is, the blood flow at the valve slows down, but at the same time, the heart muscle does not undergo any negative changes and remains healthy. Usually, regurgitation of the 1st degree is considered a physiological phenomenon.

Blood from the vessels enters the atrium (in the right - venous, in the left - arterial). Filled with blood, the atria contract, pushing their contents into the ventricles, while the valves open (tricuspid on the right, mitral on the left). After all the fluid has flowed into the ventricles, the valves close tightly, preventing backflow. After the valves close, a powerful contraction of the ventricles occurs, blood rushes through the arteries.

The left side of the heart works with a higher load, because it supplies blood to all organs and tissues of the body. This is what happens normally.

To accommodate the blood that has flowed from the ventricle and entered through the veins, the atrial chamber gradually increases. At the same time, due to the fact that the atrial cavity is partially filled at the moment of relaxation, the blood flow in the pulmonary veins worsens, leading to stagnation in the pulmonary circulation. The flow of increased volume of blood flow from the atrium into the ventricular cavity gradually leads to its increase.

The degree of health risk in this pathology depends on the size of regurgitation and how it develops.

In acute valvular insufficiency, symptoms increase rapidly.

A person develops:

stagnation of blood first in a small, and then in a large circle of blood circulation; pulmonary edema, often bilateral; insufficiency of both ventricles; cardiogenic shock.

Such patients need urgent hospitalization and resuscitation. With untimely assistance, a fatal outcome is possible.

In this case, the pathology develops gradually, at the initial stage it can be asymptomatic or accompanied by a slight pain syndrome and shortness of breath with little physical exertion.

With the further development of the disease:

cardiac decompensation occurs; stagnation of pulmonary blood flow develops; there are disturbances in the work of the right atrium, and then the ventricle.

If the disease was not diagnosed in a timely manner, the person did not start treatment, then in the future the heart increases in size and is no longer able to provide a full blood supply to organs and tissues. Insufficiency of a large circle of blood circulation develops.

Features of regurgitation in children

In childhood, the proper development and functioning of the heart and circulatory system is very important, but, unfortunately, violations are not uncommon. Most often, valvular defects with insufficiency and blood return in children are due to congenital developmental anomalies (tetralogy of Fallot, hypoplasia of the pulmonary valve, defects in the septa between the atria and ventricles, etc.).

Regurgitation in children is usually congenital. Violations in the functioning of the heart are quite common.

Congenital heart valve defects, which result in regurgitation, are caused by the following anomalies:

Hypoplasia of the pulmonary valve;
Partition defects;
Tetralogy of Fallot.

With an abnormal structure of the heart, the symptoms of regurgitation are visible soon after birth. Respiratory disorders, cyanosis of the skin, right ventricular failure are mainly observed. Significant violations often lead to death.

Experts recommend that future parents, especially mothers, carefully monitor their own health even before trying to conceive. During pregnancy, it is necessary to be observed by the attending physician. Regular ultrasound examinations are required.

Heart valve regurgitation in children mainly occurs due to congenital causes. Such cases are noted quite often. A pronounced manifestation of the disease is noted almost immediately after birth.

Signs on the face: blue skin, difficulty breathing, heart failure in the right side of the heart. Such violations can lead to the death of a newborn, therefore, during pregnancy, it is necessary to attend routine examinations from a specialist.

Mitral valve insufficiency symptoms and signs

Mitral valve insufficiency (left atrioventricular insufficiency) - non-closure (or incomplete closure) of the mitral valve cusps, leading to pathological reflux of blood (regurgitation) into the left atrium from the left ventricle during its systole. In this article, we look at the symptoms of mitral valve insufficiency and the main signs of mitral valve insufficiency in humans.

Prevalence

Isolated rheumatic mitral valve insufficiency is observed in 10% of cases of all acquired defects. It occurs more often in men. Often associated with mitral stenosis or aortic valve disease.

The pathogenesis of mitral valve insufficiency

In this case, a rupture of the tendon filaments may occur. In this regard, the aphorism "mitral regurgitation generates mitral regurgitation" is legitimate. Dilatation of the left atrium leads to tension of the posterior leaflet of the mitral valve and an increase in non-closure of the mitral orifice, which further exacerbates mitral valve insufficiency.

Constant overload of the left ventricle with excess blood volume leads to hypertrophy of its walls. An excess amount of blood in the left atrium subsequently causes a retrograde increase in pressure in the pulmonary circulation and the development of pulmonary hypertension (unlike mitral stenosis, it develops much later and is much less pronounced). In the advanced stage of mitral valve insufficiency, chronic heart failure develops (according to the right ventricular type).

Signs of mitral valve insufficiency

Clinical manifestations of mitral valve insufficiency depend on the degree of regurgitation, the rate and cause of its development, as well as on the functional state of the left ventricle and left atrium.

Mitral valve insufficiency symptoms

With unexpressed mitral valve insufficiency, there may be no complaints. With moderate insufficiency and a slight increase in pressure in the pulmonary circulation, rapid fatigue during physical exertion (low cardiac output does not provide the skeletal muscles with sufficient oxygen) and shortness of breath, quickly disappearing at rest, are of concern.

Severe mitral valve insufficiency and more pronounced pulmonary hypertension are characterized by the occurrence of shortness of breath with little physical exertion, attacks of nocturnal paroxysmal shortness of breath, congestion in the lungs, and hemoptysis. Acute mitral valve insufficiency (with myocardial infarction) is manifested by pulmonary edema or cardiogenic shock.

Examination for mitral valve insufficiency

With unexpressed mitral valve insufficiency, there are no external manifestations of the defect. In the advanced stage of mitral valve disease, there are characteristic manifestations of chronic heart failure.

Percussion for mitral valve insufficiency

The expansion of the boundaries of relative cardiac dullness to the left is characteristic with severe mitral valve insufficiency.

Palpation for mitral valve insufficiency

The apex beat is displaced to the left and down due to dilatation of the left ventricle. With severe mitral valve insufficiency, systolic trembling is detected at the apex of the heart.

Auscultation of the heart in mitral valve insufficiency

Heart sounds

The I tone is usually weakened (it is difficult to estimate at the expressed systolic noise). II tone is not changed if there is no severe pulmonary hypertension. With a significant shortening of the ejection time of the left ventricle, a paradoxical splitting of the II tone occurs. In addition, a pathological III tone is heard in diastole, which occurs with a sudden tension of the papillary muscles, tendon filaments and valves. It (together with a weakened I tone) is considered an important auscultatory sign of severe mitral valve insufficiency.

When pulmonary hypertension occurs, the accent of the II tone is heard over the pulmonary trunk in the II intercostal space to the left of the sternum.

Systolic murmur in mitral valve insufficiency

The main symptom of mitral valve insufficiency is systolic murmur. It is holosystolic (throughout the entire systole) and captures I and II heart sounds. The murmur is most pronounced at the apex of the heart; it can irradiate to the left into the axillary region with damage to the anterior leaflet and up along the sternum with damage to the posterior leaflet. The noise increases with increasing afterload (isometric arm tension).

ECG with mitral valve insufficiency

In sinus rhythm, signs of hypertrophy and dilatation of the left atrium are revealed. Signs of left ventricular hypertrophy are recorded at an advanced stage of mitral valve insufficiency. When the defect is complicated by atrial fibrillation, its signs appear on the ECG.

Echocardiography in mitral valve insufficiency

Echocardiography allows you to identify the cause of mitral valve insufficiency (by its morphology), assess the degree of regurgitation and the function of the left ventricle and atrium.

Rheumatic insufficiency of the mitral valve is characterized by thickening of its valves (especially along the edges) and tendon filaments. The posterior leaflet may be less mobile than the anterior leaflet due to subvalvular adhesions.

Infective endocarditis. Mitral valve insufficiency in infective endocarditis is characterized by the presence of vegetation, perforations of the leaflets, and tearing of the tendon filaments. More precisely, these changes can be detected by transesophageal echocardiography.

ischemic heart disease. Mitral valve insufficiency in IHD is characterized by dilatation of the left ventricular cavity, local disturbances in the movement of the walls of the left ventricle (dyskinesia), normal (non-thickened) mitral valve cusps, and the central location of the regurgitation jet in most cases.

I degree, insignificant, - the length of the jet of regurgitation is up to 4 mm from the base of the mitral valve cusps into the left atrium.

II degree, moderate, - 4-6 mm.

III degree, medium, - 6-9 mm.

IV degree, expressed - more than 9 mm.

It should be remembered that the volume of regurgitation depends on the size of the opening remaining between the leaflets of the mitral valve when they close, the magnitude of the pressure gradient between the ventricle and the atrium, and the duration of regurgitation. The degree of mitral regurgitation is not fixed and may vary in the same patient depending on the conditions and applied JTC.

X-ray examination of mitral valve insufficiency

With severe mitral valve insufficiency, dilatation of the left atrium and its auricle (third arc) and an increase in the left ventricle (fourth arc) are detected. Cardiomegaly is found at a far advanced stage of the defect.

Signs of pulmonary hypertension on the radiograph may be absent with a slight severity of the defect. With severe mitral regurgitation, characteristic signs of pulmonary hypertension appear.

Catheterization of the heart cavities in mitral valve insufficiency

I degree - less than 15% of the stroke volume of the left ventricle.

II degree - 15-30%.

III degree - 30-50%.

IV degree - more than 50% of the stroke volume.

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

Stage 1 disease has no specific symptoms.
Stage 2 does not allow patients to exercise in an accelerated mode, as shortness of breath, tachycardia, pain in the chest, heart rhythm disturbance, discomfort immediately appear. Auscultation in mitral insufficiency determines the increased intensity of the tone, the presence of background noise.
Stage 3 is characterized by left ventricular failure, hemodynamic pathologies. Patients suffer from constant shortness of breath, orthopnea, accelerated heart rate, feel discomfort in the chest, their skin is paler than in a healthy state.

It is possible to suspect the presence of mitral valve regurgitation during examination and auscultation, as well as in the presence of complaints corresponding to a certain degree. The patient is assigned laboratory tests of blood and urine. With their help, you can identify inflammation, changes in protein and blood sugar, as well as characteristic indicators of concomitant diseases. Instrumental diagnostic methods will help confirm the diagnosis:

Electrocardiography may show signs of enlargement of the left heart, ischemia, arrhythmia.
X-ray examination of the chest organs. The picture shows the expanded borders of the heart, signs of pulmonary edema and other pathology.
Daily ECG monitoring. A study is carried out using a device that monitors the work of the heart throughout the day. It helps to determine the features of the rhythm at different times of the day and to note short-term rhythm disturbances.
Ultrasound of the heart (echocardiography) is the most accessible and reliable method for diagnosing heart pathology. This type of study helps to determine the increase in the heart, the presence of changes in the valvular apparatus. With the help of ultrasound, you can visually observe the presence of reverse blood flow in the cavities of the heart and determine the degree of regurgitation.
Transesophageal ultrasound helps to examine the mitral valve in more detail and in more detail. This type of diagnosis is also indicated before valve plasty.
Before surgical treatment, cardiac catheterization is performed.
It is very important to determine the pathology of the valvular apparatus in the fetus. For this, an ultrasound examination is performed during pregnancy.

What is cardioneurosis, symptoms and treatment

With acutely developed mitral valve insufficiency (for example, due to rupture of the papillary muscles during myocardial infarction), minutes count, and immediate medical attention is required.

Chronic mitral regurgitation does not manifest itself for a long time, although the disease only progresses over time.

There are four degrees of the disease:

Insufficiency of MK 1 degree. There are no complaints. Auscultation reveals a soft soft systolic murmur at the apex of the heart, best heard when the patient lies on the left side. On R-graphy and ECG changes are nonspecific. On echocardiography, mitral regurgitation of the 1st degree is manifested by a slight divergence of the valves, minimal reverse blood flow.
MK insufficiency of the 2nd degree. The first complaints appear: weakness, fatigue, shortness of breath during physical exertion (due to stress on the pulmonary circulation). Systolic murmur at the apex persists, there is a weakening of the I tone. On R-graphy and ECG, the manifestations of the disease are still not visible. Ultrasound of the heart with a doler fixes the reverse movement of blood at a distance of 1.5 cm and below.
Insufficiency of MK 3 degrees. Complaints intensify: shortness of breath with slight exertion, a cough with difficult to separate viscous sputum, a feeling of palpitations, "somersaults" of the heart in the chest. On examination, there is a pale face with cyanosis of the lips and tip of the nose. On the ECG and R-graphy, the first signs of left ventricular hypertrophy appear: a levogram, an expansion of the shadow of the heart. Echocardiography indicates a reverse reflux of blood, occupying half of the atrium.
Insufficiency of MK 4 degrees. The terminal stage of the disease: bright signs of heart failure, pulmonary hypertension, excruciating cough with streaks of blood. A typical appearance of the patient: a pale face with a bright cyanotic blush caused by oxygen deficiency in peripheral tissues. A "heart hump" appears - a pulsating projection of the heart in the left side of the chest. ECG and X-ray indicate an increase in the left volumes of the heart: a sharp deviation of the EOS to the left, smoothing the waist of the heart and displacement of the border (the outlines of the organ take the form of a shoe). Ultrasound captures the filling of the atrium with blood during cardiac output completely.

Most patients with such a pathology do not feel any discomfort and discomfort, but gradually, as the volume of the left atrium increases, pulmonary pressure increases, as well as left ventricular remodeling. The patient begins to suffer from shortness of breath and fatigue, increased heart rate, that is, signs of heart failure manifest themselves.

Mitral regurgitation of the 1st degree does not have such signs, but in moderate and severe forms, palpation reveals an increase in the left atrium. The left ventricle is hypertrophied. In addition, noise is heard during listening.

The latter increase with squatting and shaking hands. That is, we are talking about a complication of mitral regurgitation associated with the above symptoms of heart failure and atrial fibrillation.

Prevalence

Heart sounds

II degree - 15-30%.

The clinical manifestations of this pathology will correspond to the severity of its development.

0-1 degree of regurgitation is recognized as a physiological feature. It occurs frequently in tall and thin people. Pathology of the 1st degree is asymptomatic for a long time, since the heart manages to compensate for this condition by expanding the cavities of the heart and thickening its walls. The only clinical sign of regurgitation is the presence of a murmur that can be heard on auscultation at the apex. At this time, the person does not feel any problems in the heart and, accordingly, does not complain.

Pathology of the 2nd degree. In this case, more blood is thrown, the volume of which reaches the middle of the atrium. If the return of blood is more than 25% of the total volume, then there is stagnation in the pulmonary circulation. This condition is manifested by characteristic symptoms:

pain in the chest, in the area of the projection of the heart;
feeling of tightness in the chest and lack of air;
frequent breathing;
interruptions in the work of the heart;
lethargy, constant fatigue, possible loss of consciousness.

If the reverse flow of blood reaches the posterior wall of the atrium, then in this case regurgitation of the 3rd degree develops. In this case, the myocardium can no longer cope with such a load and pulmonary hypertension occurs. It, in turn, contributes to the overload of the right heart. Insufficiency of a large circle of blood circulation develops. The patient has an increase in the size of the liver, edema. Hypertension develops.

With the development of pathology of the 4th degree, there is a pronounced violation of intracardiac circulation, aggravation of pulmonary hypertension. The patient may develop pulmonary edema, arrhythmias, cardiac asthma. Symptoms correspond to the underlying disease that caused mitral valve failure.

If a patient develops grade 1 minimal mitral regurgitation, then no clinical signs will be observed. A person can live for several years and not suspect that the work of his heart is broken.

With the development of the disease, the patient has symptoms such as shortness of breath, palpitations, fatigue, coughing up blood. If you do not engage in treatment, a person has swelling of the legs, failure of the sinus rhythm of the heart, hypoxia, heart failure.

In most cases, stage 1 of the disease does not have clearly defined symptoms. Some patients may experience signs of heart failure.

In the event that a sick person does not have this disease, such symptoms may occur due to impaired functioning of the right heart ventricle. Regurgitation of the 1st degree as an independent pathology does not cause significant disturbances in the human circulatory system.

This is due to the expansion of the chambers and the thickening of the walls of the heart muscle.

Despite the concealment of the heart defect in the first stage, some patients have the following symptoms:

severe shortness of breath;
blueing of the skin;
mild hypertension;
swelling;
weakness;
dizziness.

In cases where this defect of the pulmonary artery has a congenital form, the disease manifests itself in the first few months of a child's life. Most sick children have severe symptoms due to the severe form of the disease.

It is for this reason that both adults and children should undergo appropriate procedures and tests annually to help identify the disease at an early stage.

Chronic aortic insufficiency manifests itself when a person's left ventricular function is impaired. Symptoms:

shortness of breath (at first observed only during physical exertion, and at rest indicates the progression of the disease);
bradycardia, most often at night;
angina pectoris (less common).

The acute form of the disease is characterized by the following manifestations:

severe shortness of breath;
fainting state;
chest pain;
loss of strength.

Acute aortic regurgitation that occurs with valvular insufficiency has symptoms similar to aortic dissection. Therefore, if a person has the symptoms listed above, he needs emergency medical help.

There are also symptoms that indicate aortic valve insufficiency:

rhythmic change (pulsation) in the color of the tongue, palate, tonsils and nail plates;
constriction of the pupils, alternating with their expansion;
pronounced pulse in the temporal, carotid and brachial arteries;
pallor of the skin.

If a person has found such symptoms in himself, he should contact a cardiologist. Aortic insufficiency, like any other disease of the heart and blood vessels, must be diagnosed in a timely manner.

Mitral regurgitation of the 1st degree often does not manifest itself in any way, and the person remains practically healthy. Thus, this pathology is found in 1.8% of healthy children aged 3–18 years, which does not interfere with their future life at all.

The main symptoms of pathology:

fast fatiguability;
heartbeat;
shortness of breath, first with exertion, then at rest;
if the conduction of an impulse from the pacemaker is disturbed, atrial fibrillation;
manifestations of chronic heart failure: edema, heaviness in the right hypochondrium and liver enlargement, ascites, hemoptysis.

Listening to the tones (sounds) of the heart, the doctor finds that the 1st tone (which normally occurs when the valve leaflets close between the ventricle and the atrium) is weakened or completely absent, the 2nd tone (normally appearing due to the simultaneous closing of the aortic valves and the pulmonary trunk) splits into aortic and pulmonary components (that is, these valves close asynchronously), and between them a so-called systolic murmur is heard.

The final diagnosis is made with Doppler echocardiography. Determine the approximate volume of regurgitation, the size of the chambers of the heart and the safety of their functions, the pressure in the pulmonary artery. With echocardiography, mitral valve prolapse (sagging) can also be seen, but its degree does not affect the volume of regurgitation in any way, therefore it is not important for further prognosis.

The presence of visible pulsation of the cervical veins. Swelling of the blood vessels in the left side of the sternum and right hypochondrium. Progressive swelling of the soft tissues of the legs. Loss of efficiency and fatigue. Frequent feeling of "chillness". Feeling of rapid heartbeat. Frequent urination. Shortness of breath, which first disturbs the patient during physical exertion, and then is diagnosed at rest. Periodic bouts of abdominal pain. Yellow shade of the skin, which is combined with pain in the right hypochondrium.

The severity of the above symptoms depends on the individual characteristics of the organism and the degree of damage. So, for example, a patient diagnosed with tricuspid regurgitation at the initial stage has no pathological symptoms. A pronounced clinical picture, as a rule, is observed in the 3rd–4th phase of the disease, when radical intervention is required.

pronounced pulsation on large aortic trunks;
"dance of the carotid" (pulsation visible to the eye on the carotid arteries);
pupillary pulsation;
fainting states;
pallor and cyanotic shade of the skin;
liver enlargement;
shift of cardiac borders to the left;
the appearance of diastolic noise in the 2nd intercostal space on the left;
chest pain.

Diagnostics

Indirect signs of aortic regurgitation are noted on:

chest radiograph - the left contour of the heart shadow is expanded to the side and down, the expansion of the aortic arch looks like an aneurysm, clear signs of enlargement of the left atrium, it is possible to detect calcifications in the aortic arch;
electrocardiogram - overload of the left parts of the heart is detected.

In the diagnosis of regurgitation, echocardiography is the main objective method, it allows you to determine the cause, the degree of regurgitation, the sufficiency of compensatory reserves, circulatory disorders even in the asymptomatic stage of the disease with minimal disturbances. It is recommended for patients in the initial stage annually, with the appearance of clinical symptoms twice a year.

The calculations take into account the surface area of the patient's body, due to the absence of a pronounced expansion of the ventricular chamber in short people.

The most commonly used mode is color Doppler scanning. The sensors are installed in such a way as to measure the area of blood flow at the aortic cusps, in the initial section of the aorta and compare it with the width of the passage. In severe cases, it exceeds 60% of the ring diameter.

In the practice of cardiologists, the division of the return jet into 4 degrees is used in relation to its length to the size and internal formations of the left ventricle:

1 - does not go beyond the border of half the length of the anterior leaflet at the mitral valve;
2 - reaches or passes the sash;
3 - in terms of flow, it approaches half the length of the ventricle;
4 - the jet touches the top.

If there is not enough information with Doppler sonography, the following are performed:

magnetic resonance imaging;
radionuclide angiography;
cardiac catheterization.

The degree of this pathology is determined by Doppler echocardiography. In addition, the doctor may additionally recommend Holter monitoring, x-rays, blood tests and exercise testing, such as undergoing a procedure such as bicycle ergometry. Only after that the doctor decides on a reasonable therapy.

In acute mitral regurgitation, emergency mitral valve repair or replacement is performed. Surgeons cannot determine the ideal time for the operation, but if it is done before the development of ventricular decompensation, including in children, the chances of preventing worsening of the left ventricle increase.

I must say that the pathology of the first and second degree is not a contraindication to pregnancy and childbirth, but in more severe cases, it is necessary to first assess all the risks and only then make a decision.

The prognosis is largely determined by the functions of the left ventricle, the degree and duration of this pathology, its severity and causes. As soon as the disease manifests itself first with minimal, and then with pronounced symptoms, then every year about 10% of patients are admitted to the hospital with clinical manifestations of mitral regurgitation. About 10% of patients with chronic pathology require surgical intervention.

Common methods for detecting NMC:

If there is the slightest suspicion of a violation in the work of the heart, you should contact a cardiologist. You can also first visit a therapist who, if necessary, will refer you to the right specialist. During the examination, the doctor examines the symptoms, medical history, conducts auscultation.

If there is regurgitation, then when listening, the doctor reveals that the first tone is very weak or does not appear at all, and the second tone is divided into two sounds and is accompanied by a systolic murmur. The presence of noise and suggests a violation of blood flow in the heart.

With a severe degree of development of the pathology, listening shows the appearance of an additional third tone. It appears due to the fact that the ventricle is quickly filled with a large volume of blood.

To make an accurate diagnosis, the doctor prescribes an echocardiography (ultrasound of the heart). This method allows you to assess the state of the organ, its activity, determine the pressure in the pulmonary artery, detect cardiac pathologies and defects. As an addition, the doctor may prescribe phonography, magnetic resonance imaging.

Modern technologies are able to do everything possible to ensure that pulmonary regurgitation is diagnosed as soon as possible. This can be done with an ultrasound scan, which will reveal any changes in the work of the heart.

Dopplerography is designed to determine the nature of the movement of blood in the heart chambers in a particular person. After receiving the results, the attending physician compares them with the norms. Echocardiography is the best way to determine the disease. It shows the work of the heart muscle in real time.

An ECG is another helper in making a diagnosis. It is able to identify some signs of the disease that are not symptomatic. Ultrasound will determine this pathology in an unborn child. In most cases, it is caused by chromosomal abnormalities.

Treatment can be prescribed only by a doctor who has compared the symptoms and well-being of the patient with the degree of pathology. Also, the appointment of a certain list of medicines and procedures should take into account the chronic diseases that a person has and the presence of heart failure.

Surgery gives the best results. With the help of surgery, the patient is replaced by a defective valve with a healthy one. 1 degree of the disease most often does not involve complex therapeutic treatment regimens, and the latter is due only to the intake of drugs.

With the help of medications, the patient will be able to normalize blood flow, eliminate arrhythmia and improve blood circulation in tissues. Usually such diseases are handled by a cardiologist. It is he who will be able to prescribe the appropriate treatment, taking into account all the characteristics of the patient.

Self-therapy for pulmonary regurgitation is unacceptable. The lack of qualified assistance or improperly selected drugs will only worsen the situation and well-being of the patient, and can lead to complications. Before starting treatment, the cardiologist conducts a number of tests, compares their results and contraindications that a person has. Only after that the patient is prescribed a list of drugs suitable for him.

Modern research methods help not only to make an accurate diagnosis, but also to determine the degree of the disease. If you suspect aortic regurgitation and aortic insufficiency, the patient should undergo the following studies:

Electrocardiogram: informative only with a severe degree of illness.
Phonocardiogram: a diastolic murmur is heard, coming after the second tone.
Radiography of the heart: reveals an increase in the size of the organ due to enlargement of the left ventricle and expansion of the ascending aorta.
Echocardiography: the most informative diagnostic method.
Aortography: the degree of regurgitation is determined.
Catheterization: assessment of the regurgitation wave and pulmonary capillary pressure (when examining the right sections), assessment of the amplitude of pulse pressure (left sections).

X-ray. An x-ray will show enlargement of the left side of the heart. With advanced pathologies, an increase in all departments of the organ is possible. ECG. This method is not informative. Only in the case when the posterior papillary muscle of the myocardium is affected, negative T waves are recorded on the electrocardiogram in II and III leads, moderate tachycardia is noted.

Echocardiography. The study allows you to determine the size of the valvular gap at the time of closure of the valves, the amount of reverse reflux and the cause of the violation (prolapse, rupture of the valve muscles or destructive changes). Transesophageal echocardiography. It is used infrequently, mainly in severe cases.

Cardiac patients undergo the following diagnostic measures:

Visual examination of the patient and listening to heart sounds with a phonendoscope. Ultrasound examination, which allows you to find out the condition of the heart tissue and valve. Electrocardiography. The method determines the early signs of enlargement of the right stomach and atrium. X-ray of the chest organs. Such a study determines violations in the valve system. Cardiac catheterization is an innovative minimally invasive procedure that is used to diagnose and treat cardiac diseases.

Click on photo to enlarge

Medicine does not stand still, and the diagnosis of diseases is becoming more reliable and of high quality. The use of ultrasound has made significant progress in the detection of a number of diseases. The addition of ultrasound examination of the heart (EchoCG) with Dopplerography makes it possible to assess the nature of blood flow through the vessels and cavities of the heart, the movement of the valve leaflets at the time of myocardial contractions, to establish the degree of regurgitation, etc.

Overview of Tricuspid Regurgitation: Causes, Grades, Treatment

The choice of treatment method depends on the stage of the disease and the causative factor that caused it. If possible, medical correction of the condition is carried out: bicillin prophylaxis for rheumatism, taking antihypertensive, antiarrhythmic drugs, nitrates, beta-blockers. Mitral regurgitation of the 1st degree does not require special methods of treatment, it is only necessary to be regularly observed by a cardiologist.

With decompensation, surgical treatment is indicated. In cases where the restoration of the mitral valve is impossible, they resort to transplanting it. Prostheses can be either biological (predominantly made from animal aorta) or mechanical. Mitral regurgitation of 2-3 degrees and minor changes in the papillary muscles allow for plastic surgery that restores the integrity of the valves of its own valve.

Treatment of aortic regurgitation depends entirely on the underlying disease and the completeness of the elimination of the causes.

Medical therapy uses drugs that can lower systolic blood pressure and reduce return flow.

A group of vasodilators is used (Nifedipine, Hydralazine, ACE inhibitors). They are not indicated in asymptomatic patients with mild or moderate regurgitation.

The only form of surgery is aortic valve replacement. The operation is shown when:

severe form of regurgitation with dysfunction of the left ventricle;
if the course is asymptomatic, with preserved ventricular function, but pronounced expansion (dilatation).

Mild mitral valve regurgitation does not require treatment. The doctor chooses the tactics of monitoring the development of the disorder. The patient will need to be regularly examined by a cardiologist to monitor any changes in the work of the heart.

If a second or third degree of pathology is detected, drug treatment is prescribed. The objective of this method is to eliminate the clinical manifestations and eliminate the causes that caused the development of regurgitation.

Antibacterial agents. A group of penicillins is used, with the help of which the development of an infectious process is prevented or eliminated.
Anticoagulants. Thanks to them, the blood is thinned, the formation of blood clots is prevented.
Diuretics. Designed to remove excess fluid from the body, reduce the load on the heart and cope with edema.
Beta blockers. They are used to normalize the heart rate.

The operation is prescribed only for severe mitral regurgitation. The objective of the intervention is to eliminate defects in the valve leaflets or replace the valve with a prosthesis. It is best to perform the operation before ventricular decompensation occurs.

The effectiveness of the surgical technique is quite high. In humans, the activity of the heart is normalized, so the hemodynamics are restored and the clinical manifestations cease to disturb the patient.

To eliminate symptoms and improve the general condition of a person, many people use traditional medicine. Preference is given to herbal infusions and decoctions, which produce a sedative effect.

The most effective is the following recipe: make a mixture of the same amount of valerian, motherwort, hawthorn, mint, then pour boiling water over a small spoonful of the collection, let it brew and drink it like regular tea.

Another popular folk remedy recipe: a mixture of equal proportions of motherwort, hawthorn, heather and blackthorn mixed in one proportion. Pour one large spoonful of herbs with a glass of hot water, wait until it cools down, and drink during the day, divided into several doses.

Particular attention should be paid to nutrition during and after the treatment of mitral and tricuspid regurgitation. Patients will have to give up junk food and alcohol. To improve the work of the heart in the diet should be grapes, nuts, dried apricots, rosehip broth.

If a person has an acute form of aortic insufficiency, then urgent replacement of the aortic valve is shown to him. This is an open cardiac surgery involving the removal of the affected valve and the implantation of its artificial, fully functioning counterpart. After the operation, the reception is shown:

vasodilators;
inotropic drugs.

Treatment for chronic aortic regurgitation depends on the symptoms the patient experiences. If the manifestations of the disease interfere with a full life, aortic valve replacement is indicated for a person.

With minor symptoms of the disease, a person should reduce the intensity of physical activity and visit a cardiologist regularly. Your doctor may prescribe vasodilators to optimize left ventricular function. In case of ventricular failure, diuretics (Veroshpiron, Veroshpilakton) and angiotensin-converting enzyme inhibitors (Lisinopril) can also be prescribed. With a similar diagnosis, it is not recommended to take beta-blockers in a large dose.

For patients with this disease and those who have undergone an operation to implant an artificial valve, it is extremely important to prevent infective endocarditis. Its essence lies in taking antibiotics, especially with the following medical procedures:

treatment and extraction of teeth;
removal of tonsils and adenoids;
urinary tract or prostate surgery;
operations on the organs of the gastrointestinal tract.

Prevention of infective endocarditis is provided by drugs:

Ampicillin.
Clindamycin.
Amoxicillin.

Antibiotics are taken strictly according to the scheme prescribed by the doctor.

An increase in the intensity of symptoms of aortic insufficiency is an indication for termination of pregnancy.

In the absence of clinical manifestations of the disease, it is recommended to limit intense physical activity. With decompensation of the disease and symptoms of CHF, it is necessary to limit the intake of sodium with food.

If surgical treatment is not possible (for example, with severe concomitant diseases), medical treatment of mitral regurgitation is carried out. The use of nitrates and diuretics is justified, although controlled studies of the effectiveness of these drugs in mitral regurgitation have not been conducted. The use of ACE inhibitors, according to a small number of studies, is effective in patients with mitral regurgitation and CHF.

With atrial fibrillation, the appointment of digoxin and anticoagulants is indicated. In general, patients with mitral regurgitation are less prone to embolic complications than patients with mitral stenosis, but they are more likely to develop infective endocarditis.

The main method of treatment of mitral regurgitation is surgical (plastic or mitral valve replacement). Surgical treatment is indicated when symptoms of CHF appear or if LV systolic function is impaired.

The main indications for surgical intervention in mitral regurgitation

Reconstructive surgery (mitral valve repair) is preferred over prosthetics in most patients with severe mitral regurgitation: patients should be referred to cardiac surgery centers experienced in mitral valve repair (Class I, Level of Evidence C).

In non-ischemic mitral regurgitation, the operation of choice is reconstructive surgery (mitral valve repair), regardless of age and the need for coronary bypass surgery. In other words, an elderly patient with rheumatic mitral regurgitation and concomitant coronary artery disease with preserved LV function is indicated for mitral valve repair rather than mitral valve replacement.

Mitral regurgitation is treated promptly: either by making the valve plastic, or by replacing it with a prosthesis - the technique is determined by the cardiac surgeon.

The patient is prepared for surgery either after they develop symptoms or if the examination reveals that left ventricular function is impaired, atrial fibrillation has occurred, or pressure in the pulmonary artery has risen.

Ideally, the goal of conservative therapy is to improve the patient's condition so that it becomes possible to operate on him.

If the pathology has developed acutely, an emergency operation is performed.

If mitral regurgitation was detected during a preventive examination, its volume is small, and the patient himself does not complain about anything, the cardiologist puts him under observation, re-examining once a year. The person is warned that if his health changes, you need to visit a doctor outside the schedule.

Possible complications and postoperative consequences

With severe symptoms of NMC, the patient is indicated for surgical intervention. The operation is urgent for the following reasons:

In the second and later stages, despite the fact that the volume of blood ejection is from 40% of its total amount.
In the absence of the effect of antibiotic therapy and the aggravation of infectious endocarditis.
Reinforced deformations, sclerosis of the valves and tissues located in the subvalvular space.
If there are signs of progressive dysfunction of the left ventricle, together with general heart failure, occurring at 3-4 degrees.
Heart failure in the early stages can also be a reason for surgery, however, for the formation of indications, thromboembolism of large vessels located in the systemic circulation must be detected.

The following operations are practiced:

Valve-preserving reconstructive surgeries are necessary for the correction of CVD in childhood.
Commissuroplasty and decalcification of the leaflets are indicated for severe MV insufficiency.
Chordoplasty is designed to normalize the mobility of the valves.
Cord translocation is shown when they fall off.
Fixation of parts of the papillary muscle is carried out using Teflon gaskets. This is necessary when separating the head of the muscle from the rest of the components.
Prosthetics of chords is necessary when they are completely destroyed.
Valvuloplasty avoids leaflet stiffness.
Anuloplasty is designed to rid the patient of regurgitation.
Valve prosthetics is carried out with its severe deformation or the development of irreparable fibrosclerosis that interferes with normal life. Mechanical and biological prostheses are used.

With the development of regurgitation of the heart, a person may experience some complications. It could be:

Arrhythmia, the characteristic of which is the failure of the rhythm of the heart.
Atrioventricular blockade, in which there is a deterioration in the movement of the impulse from one chamber of the heart to another.
Infectious endocarditis.
Heart failure.
Pulmonary hypertension.

If the patient underwent heart surgery in order to eliminate the cause of regurgitation, he may have the following negative consequences:

Ischemic stroke, which occurs due to blockage of cerebral vessels and is characterized by the death of its tissues.
Endocarditis, in which an inflammatory process occurs in the inner lining of the heart.
Atrioventricular block.
Thrombosis of the installed prosthesis.
Destruction or calcification of a biological prosthesis.

To prevent these complications and postoperative consequences from occurring, the patient should strictly follow all the recommendations of the attending physician, both during and after treatment.

Consequences of aortic regurgitation

The return of blood to the left ventricle inevitably leads to its expansion and increase in volume. Perhaps the expansion of the mitral ring and a further increase in the left atrium.

In the place of contact of the blood flow on the endocardium, "pockets" are formed. The greater the degree of regurgitation, the faster the overload of the left ventricle develops.

Studies have shown the importance of heart rate:

bradycardia increases the volume of the return flow and contributes to decompensation;
tachycardia reduces regurgitation and causes more adjustment.

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

The development of thromboembolism due to the constant stagnation of a large part of the blood.
valve thrombosis.
Stroke. Valvular thrombosis that occurred earlier is of great importance in the risk factors for stroke.
Atrial fibrillation.
Symptoms of chronic heart failure.
Mitral regurgitation (partial failure to perform the functions of the mitral valve).

What to expect and preventive measures

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

If valve insufficiency manifests itself in a moderate or moderate form, women have the opportunity to bear and give birth to children. When the disease becomes chronic, all patients should have an annual ultrasound and visit a cardiologist. If deterioration occurs, more frequent visits to the hospital should be made.

Prevention of NMC is to prevent or promptly treat the diseases that cause this pathology. All diseases or manifestations of mitral valve insufficiency due to its incorrect or reduced valve must be quickly diagnosed and treated in a timely manner.

NMC is a dangerous pathology leading to severe destructive processes in the heart tissue, therefore, it needs proper treatment. Patients, subject to the recommendations of the doctor, can return to normal life some time after the start of treatment and cure the disorder.

Forecast

The prognosis for the patient's life depends on the underlying disease, the degree of regurgitation, and the form. An early mortality rate is typical for the acute development of pathology. In the chronic form, 75% of patients live more than 5 years, and half live 10 years or more.

In the absence of timely surgical intervention, the development of heart failure is noted in the next 2 years.

Treatment of a moderate clinical picture is accompanied by positive results in 90% of patients. This confirms the importance of examination and observation of patients with aortic regurgitation.

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The prognosis for mitral valve regurgitation depends on the extent to which it occurs, whether there are comorbidities, how old the patient is, whether he follows the recommendations of the treating doctor. With a mild form of impairment, people live for many more years without loss of working capacity.

With a pronounced course of pathology, the prognosis is less favorable. With the progression of regurgitation, other disorders in the work of the heart join, which are quite difficult to treat. Therefore, most people with a severe form live for about 5 years, in rare cases a person can live 10 years.

Mitral valve regurgitation is a pathological process in which inadequate closure of the valve leaflets or dysfunction of the subvalvular apparatus occurs, which leads to impaired blood circulation. Timely detection and elimination of the disease helps to avoid possible complications and prolong human life.

This is especially important during pregnancy. After all, many heart defects occur even during the intrauterine development of a newborn. Therefore, at the slightest suspicion of a violation of the fetal heart, you should immediately be examined by a cardiologist.

If a person has aortic regurgitation of II (III) severity without any signs, and there is no left ventricular dysfunction, then the prognosis will be favorable. For patients with grade I aortic valve insufficiency, the probability of 10-year survival can reach 95%, with grade II (III) - 50%.

For people with mild aortic regurgitation, follow-up with a cardiologist and an annual echocardiogram is indicated. A similar recommendation is relevant for patients with severe aortic insufficiency occurring against the background of the full functioning of the left ventricle. If aortic root enlargement is diagnosed, it is recommended to monitor the extent of the pathology at least once a year.

With mitral insufficiency, a fairly long period of compensation is characteristic. With the formation of LV systolic dysfunction, symptoms of CHF appear. The prognosis for rheumatic mitral regurgitation is more favorable than for ischemic.

Chronic mitral regurgitation develops slowly and remains compensated for a long time. The prognosis sharply worsens with the development of chronic heart failure. Without surgery, the six-year survival rate in men is 37.4%, in women - 44.9%. In general, the prognosis is more favorable for mitral insufficiency of rheumatic origin compared with ischemic.

If mitral insufficiency appeared acutely, the prognosis is extremely unfavorable.

Prediction depends on what disease was the result of the onset and development of regurgitation. Other factors are the age of the patient, diseases of the organs of other systems, the degree of pathology. Early mortality is typical for the group of patients with acute regurgitation.

If the pathology is in a chronic form, then three-quarters of patients live for the next five years after diagnosis, and half live for more than ten.
If surgery is not undertaken on time, heart failure develops within two years.
If a moderate clinical picture is observed, then a positive effect of therapy is observed in the vast majority of patients.

Mitral, tricuspid, aortic, and pulmonic regurgitation is far from a death sentence.

It is very important to timely identify the problem, prescribe appropriate therapy, as well as regular monitoring by a cardiologist.

For patients with minor AP and asymptomatic course, the prognosis is favorable.

With a compensated course and adherence to the prescribed treatment, the disease can proceed for a long time without progression. The average survival is from twenty to thirty years, so the prognosis can be considered relatively favorable.

LV dysfunction, without surgical treatment, the average survival does not exceed four years;
heart failure - about two years.

Patients with acute AP may die from severe arrhythmias, heart failure, or cardiogenic shock.

The prognosis for first-degree valvular regurgitation is favorable. With constant monitoring by the attending physician, complications are detected immediately and, if necessary, treatment is prescribed.

In the second degree, the situation is different. Once diagnosed, only sixty percent remain on their feet, and then only for fifteen years. Death comes due to a heart attack, heart failure, embolism, pulmonary pneumonia.

Preventive measures are aimed at reducing the risk of reverse blood flow in the heart.

Thus, valvular regurgitation is a serious condition. Which can be both acquired and congenital. It is localized between different parts of the heart (in its right side or left). It has various degrees of development, the first of which is the simplest, has no symptoms, so the disease is difficult to calculate.

If pathology is detected, treatment is carried out by surgical methods or medication. The main thing is not to be late, therefore, a systematic examination of the body by a specialist is recommended.

The heart has several valves: mitral, tricuspid, aortic, pulmonary. They are designed to prevent backflow of blood. For this, they have special sashes. One of the important valves is the mitral valve, in the presence of a defect in which the blood begins to return to the original section, which is called regurgitation.

What is this violation?

Mitral regurgitation is a pathological process in which blood from the left ventricle returns to the left atrium. In the international classification of diseases ICD-10, it has the code I05.1.

Regurgitation can occur in two forms:

Acute. Appears unexpectedly, characterized by ruptures of chords, papillary muscles, valve cusps. Heart damage, endocarditis can lead to the development of this form of pathology. In acute regurgitation, the risk of death of the patient is high.
Chronic. Development occurs slowly under the influence of endocarditis, congenital malformations, disorders of the papillary or mitral-papillary muscles, and other diseases.

A healthy person may also show mild mitral regurgitation. In this case, it is called physiological. It is diagnosed in most people, does not bother a person and does not require medical intervention.

Classification

There are several degrees of mitral regurgitation. They differ in the amount of blood returned. There are only 4 stages:

First. The volume of reverse blood flow is less than 25%. Mitral regurgitation of the 1st degree at the beginning of its development is not characterized in any way, but on the electrocardiogram one can already detect small malfunctions in the activity of the valves.
Second. In the pathology of the second degree, there is already a more significant hemodynamic failure. The blood returns in a volume of more than 25%, but not more than 50%. This results in pulmonary hypertension. Regurgitation at this stage can cause disturbances in the work of the myocardium. The ECG reveals a malfunction of the heart.
Third. When the disease progresses to the third stage, the volume of returned blood exceeds 50%. At this stage, other diseases often join, for example,. The electrocardiogram clearly shows cardiac dysfunction.
Fourth. Regurgitation of this degree refers to a severe form of pathology. Because of it, a person can completely lose his ability to work, get a disability. At this stage, only surgery can prolong the life of the patient.

Causes

There are many reasons for the development of mitral valve regurgitation. But there are a number of pathologies that are most often found in patients. These include such diseases:

with regurgitation of the 1st degree (PMC),
endocarditis,
heart disease,
myocardial infarction,
rheumatism.

In addition to diseases, chest injuries can lead to the development of regurgitation, in which the heart is damaged.

Symptoms

If a patient develops grade 1 minimal mitral regurgitation, then no clinical signs will be observed. A person can live for several years and not suspect that the work of his heart is broken.

Possible complications and postoperative consequences

With the development of regurgitation of the heart, a person may experience some complications. It could be:

Arrhythmia, the characteristic of which is the failure of the rhythm of the heart.
Atrioventricular blockade, in which there is a deterioration in the movement of the impulse from one chamber of the heart to another.
Infectious endocarditis.
Heart failure.

If the patient underwent heart surgery in order to eliminate the cause of regurgitation, he may have the following negative consequences:

Ischemic stroke, which occurs due to blockage of cerebral vessels and is characterized by the death of its tissues.
Endocarditis, in which an inflammatory process occurs in the inner lining of the heart.
Atrioventricular block.
Thrombosis of the installed prosthesis.
Destruction or biological prosthesis.

To prevent these complications and postoperative consequences from occurring, the patient should strictly follow all the recommendations of the attending physician, both during and after treatment.

Diagnostics

Treatment of pathology

Antibacterial agents. A group of penicillins is used, with the help of which the development of an infectious process is prevented or eliminated.
Anticoagulants. Thanks to them, the blood is thinned, the formation of blood clots is prevented.
Diuretics. Designed to remove excess fluid from the body, reduce the load on the heart and cope with edema.
Beta blockers. They are used to normalize the heart rate.

To eliminate symptoms and improve the general condition of a person, many people use traditional medicine. Preference is given to herbal infusions and decoctions, which produce a sedative effect.

Particular attention should be paid to nutrition during and after mitral treatment. Patients will have to give up junk food and alcohol. To improve the work of the heart in the diet should be grapes, nuts, dried apricots, rosehip broth.

Forecast

This is especially important during pregnancy. After all, many heart defects occur even during the intrauterine development of a newborn. Therefore, at the slightest suspicion of a violation of the fetal heart, you should immediately be examined by a cardiologist.

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

In mitral regurgitation, the left ventricle gradually increases in size as it has to pump more blood. As a result, each heart contraction intensifies, and the person experiences a heartbeat, especially when lying on his left side.

To accommodate excess blood coming from the left ventricle, the left atrium enlarges, begins to contract abnormally and too quickly due to atrial fibrillation. The pumping function of the heart muscle in mitral insufficiency is impaired due to an irregular rhythm. The atria do not contract, but tremble. Violation of blood flow leads to thrombosis. With severe regurgitation, heart failure develops.

Thus, we can name the following possible signs of the disease, which usually appear at a late stage of mitral valve insufficiency:

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

However, these symptoms of mitral insufficiency cannot be the basis for making such a diagnosis. All these signs are present in other heart defects.

Causes

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

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

Diagnostics

The main diagnostic methods of mitral insufficiency include:

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

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

Treatment

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

With severe NMC, surgical treatment is prescribed. The operation to repair the valve should be carried out as early as possible, until irreversible changes in the left ventricle appear.

With surgical treatment of mitral valve insufficiency, it is restored. This operation is indicated if the changes in the heart valve are minor. It can be ring plastic, leaflet plastic, ring narrowing, leaflet replacement.

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

Forecast

The prognosis depends on the severity of valve damage and the condition of the myocardium. Severe insufficiency and poor condition of the myocardium quickly lead to severe circulatory disorders. We can talk about an unfavorable prognosis in case of chronic heart failure. The annual mortality rate is 28%. With relative insufficiency of UA, the outcome of the disease is determined by the severity of circulatory disorders and the disease that led to the defect.

With a mild and moderate form of mitral insufficiency, a person can remain functional for a long time if he is observed by a cardiologist and follows his advice. The disease at these stages is not a contraindication for the birth of a child.

Mitral valve insufficiency symptoms and signs

Mitral valve insufficiency (left atrioventricular insufficiency) - non-closure (or incomplete closure) of the mitral valve leaflets, leading to pathological reflux of blood (regurgitation) into the left atrium from the left ventricle during its systole. In this article, we look at the symptoms of mitral valve insufficiency and the main signs of mitral valve insufficiency in humans.

Prevalence

Isolated rheumatic mitral valve insufficiency is observed in 10% of cases of all acquired defects. It occurs more often in men. Often associated with mitral stenosis or aortic valve disease.

The pathogenesis of mitral valve insufficiency

Non-closure of the mitral valve leaflets during left ventricular systole leads to the appearance of pathological blood flow from the left ventricle to the left atrium. The blood thrown into the left atrium creates its volume overload during systole and the volume overload of the left ventricle in diastole. Excessive blood volume in the left ventricle leads to its dilatation and expansion of the mitral annulus. In this case, a rupture of the tendon filaments may occur. In this regard, the aphorism "mitral regurgitation generates mitral regurgitation" is legitimate. Dilatation of the left atrium leads to tension of the posterior leaflet of the mitral valve and an increase in non-closure of the mitral orifice, which further exacerbates mitral valve insufficiency.

constant overload of the left ventricle with an excess volume of blood leads to hypertrophy of its walls. An excess amount of blood in the left atrium subsequently causes a retrograde increase in pressure in the pulmonary circulation and the development of pulmonary hypertension (unlike mitral stenosis, it develops much later and is much less pronounced). In the advanced stage of mitral valve insufficiency, chronic heart failure develops (according to the right ventricular type).

Signs of mitral valve insufficiency

Mitral valve insufficiency symptoms

With unexpressed mitral valve insufficiency, there may be no complaints. With moderate insufficiency and a slight increase in pressure in the pulmonary circulation, rapid fatigue during physical exertion (low cardiac output does not provide the skeletal muscles with sufficient oxygen) and shortness of breath, quickly disappearing at rest, are of concern. Severe mitral valve insufficiency and more pronounced pulmonary hypertension are characterized by the occurrence of shortness of breath with little physical exertion, attacks of nocturnal paroxysmal shortness of breath, congestion in the lungs, and hemoptysis. Acute mitral valve insufficiency (with myocardial infarction) is manifested by pulmonary edema or cardiogenic shock.

Examination for mitral valve insufficiency

Percussion for mitral valve insufficiency

The expansion of the boundaries of relative cardiac dullness to the left is characteristic with severe mitral valve insufficiency.

Palpation for mitral valve insufficiency

The apex beat is displaced to the left and down due to dilatation of the left ventricle. With severe mitral valve insufficiency, systolic trembling is detected at the apex of the heart.

Auscultation of the heart in mitral valve insufficiency

Heart sounds

The I tone is usually weakened (it is difficult to estimate at the expressed systolic noise). II tone is not changed if there is no severe pulmonary hypertension. With a significant shortening of the ejection time of the left ventricle, a paradoxical splitting of the II tone occurs. In addition, a pathological III tone is heard in diastole, which occurs with a sudden tension of the papillary muscles, tendon filaments and valves. It (together with a weakened I tone) is considered an important auscultatory sign of severe mitral valve insufficiency.

When pulmonary hypertension occurs, the accent of the II tone is heard over the pulmonary trunk in the II intercostal space to the left of the sternum.

Systolic murmur in mitral valve insufficiency

The main symptom of mitral valve insufficiency is systolic murmur. It is holosystolic (throughout the entire systole) and captures I and II heart sounds. The murmur is most pronounced at the apex of the heart; it can irradiate to the left into the axillary region with damage to the anterior leaflet and up along the sternum with damage to the posterior leaflet. The noise increases with increasing afterload (isometric arm tension).

ECG with mitral valve insufficiency

Echocardiography in mitral valve insufficiency

Echocardiography allows you to identify the cause of mitral valve insufficiency (by its morphology), assess the degree of regurgitation and the function of the left ventricle and atrium.

Infective endocarditis. Mitral valve insufficiency in infective endocarditis is characterized by the presence of vegetation, perforations of the leaflets, and tearing of the tendon filaments. More precisely, these changes can be detected by transesophageal echocardiography.

ischemic heart disease. Mitral valve insufficiency in IHD is characterized by dilatation of the left ventricular cavity, local disturbances in the movement of the walls of the left ventricle (dyskinesia), normal (non-thickened) mitral valve cusps, and the central location of the regurgitation jet in most cases.

With one-dimensional and two-dimensional echocardiography, indirect signs of mitral valve insufficiency are revealed: dilatation of the left atrium and ventricle, increased mobility of the walls of the left ventricle (hyperkinesis). In Doppler studies, direct signs of mitral valve insufficiency are determined: throwing a stream of blood from the left ventricle into the left atrium during systole. According to the severity of the jet of regurgitation in the left atrium, four degrees of mitral valve insufficiency are distinguished:

I degree, insignificant, - the length of the jet of regurgitation is up to 4 mm from the base of the mitral valve cusps into the left atrium.

II degree, moderate, - 4-6 mm.

III degree, medium, - 6-9 mm.

IV degree, expressed - more than 9 mm.

It should be remembered that the volume of regurgitation depends on the size of the opening remaining between the leaflets of the mitral valve when they close, the magnitude of the pressure gradient between the ventricle and the atrium, and the duration of regurgitation. The degree of mitral regurgitation is not fixed and may vary in the same patient depending on the conditions and applied JTC.

X-ray examination of mitral valve insufficiency

Signs of pulmonary hypertension on the radiograph may be absent with a slight severity of the defect. With severe mitral regurgitation, characteristic signs of pulmonary hypertension appear.

Catheterization of the heart cavities in mitral valve insufficiency

Cardiac catheterization is an accurate method for assessing the degree of mitral regurgitation, which makes it possible to determine the volume of regurgitant blood in the left atrium (expressed as a percentage of the stroke volume of the left ventricle). There are four degrees of mitral regurgitation according to catheterization:

I degree - less than 15% of the stroke volume of the left ventricle.

II degree - 15-30%.

III degree - 30-50%.

IV degree - more than 50% of the stroke volume.

mitral valve insufficiency

mitral valve insufficiency- this is the development of arterial blood regurgitation in the cavities of the left heart during the period of systolic contraction of the ventricular myocardium, which occurs against the background of impaired closure of the leaflet structures of the mitral valve.

The share of an isolated defect in the form of mitral valve insufficiency accounts for at least 2% of all possible cardiac defects. Much more often, the patient has a combined lesion of the mitral valve in the form of a combination of stenosis and insufficiency.

Mitral valve insufficiency causes

Mitral valve insufficiency, unlike stenosis of the same localization, is a polyetiological pathology, that is, a number of factors affect the development of its signs, although each of them individually can initiate the development of this defect.

Organic mitral valve insufficiency, which occurs as a result of a primary lesion of the valvular apparatus, can be observed in the following diseases of a cardiac and extracardiac nature: rheumatic fever, infection of the endocardium, myxomatous degeneration of the leaflets and severe calcification in the projection of the valves, ischemic myocardial damage in atherosclerotic disease, connective tissue pathologies hereditary nature (Marfan's disease), systemic autoimmune damage to the connective tissue (scleroderma, dermatomyositis), traumatic heart injury.

The fundamental difference between organic mitral valve insufficiency and functional changes in the mitral valve is its development against the background of the existing severe myocardial damage, accompanied by the development of severe dilatation of the left ventricular cavity. Dilatational changes in the left ventricle over time provoke stretching of the valve ring and displacement of the papillary muscles laterally, against the background of which dysfunction of the mitral valve cusps occurs in the complete absence of their organic damage.

Hypertrophic cardiomyopathy of the constrictive type is also accompanied by the development of signs of mitral valve insufficiency, and the pathogenetic mechanism of its development is hyperdynamic contraction of the left ventricle, during which the anterior part of the leaflets is drawn into the outflow tract of the enlarged left ventricle.

Mitral valve insufficiency signs

Mitral valve insufficiency is characterized by a sluggish course with a gradual increase in clinical symptoms. In cardiology practice, a separate category of patients is distinguished who may not have clinical manifestations, and changes in the valvular apparatus are detected during instrumental research methods.

The initial complaints that are most often made by patients suffering from mitral valve insufficiency are: increasing shortness of breath, which is a consequence of venous congestion in the lung parenchyma, decreased performance and fatigue due to a decrease in cardiac output. Depending on the degree of damage to the leaflets of the valve apparatus, respiratory disorders of cardiac origin may be minor or severe, up to the development of signs of pulmonary edema.

Mitral valve insufficiency has a whole range of specific changes diagnosed by an experienced cardiologist during the initial objective examination. The skin of patients with mitral valve insufficiency becomes bluish in the projection of the distal parts of the limbs and face. On palpation of the pulse, as a rule, no changes can be detected, but in some cases there are signs of a positive venous pulse. A pronounced expansion of the boundaries of cardiac dullness, as well as displacement and intensification of the apex beat, is observed only in severe dilatation of the left ventricular cavity. When examining a patient with signs of pulmonary hypertension, an abnormal pulsation is determined in the projection of the fourth intercostal space along the left contour of the sternum.

The most characteristic sign of mitral valve insufficiency is the presence of a pansystolic murmur in the projection of the apex of the heart with conduction to the axillary region on the left. A specific symptom, characteristic exclusively for mitral valve insufficiency, is an increase in noise in the transfer of the body to a horizontal position on the left side. The degree of manifestation of noise depends more on the contractility of the myocardium of the left ventricle than on the severity of regurgitation. If the noise is not very pronounced, it is possible to distinguish a weakening of the first tone, due to a violation of the complete closure of the mitral valve cusps. With severe regurgitation, a prognostically unfavorable sign occurs - the appearance of a third tone. Listening to the accent of the second tone in the projection of the pulmonary artery testifies in favor of the development of signs of pulmonary hypertension.

Mitral valve insufficiency degree

The division of mitral valve insufficiency is used to determine the degree of violation of the central cardiohemodynamics, as well as to determine the appropriateness of the use of surgical intervention.

The first (1) degree of mitral valve insufficiency is characterized as a compensatory stage, that is, the regurgitation of the blood flow is so minimal that it is not accompanied by cardiohemodynamic disorders. The only clinical symptom that a patient has in the compensatory stage of the disease may be the appearance of a systolic murmur in the projection of the apex of the heart. In this situation, the patient is shown an echocardiographic study to determine the presence of regurgitation. Mitral insufficiency at this stage does not require the use of surgical methods of treatment.

The second (2) degree of mitral valve insufficiency, or the stage of subcompensation, is accompanied by an increase in the volume of reverse blood flow during the period of systolic contraction of the ventricle, there are signs of compensatory hypertrophy of the left ventricular wall in order to compensate for hemodynamic disorders. At this stage of the defect, most patients note an increase in dyspnea with excessive physical activity, and a moderately pronounced systolic murmur is auscultated in the projection of the apex of the heart. Fluoroscopy allows you to determine the expansion of the boundaries of the left heart, as well as their excessive pulsation. This stage is reflected in the ECG registration in the form of the formation of a levogram and the appearance of signs of overload of the left heart. An echocardiographic sign is the presence of moderate regurgitation in the projection of the mitral valve cusps. The stage of subcompensation is not a rationale for the use of surgical correction techniques.

The third (3) degree of mitral valve insufficiency is characterized by the appearance of severe left ventricular decompensation due to significant blood regurgitation into the cavity of the left ventricle. Clinical symptoms indicating the development of decompensated heart failure. is progressive shortness of breath with minimal physical activity, and visualization of the pulsation of the anterior chest wall in the projection of the apex of the heart. Listening to a coarse systolic murmur in the projection of the apex of the heart is not difficult, and instrumental additional methods of examining a patient make it possible to determine the presence of left ventricular myocardial hypertrophy and a pronounced backflow of blood through the uncovered mitral valve cusps. The only effective treatment for mitral regurgitation at this stage is surgery.

The fourth (4) degree of mitral valve insufficiency is accompanied by the addition of signs of right ventricular failure and is called "dystrophic". Distinctive visual symptoms are pronounced pulsation of the jugular veins and displacement of the apex beat, as well as its strengthening. Mitral valve insufficiency in this category of patients is accompanied not only by hemodynamic disturbances, but also by a failure in the rhythm of cardiac activity. Radiography allows you to visualize a pronounced expansion of the mediastinal shadow due to an increase in all parts of the heart, as well as the appearance of signs of stagnation in the pulmonary circulation system. At this stage of the disease, extracardiac symptoms of functional changes in the kidneys and liver appear. Surgical methods of correction are widely used and in most cases have a favorable outcome.

The fifth (5) degree of mitral valve insufficiency is terminal and is characterized by the manifestation in the patient of the entire clinical symptom complex, characteristic of the third stage of cardiovascular insufficiency. The severity of the patient's condition does not allow for surgical intervention, and the prognosis of mitral valve insufficiency at this stage is extremely unfavorable. In the terminal stage of the defect, complications are often observed, each of which can cause a fatal outcome of the disease: paroxysmal atrial fibrillation, infective endocarditis. as well as systemic thromboembolism of vessels of various calibers.

mitral valve insufficiency treatment

The degree of severity of regurgitation in the projection of the mitral valve is decisively influenced by the magnitude of systolic pressure in the lumen of the aorta, therefore, the appointment of vasodilators for a long time is pathogenetically justified. The drugs of choice in this situation are ACE inhibitors in a dosage that allows you to keep the systolic pressure at the level of 120 mm Hg. (Berlipril at an initial daily dosage of 2.5 mg, followed by titration of the drug to a therapeutic dose and continuous use of the drug). Recent randomized trials prove the need for the use of vasodilators even in asymptomatic mitral valve insufficiency with minimal regurgitation.

Already in the second or third degree of mitral valve insufficiency, when there are dilatational changes in the cavities of the left parts of the heart, it is advisable to use anticoagulants for life as a prevention of the development of thromboembolic complications (Aspecard in a daily dose of 100 mg orally).

In a situation where the patient has electrocardiographic signs of arrhythmia, the use of adrenergic blockers (Metoprolol at an average daily dose of 100 mg orally) is recommended.

The use of surgical methods for correcting mitral valve insufficiency is absolutely indicated in the following situations:

- the level of regurgitation is about 40% of cardiac output;

- the absence of a positive result from the use of massive antibiotic therapy in the aggressive course of infectious endocarditis, which complicates the course of the underlying disease;

- pronounced sclerotic changes in the valvular apparatus, which are irreversible;

- pronounced dilated enlargement of the left ventricle with signs of systolic dysfunction;

single or multiple episodes of vascular thromboembolism.

At present, the cardiosurgical branch of medicine allows the use of the latest reconstructive surgical aids, which make it possible to preserve the structure of the valvular apparatus as much as possible. In a situation where there are pronounced sclerotic changes in the valve leaflets and it is not possible to perform surgical decalcification, a prosthetic technique using both synthetic and xenopericardial materials is used. In order to eliminate the rigidity of the valve structures, the valvuloplasty technique is used, which in most cases completely eliminates the signs of regurgitation.

heal-cardio.ru

Causes and mechanism of development

The human heart is a four-chamber structure, the cavities of which are separated by valves. This prevents mixing of venous and oxygenated arterial blood, which keeps the heart working smoothly.

The mitral valve leaflets (MV) are 2 folds of connective tissue located between the left ventricle and the atrium. Violation of their functioning can be caused by:

infective endocarditis.
Rheumatism.
Mitral valve prolapse.
Congenital heart defects.
A history of acute myocardial infarction.
Injuries and wounds of the chest.
Diseases leading to an increase in the left side of the heart - angina pectoris, arterial hypertension (the so-called relative mitral regurgitation).
Systemic diseases (amyloidosis, rheumatoid arthritis, Marfan's syndrome, etc.).

Clinical symptoms and diagnosis

With acutely developed mitral valve insufficiency (for example, due to rupture of the papillary muscles during myocardial infarction), minutes count, and immediate medical attention is required.

Chronic mitral regurgitation does not manifest itself for a long time, although the disease only progresses over time.

There are four degrees of the disease:

Insufficiency of MK 1 degree. There are no complaints. Auscultation reveals a soft soft systolic murmur at the apex of the heart, best heard when the patient lies on the left side. On R-graphy and ECG changes are nonspecific. On echocardiography, mitral regurgitation of the 1st degree is manifested by a slight divergence of the valves, minimal reverse blood flow.
MK insufficiency of the 2nd degree. The first complaints appear: weakness, fatigue, shortness of breath during physical exertion (due to stress on the pulmonary circulation). Systolic murmur at the apex persists, there is a weakening of the I tone. On R-graphy and ECG, the manifestations of the disease are still not visible. Ultrasound of the heart with a doler fixes the reverse movement of blood at a distance of 1.5 cm and below.
Insufficiency of MK 3 degrees. Complaints intensify: shortness of breath with slight exertion, a cough with difficult to separate viscous sputum, a feeling of palpitations, "somersaults" of the heart in the chest. On examination, there is a pale face with cyanosis of the lips and tip of the nose. On the ECG and R-graphy, the first signs of left ventricular hypertrophy appear: a levogram, an expansion of the shadow of the heart. Echocardiography indicates a reverse reflux of blood, occupying half of the atrium.
Insufficiency of MK 4 degrees. The terminal stage of the disease: bright signs of heart failure, pulmonary hypertension, excruciating cough with streaks of blood. A typical appearance of the patient: a pale face with a bright cyanotic blush caused by oxygen deficiency in peripheral tissues. A "heart hump" appears - a pulsating projection of the heart in the left side of the chest. ECG and X-ray indicate an increase in the left volumes of the heart: a sharp deviation of the EOS to the left, smoothing the waist of the heart and displacement of the border (the outlines of the organ take the form of a shoe). Ultrasound captures the filling of the atrium with blood during cardiac output completely.

Treatment

With decompensation, surgical treatment is indicated. In cases where the restoration of the mitral valve is impossible, they resort to transplanting it. Prostheses can be either biological (predominantly made from animal aorta) or mechanical. Mitral regurgitation of 2-3 degrees and minor changes in the papillary muscles allow for plastic surgery that restores the integrity of the valves of its own valve.

The prognosis of the disease is associated with many factors: the severity of valve insufficiency, the previous cause - but generally favorable. Careful attention to your health, following the recommendations of a cardiologist guarantee a quick recovery of hemodynamics and a return to an active lifestyle.

asosudy.ru

Description of the disease

Mitral valve insufficiency (MIV) is the most common cardiac anomaly. Of all the patients 70% suffer from an isolated form of NMC. Usually, rheumatic endocarditis is the main underlying cause of the development of the disease. Often a year after the first attack, the condition of the heart leads to chronic insufficiency, the cure of which is quite difficult.

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

Septic endocarditis leads to the destruction of many cardiac structures, so NMC has the most severe manifestations. The flaps of the valve adjoin each other not tightly enough. When they are incompletely closed through the valve, too much blood flow, which provokes its reboot and the formation of stagnant processes, an increase in pressure. All signs lead to the increasing insufficiency of MK.

Causes and risk factors

NMC affects people who have one or more of the following pathologies:

congenital predisposition.
Syndrome of connective tissue dysplasia.
Mitral valve prolapse, characterized by regurgitation of 2 and 3 degrees.
Destruction and breakage of chords, rupture of the valves of the MC due to injuries in the chest area.
The rupture of the valves and chords in the development of endocarditis is infectious in nature.
Destruction of the apparatus that unites the valves in endocarditis due to diseases of the connective tissue.
Infarction of a part of the mitral valve with subsequent scar formation in the subvalvular region.
Change in the shape of the leaflets and tissues under the valves, with rheumatism.
Enlargement of the mitral annulus with dilated cardiomyopathy.
Insufficiency of valve function in the development of hypertrophic cardiomyopathy.
MK insufficiency due to the operation.

Mitral insufficiency is often accompanied by another defect - mitral valve stenosis.

Types, forms, stages

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

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

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

When determining the features of the movement of the mitral valves, they distinguish 3 types of pathology classification:

1 - the standard level of leaflet mobility (in this case, painful manifestations are dilatation of the fibrous ring, perforation of the leaflets).
2 - destruction of the valves (the chords take the most damage, as they are stretched or torn, and the integrity of the papillary muscles is also impaired.
3 - decrease in the mobility of the valves (forced connection of the commissures, reduction in the length of the chords, as well as their fusion).

Danger and complications

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

The development of thromboembolism due to the constant stagnation of a large part of the blood.
valve thrombosis.
Stroke. Valvular thrombosis that occurred earlier is of great importance in the risk factors for stroke.
Atrial fibrillation.
Symptoms of chronic heart failure.
Mitral regurgitation (partial failure to perform the functions of the mitral valve).

Symptoms and signs

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

1 stage disease has no specific symptoms.
2 stage does not allow patients to carry out physical activity in an accelerated mode, as shortness of breath, tachycardia, pain in the chest, heart rhythm disturbance, and discomfort immediately appear. Auscultation in mitral insufficiency determines the increased intensity of the tone, the presence of background noise.
3 stage characterized by insufficiency of the left ventricle, pathologies of hemodynamics. Patients suffer from constant shortness of breath, orthopnea, accelerated heart rate, feel discomfort in the chest, their skin is paler than in a healthy state.

Learn more about mitral regurgitation and hemodynamics with it from the video clip:

When to see a doctor and to whom

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

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

Diagnostics

Common methods for detecting NMC:

Learn more about symptoms and diagnosis from the video:

It is necessary to distinguish NMC from other pathologies of the heart:

Myocarditis in severe form.
Congenital and acquired heart defects of related etiology.
Cardiomyopathy.
Prolapse MK.

Therapy Methods

With severe symptoms of NMC, the patient is indicated for surgical intervention. The operation is urgent for the following reasons:

In the second and later stages, despite the fact that the volume of blood ejection is from 40% of its total amount.
In the absence of the effect of antibiotic therapy and the aggravation of infectious endocarditis.
Reinforced deformations, sclerosis of the valves and tissues located in the subvalvular space.
If there are signs of progressive dysfunction of the left ventricle, together with general heart failure, occurring at 3-4 degrees.
Heart failure in the early stages can also be a reason for surgery, however, for the formation of indications, thromboembolism of large vessels located in the systemic circulation must be detected.

The following operations are practiced:

Valve-preserving reconstructive surgeries are necessary for the correction of CVD in childhood.
Commissuroplasty and decalcification of the leaflets are indicated for severe MV insufficiency.
Chordoplasty is designed to normalize the mobility of the valves.
Cord translocation is shown when they fall off.
Fixation of parts of the papillary muscle is carried out using Teflon gaskets. This is necessary when separating the head of the muscle from the rest of the components.
Prosthetics of chords is necessary when they are completely destroyed.
Valvuloplasty avoids leaflet stiffness.
Anuloplasty is designed to rid the patient of regurgitation.
Valve prosthetics is carried out with its severe deformation or the development of irreparable fibrosclerosis that interferes with normal life. Mechanical and biological prostheses are used.

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

What to expect and preventive measures

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

If valve insufficiency is moderate or moderate, women have the ability to bear and bear children. When the disease becomes chronic, all patients should have an annual ultrasound and visit a cardiologist. If deterioration occurs, more frequent visits to the hospital should be made.

Prevention of NMC is in the prevention or prompt treatment of the diseases causing this pathology. All diseases or manifestations of mitral valve insufficiency due to its incorrect or reduced valve must be quickly diagnosed and treated in a timely manner.