Pathologies of the heart valves (diseases of the heart valves). Heart valve defects, or heart valve abnormalities Acquired valvular heart disease

Acquired valvular heart disease is a common pathology. For the most part, heart valve disease develops as a result of penetration into harmful bacteria. They can directly affect the valves themselves, or the disease occurs as a result of their destructive effect on. In this case, the bacteria do not develop directly on the valves, but provoke their secondary damage.

When the heart valves are affected, an inflammatory process can develop in the inner lining of the heart. It is called the endocardium. In this case, the body's defenses do not cope, allowing microbes to penetrate into the blood, after which they penetrate into it and settle on weak spot valve tissue.
Causes of valve defects

Most often, defects occur due to rheumatic or infective endocarditis. These diseases provoke the beginning of the process of shortening or destruction of the valves, which causes valvular insufficiency. In the future, a fibrosing process may begin, which fixes or enhances the deformities that have arisen. This leads to narrowing of the valve ring and stenosis develops.

Usually the entrance gate for infection is the oral cavity (teeth, gums), urinary tract and skin. Therefore, it is very important to observe the rules of oral hygiene and the whole body. This will help prevent inflammation of the endocardium.
Most susceptible to pathogenic bacteria that have penetrated the delicate valves of the heart. Especially if they have already been damaged by various inflammatory processes or pre-existing heart disease. These pathologies leave small blood clots, which are excellent. nutrient medium for the development of microbes.

Mitral and aortic valve disease

The most common defect mitral valve hearts. The aortic valve is less commonly affected, the tricuspid valve and the pulmonary valve are very rarely affected. There are lesions of one, two or several valves at once. For example, for rheumatic lesion The heart is characterized by complex lesions, as well as a combination of valvular insufficiency with stenosis.

Usually, the pathology is not formed immediately, but develops within 1-3 years, while the active stage of the primary or recurrent rheumatic, septic process passes. After the suppression of characteristic clinical signs, fibrosing processes continue for some time. There is a change in the state of the myocardium, causing some dynamics in the clinical picture.

In this regard, the prevention of the development of defects that develop in the valves of the heart is reduced to preventing the penetration of streptococcal infection and the occurrence of rheumatism.

Often, the pathology is associated not only with damage to the valvular apparatus, but with a serious stretching of the heart cavities. As a result of this violation, the valve ring expands excessively, from which relative valve insufficiency develops.
In other cases, the previous lumen of the valve opening is not sufficient for the blood to flow freely between the enlarged chambers and dilated vessels. This situation called relative valvular stenosis.

In addition to the mitral valve, aortic valve disease is also possible. This is the so-called insufficiency of the aortic valve and aortic stenosis.

With the development of aortic valve disease, blood can freely move from the aorta to the left ventricle, due to the modification of the “doors” that do not close this duct tightly. This type of disease can only be acquired and occurs as a consequence of rheumatic changes, myxomatous disease, some mechanical damage or due to infectious endocarditis.

In the case of aortic stenosis, the flow of blood from the left ventricle into the aorta is disturbed and the blood pressure in this section becomes elevated. Pathology has well-defined symptoms and manifests itself in the form of angina pectoris, fainting, shortness of breath, shortness of breath, especially during physical exertion.

Aortic stenosis can be congenital or acquired, resulting from any disease, primarily rheumatism.

Tricuspid valve disease

This pathology is characterized by insufficiency of the tricuspid valve, as well as its stenosis. In this case, the disease is accompanied by a feeling of increased blood pulsation in the neck. In case of circulatory disorders in the liver, pain occurs in the area where this organ is located. With stenosis, constant weakness is most often felt.
Stenosis can be caused by carcinoid, autoimmune diseases. Although it may be congenital.

Heart disease is a long-standing designation of a congenital or acquired morphological change in the valvular apparatus, heart septa and large vessels extending from it. This chapter will consider acquired heart defects - conditions that have developed during the patient's life as a result of diseases or traumatic injuries hearts.

The essence of the disease is that as a result of shortening of the valve leaflets (insufficiency) or narrowing of the orifice (stenosis), often combined with changes in the subvalvular apparatus (shortening and deformation of tendon chords and papillary muscles), intracardiac hemodynamic disorders occur, followed by the development of compensatory hyperfunction and hypertrophy corresponding chambers of the heart. In the future, as a result of a violation of the contractile function of the myocardium, disorders occur in one or another circle of blood circulation. Thus, with the progression of valvular lesions, heart defects naturally pass through several stages. In this regard, the clinical picture of the disease with the same heart disease in different patients will vary significantly.

The most common defects of the mitral valve (50-70%, according to various authors), somewhat less often - the aortic valve (8-27%).

Isolated defects of the tricuspid valve occur no more than in 1% of cases, however, in combination with defects of other valves, damage to this valve was observed in about half of the patients.

The nature of the valve damage (insufficiency or stenosis of the orifice) leaves an imprint on the course of the disease. The reasons for the development of acquired heart defects are very diverse, but the most common of them is ARF in young people, as well as degenerative changes in the tissue of the valve and subvalvular apparatus with the inclusion of calcium salts (mainly in the elderly).

The name of the defect includes the name of the affected valve and reflects the characteristics of the defect itself (insufficiency or stenosis of the orifice). Before the name of the defect, its origin (etiology) is indicated, after the name - complications and the stage of heart failure (if it develops).

In the clinical picture of the disease, 2 groups of symptoms are distinguished:

Direct signs of a defect caused by a malfunction of the valvular apparatus (the so-called valvular signs);

Indirect signs of a defect caused by compensatory hypertrophy and dilatation of the corresponding chambers of the heart, as well as circulatory disorders in various vascular areas.

Direct (valvular) signs act as criteria for the presence of a particular heart disease. Their detection allows the diagnosis of valve damage. The presence of indirect signs indicates the severity of valve damage and the degree of hemodynamic disorder. However, the presence of only indirect signs does not give grounds for the diagnosis of heart disease.

Mitral valve defects Mitral valve insufficiency

mitral valve insufficiency(mitral insufficiency) - a pathological condition in which the leaflets of the bicuspid valve do not completely close the mitral opening, and during ventricular systole, blood flows back from the left ventricle to the left atrium (the so-called mitral regurgitation). This is possible in two situations.

During ventricular systole, incomplete closure of the mitral valve cusps occurs due to their organic changes in the form of shortening, wrinkling, which is often combined with the deposition of calcium salts in the valve tissue, and also due to shortening of the tendon chords. In this case, we speak of valvular insufficiency.

Mitral regurgitation occurs due to a violation of the coordinated functioning of the mitral "complex" (annulus fibrosus, tendon chords, papillary muscles) with unchanged valve leaflets. In this case, one speaks of relative mitral insufficiency.

Relative mitral insufficiency occurs due to various reasons:

With the expansion of the cavity of the left ventricle, the leaflets of the mitral valve cannot completely close the atrioventricular orifice;

The leaflets of the mitral valve during the systole of the left ventricle can bend into the cavity of the left atrium - mitral valve prolapse syndrome;

With dysfunction of the papillae of the muscles as a result of their ischemia, cardiosclerosis;

Due to rupture of the tendon chords connecting the valves with the papillary muscles;

With calcification of the valvular fibrous ring, which makes it difficult to narrow during ventricular systole.

Isolated mitral regurgitation is rare. Much more often it is combined with stenosis of the left atrioventricular orifice (mitral stenosis).

Etiology

Mitral regurgitation can be caused by:

Degenerative changes in valve tissue with the deposition of calcium salts;

Diffuse diseases connective tissue(rheumatoid arthritis, SLE, scleroderma);

Traumatic rupture of the valve leaflet.

In recent years, the role of ARF as a cause of mitral insufficiency has been steadily declining. Thus, according to the European Study on Heart Disease (2001), rheumatic origin of mitral insufficiency was noted in 14.2%, while degenerative calcification was the cause in 61.3% of cases.

Pathogenesis

Incomplete closure of the mitral valve leaflets leads to the return of part of the blood from the left ventricle to the left atrium during ventricular systole. A larger amount of blood accumulates in the left atrium, as a result of which its dilatation develops. An increased amount of blood also enters the left ventricle, which causes its dilatation and compensatory hypertrophy. Additional stretching of the atrial blood leads to an increase in pressure in its cavity and myocardial hypertrophy. The defect is compensated for a long time due to the work of a powerful left ventricle. In the future, with the weakening of the contractile function of the left ventricle in the cavity of the left atrium, the pressure increases, retrogradely transmitted to the pulmonary veins, capillaries, arterioles. There is a so-called venous ("passive") pulmonary hypertension, leading to moderate hyperfunction and hypertrophy of the right ventricle. With an increase in pressure in the pulmonary circulation and the development of dystrophic changes in the myocardium of the right ventricle, its contractile function decreases, and congestion occurs in the systemic circulation.

Clinical picture

The presence and severity of signs determine the clinical picture of the defect.

Direct or "valve" signs due to dysfunction of the mitral valve.

Indirect or "left-hearted" signs due to compensatory hyperfunction of the left ventricle and left atrium, followed by the development of dilation and hypertrophy.

Signs of "passive" pulmonary hypertension.

Signs of congestion in the systemic circulation.

On the first stage of diagnostic search during the period of defect compensation, the patient may not have any complaints. Patients can perform a lot of physical activity, and the defect is often discovered in them quite by accident (for example, during a preventive examination).

With a decrease in the contractile function of the left ventricle, which takes part in the compensation of the defect and the development of pulmonary hypertension, patients complain of shortness of breath during physical activity and on the heartbeat. The increase in congestion in the pulmonary circulation can cause attacks of cardiac asthma, as well as shortness of breath at rest.

In some patients, with the development of chronic congestion in the lungs, a cough develops, dry or with a small amount of sputum, often mixed with blood (hemoptysis). With an increase in right ventricular failure, edema and pain in the right hypochondrium are noted due to an increase in the liver and stretching of its capsule.

Patients often experience pain in the region of the heart. The nature of the pains is different: aching, stabbing, pressing; their relationship with physical activity is not always possible to detect.

With a sufficient number of complaints, it can only be concluded that there is a circulatory disorder in the pulmonary circulation, however, the cause of these disorders (i.e., the presence of a defect) can only be judged at the next stage of the diagnostic search.

On the second stage of diagnostic search it is necessary, first of all, to identify direct signs, on the basis of which it is possible to make a diagnosis of mitral insufficiency: systolic murmur over the apex of the heart in combination with a weakening of the first tone. These symptoms are directly related to dysfunction of the mitral valve: the weakening (sometimes complete absence) of the first tone is explained by the absence of a “period of closed valves”: systolic murmur occurs due to the passage of a reverse blood wave (regurgitation wave) from the left ventricle to the left atrium through a relatively narrow opening between the loose closed leaflets of the mitral valve. The intensity of the systolic murmur varies widely and is usually due to the severity of the valve defect. The timbre of the noise is different: soft, blowing or rough, which can be combined with palpable palpable systolic trembling at the apex. The murmur is best heard in the region of the apex of the heart and more clearly in the position of the patient on the left side while holding the breath in the exhalation phase, as well as after exercise. After taking nitroglycerin, the noise weakens. The systolic murmur may occupy part of the systole or the entire systole (pansystolic murmur).

During auscultation, in cases of pronounced mitral insufficiency above the apex of the heart, a third tone can be heard, which appears due to fluctuations in the walls of the left ventricle when an increased amount of blood is received from the left atrium. This III tone is always combined with a significant weakening of the I tone and a pronounced systolic murmur. Sometimes the third tone can be heard in young healthy people, but in this case, the first tone is sonorous, and in the presence of systolic murmur (usually functional origin), it is unsharply pronounced, short, soft in tone and usually disappears during exercise.

Sometimes the III tone is mistaken for the “mitral valve opening tone” with mitral stenosis, however, the mitral valve opening tone is necessarily combined with an increase in the I tone and diastolic murmur (i.e., valvular signs of mitral stenosis). With a slightly pronounced insufficiency of the mitral valve, the III tone is not auscultated.

At the second stage of the diagnostic search, indirect signs are also determined, indicating the severity of heart disease and circulatory disorders in various vessels. These include hypertrophy and dilatation of the left ventricle and left atrium, signs of pulmonary hypertension and congestion in the systemic circulation. The degree of enlargement of the left ventricle and left atrium corresponds to the degree of mitral regurgitation. An increase in the left heart can be detected during examination and palpation of the heart area: displacement of the apex beat to the left (with significant dilatation of the left ventricle) and down, as well as during percussion (lateral displacement of the left border due to the expansion of the left ventricle, and the upper border upward due to dilatation left atrium).

With a decrease in the contractility of the left ventricle and the development of pulmonary hypertension, the corresponding symptoms are revealed: the accent of the II tone over the pulmonary artery in combination with its splitting (this is due to a slight delay in the pulmonary component of the tone, as well as an earlier closing of the aortic valve due to the fact that the left ventricle is emptied after two holes). Pulmonary hypertension leads to the development of compensatory hyperfunction and hypertrophy of the right ventricle, which can cause the appearance of pulsation in the epigastric region (increasing at the height of inspiration). At severe violations circulation in the pulmonary circulation, acrocyanosis can be observed up to the development of a typical facies mitralis.

In the case of a decrease in the contractile function of the right ventricle, signs of stagnation in the systemic circulation are found: liver enlargement, swelling of the cervical veins, edema in the feet and legs. Pulse and blood pressure are usually unchanged.

On the third stage of diagnostic search clarify direct and indirect signs.

FKG gives a detailed description of systolic murmur and altered tones. Systolic murmur occurs along with the initial oscillations of the I tone and occupies the entire systole or most of it, the amplitude of the murmur curve is greater, the more pronounced valve insufficiency. When recording from the apex of the heart in severe cases of defect, the amplitude of the I tone decreases significantly, the I tone can completely merge with the systolic murmur. The QI tone interval may be increased to 0.07-0.08 s as a result of an increase in pressure in the left atrium and some delay in closing the mitral valve cusps.

The third tone is better recorded from the top of the heart - in the form of 2-4 rare oscillations. It should be emphasized that the interval between recording II and III tones is not less than 0.12 s. This is very important feature for differentiation of the III tone and the tone of opening observed at a mitral stenosis.

On the ECG with this defect, very different signs are revealed, depending on the severity of the valvular defect and the degree of pressure increase in the pulmonary circulation.

With a slight and moderate defect, the ECG may remain unchanged. In more severe cases, one sees signs of left atrial hypertrophy:

Appearance of a bicuspid tooth R in leads I, aVL, V 4 -V 6 , and the second peak, reflecting the excitation of the left atrium, exceeds the first, due to the excitation of the right atrium;

In lead V 1, the second (negative) phase of the wave sharply increases in duration and amplitude R;

As the degree of hypertrophy increases, the tooth R lengthens and exceeds 0.10 s.

signs left ventricular hypertrophy:

Increasing the amplitude of the tooth R in leads V 4 -V 6 and tooth S in leads V-V;

In leads V 4 -V 6, less often in V 1 and aVL segment ST decreases, and the tooth T changes its shape (its amplitude decreases, then it becomes isoelectric and, finally, biphasic and negative).

With the development of severe pulmonary hypertension, the ECG shows signs of right ventricular hypertrophy in the form of an increase in the amplitude of the wave R in leads V 1 -V 2 , and the ECG becomes characteristic of hypertrophy of both ventricles.

Echocardiography reveals an increase in the cavity of the left atrium and left ventricle. This method also reveals calcification of the mitral valve. With Doppler echocardiography, direct signs of a defect are determined - the reflux of a jet of blood from the left ventricle into the left atrium during ventricular systole. According to the size of the jet of regurgitation, 4 degrees of severity of the defect 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).

II degree - moderate, the jet of regurgitation is 4-6 mm.

III degree - medium, the jet of regurgitation is 6-9 mm.

IV degree - pronounced, jet of regurgitation more than 9 mm.

Finally, this method reveals the magnitude of the transmitral pressure gradient.

An x-ray examination reveals an increase in the left atrium (displacement of the contrasted esophagus by the atrium along a large radius arc, bulging of the third arc on the left heart contour), as well as an increase in the left ventricle (rounding of the fourth arc on the left heart contour, reduction of the retrocardial space). In the case of the development of pulmonary hypertension, there is an expansion of the roots of the lungs with fuzzy contours, vessels that can be traced to the periphery of the lung fields. An increase in the right ventricle as a reaction to an increase in pressure in the pulmonary artery is usually expressed mildly, since pulmonary hypertension in this defect does not reach high degrees.

Flow

The course of mitral valve insufficiency is very diverse. With no other defect, there is such a variability in the clinical picture: some patients suffering from the defect for many years endure great physical exertion, and the other part of the patients suffer from severe shortness of breath and severe right ventricular failure. With moderately severe regurgitation and the absence of serious myocardial damage as a result of repeated ARF attacks, patients can remain able-bodied for a long time. Pronounced mitral insufficiency quickly leads to the development of heart failure. During the vice, three periods can be distinguished.

First period: compensation of the “valvular” defect by increased work of the left atrium and left ventricle. This is a long period of good health of patients and the absence of symptoms of heart failure.

Second period: the development of "passive" (venous) pulmonary hypertension due to a decrease in the contractile function of the left heart. During this period, characteristic symptoms of circulatory disorders in the pulmonary circulation appear in the form of shortness of breath (during exercise and at rest), coughing, sometimes hemoptysis and attacks of cardiac asthma. This period does not last long, as congestion in the pulmonary circulation progresses rapidly and the right ventricle does not have time to adapt to the new conditions of functioning.

Third period: right ventricular failure with all the characteristic symptoms in the form of an enlarged liver, edema, increased venous pressure.

Complications

The main complications of the defect are associated with the development pulmonary hypertension and dilatation of the left atrium. These include:

Hemoptysis and pulmonary edema;

Violations heart rate in the form of atrial fibrillation (AF) and supraventricular extrasystole;

Thromboembolic complications (thrombosis of the left atrium with embolism in the kidneys, mesenteric vessels and vessels of the brain).

Diagnostics

The diagnosis of mitral insufficiency can be made upon detection of direct (valvular) signs of defect, supported by indirect ones (with auscultatory symptoms being the most important). Enlargement of the left ventricle and left atrium - less pronounced symptoms, especially in initial stage vice; they become expressed only with the progression of the defect and its long existence. Doppler echocardiography is of great help.

Differential Diagnosis

In the differential diagnosis of mitral insufficiency, the following should be borne in mind.

In healthy people, a functional systolic murmur can be heard above the apex of the heart, but more often it is determined above the base. In contrast to patients with heart disease, these individuals do not have altered heart sounds, there are no indirect signs of defect (enlargement of the left atrium and left ventricle), soft tone noise is variable in intensity. On FCG, the amplitude of the murmur is small, the murmur begins later than with heart disease, is less prolonged, I tone has a normal amplitude.

With “mitralization” during diseases accompanied by a sharp expansion of the cavity of the left ventricle and stretching of the fibrous ring of the mitral orifice (HA, post-infarction aneurysm of the left ventricle, diffuse severe myocarditis, DCMP, etc.), a systolic murmur is heard above the apex due to relative mitral insufficiency. However, unlike heart disease, in these diseases, a moderate increase in the left atrium is noted, which does not correspond to a much greater degree of left ventricular enlargement. In addition, differentiation is helped by the analysis of the entire clinical picture.

A systolic murmur at the apex of the heart may be associated with mitral valve prolapse syndrome. This syndrome consists in the bulging of the valve leaflets into the cavity of the left atrium, which causes blood regurgitation. Unlike mitral insufficiency, with prolapse, the first tone is not changed, an additional tone (mesosystolic click) is determined during the systole period, the systolic murmur occurs in the second half of the systole, which is clearly detected on the FCG; this noise is registered between a mesosystolic click and the II tone. When the patient moves to a vertical position or after taking nitroglycerin, the noise increases, while taking beta-blockers leads to a decrease in noise. Echocardiography finally resolves diagnostic difficulties by detecting mitral valve prolapse.

Systolic murmur over the apex of the heart can also be heard with other defects (stenosis of the aortic orifice, tricuspid insufficiency).

Treatment

There are no special methods of conservative treatment of patients with this heart disease. With developing heart failure, as well as cardiac arrhythmias, treatment is carried out according to generally accepted methods.

Surgical treatment (mitral valve replacement) is indicated for mitral valve insufficiency III and IV degrees (even in a satisfactory condition of the patient), as well as signs of left ventricular dysfunction (fall in cardiac output, final systolic size more than 45 mm).

Heart defects- These are changes in the structure of the heart that cause disturbances in its work. These include defects in the wall of the heart, ventricles and atria, valves, or outgoing vessels. Heart defects are dangerous because they can lead to impaired circulation in the heart muscle itself, as well as in the lungs and other organs, and cause life-threatening complications.

Heart defects are divided into 2 large groups.

• congenital heart defects
• Acquired heart defects

birth defects appear in the fetus between the second and eighth weeks of pregnancy. 5-8 babies out of a thousand are born with various anomalies in the development of the heart. Sometimes the changes are minor, and sometimes a major operation is needed to save the child's life. The cause of abnormal development of the heart can be heredity, infections during pregnancy, bad habits, the effects of radiation and even the extra weight of a pregnant woman.

It is believed that 1% of children are born with a defect. In Russia, this amounts to 20,000 people annually. But to these statistics it is necessary to add those cases when congenital malformations are detected after many years. The most common problem is a ventricular septal defect, accounting for 14% of all cases. It happens that at the same time in the heart of a newborn several defects are detected at once, which usually occur together. For example, tetralogy of Fallot is about 6.5% of all newborns with heart defects.

Acquired vices appear after birth. They can be the result of trauma heavy loads or diseases: rheumatism, myocarditis, atherosclerosis. The most common cause of the development of various acquired defects is rheumatism - 89% of all cases.

Acquired heart defects are a fairly common phenomenon. Do not think that they appear only in old age. A large proportion falls on the age of 10-20 years. But still, the most dangerous period is after 50. In old age, 4-5% of people suffer from this problem.

After the past diseases, there are mainly violations of the heart valves, which ensure the movement of blood in the right direction and prevent it from returning back. Most often, problems arise with the mitral valve, which is located between the left atrium and the left ventricle - 50-75%. In second place in the risk group is the aortic valve, located between the left ventricle and the aorta - 20%. The pulmonary and tricuspid valves account for 5% of cases.

Modern medicine has the ability to correct the situation, but surgery is necessary for a complete cure. Medication may improve well-being, but will not eliminate the cause of the disorder.

Anatomy of the heart

In order to understand what changes cause heart disease, you need to know the structure of the organ and the features of its work.

Heart- a tireless pump that pumps blood around our body without stopping. This organ is the size of a fist, has the shape of a cone and weighs about 300 g. The heart is divided lengthwise into two halves, right and left. top each half is occupied by the atria, and the lower ventricles. Thus, the heart consists of four chambers.
Oxygen-poor blood comes from the organs to the right atrium. It contracts and pumps a portion of blood into the right ventricle. And he sends it to the lungs with a powerful push. This is the beginning pulmonary circulation Key words: right ventricle, lungs, left atrium.

In the alveoli of the lungs, the blood is enriched with oxygen and returns to the left atrium. Through the mitral valve, it enters the left ventricle, and from it goes through the arteries to the organs. This is the beginning great circle circulation: left ventricle, organs, right atrium.

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

The second prerequisite A: Blood should only move in one direction. This is provided by valves that do not allow blood to take "a single step back."

What is the heart made of

The function of the heart is to contract and expel blood. The special structure of the heart helps it pump 5 liters of blood per minute. This is facilitated by the structure of the body.

The heart has three layers.

1. Pericardium - outer two-layer bag of connective tissue. Between outer and inner layer there is a small amount of fluid that helps reduce friction.
2. Myocardium - middle muscle layer, which is responsible for the contraction of the heart. It consists of special muscle cells that work around the clock and have time to rest in a split second between beats. In different parts, the thickness of the heart muscle is not the same.
3. Endocardium - the inner layer that lines the chambers of the heart and forms the septa. Valves are folds of the endocardium along the edges of the holes. This layer consists of strong and elastic connective tissue.

Valve anatomy

The chambers of the heart are separated from each other and from the arteries by fibrous rings. These are layers of connective tissue. They have holes with valves that let blood flow in the right direction, and then close tightly and prevent it from returning back. Valves can be compared to a door that only opens one way.

There are 4 valves in the heart:

1. mitral valve between the left atrium and the left ventricle. It consists of two valves, papillary or papillary muscles and tendon filaments - chords that connect the muscles and valves. When blood fills the ventricle, it presses on the valves. The valve closes under blood pressure. Tendon chords do not allow the valves to open towards the atrium.
2. tricuspid, or tricuspid valve - between the right atrium and the right ventricle. It consists of three valves, papillary muscles and tendon chords. The principle of its operation is the same.
3. aortic valve between the aorta and the left ventricle. It consists of three petals, which have a crescent shape and resemble pockets. When blood is pushed into the aorta, the pockets fill up, close, and prevent it from returning to the ventricle.
4. Pulmonary valve between the right ventricle and the pulmonary artery. It has three leaflets and works on the same principle as the aortic valve.

The structure of the aorta

It is the largest and most important artery in the human body. It is very flexible and stretches easily a large number elastic fibers of connective tissue. An impressive layer of smooth muscles allows it to narrow and not lose its shape. Outside, the aorta is covered with a thin and loose membrane of connective tissue. It carries oxygen-enriched blood from the left ventricle and divides into many branches, these arteries wash all organs.

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

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

Arterialor botallian duct

While the fetus develops inside the uterus, it has a duct between the aorta and the pulmonary trunk - a vessel that connects them. As long as the child's lungs are not working, this window is vital. It protects the right ventricle from overflow.

Normally, after birth, a special substance is released - bradycardin. It causes the muscles of the arterial duct to contract and it gradually turns into a ligament, a strand of connective tissue. This usually happens within the first two months after birth.

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

oval hole

The foramen ovale is the door between the left and right atrium. It is necessary for the child while he is in the uterus. During this period, the lungs do not work, but they need to be fed with blood. Therefore, the left atrium, through the foramen ovale, transfers part of its blood to the right, so that there is something to fill the pulmonary circulation.

After childbirth, the lungs begin to breathe on their own and are ready to supply oxygen to a small organism. The oval hole becomes unnecessary. Usually it is closed with a special valve, like a door, and then completely overgrown. This happens during the first year of life. If this does not happen, then the oval window may remain open throughout life.

Interventricular septum

Between the right and left ventricles there is a septum, which consists of muscle tissue and is covered with a thin layer of connective cells. Normally, it is solid and tightly separates the ventricles. This structure ensures the supply of oxygen-rich blood to the organs of our body.

But some people have a hole in this septum. Through it, the blood of the right and left ventricles is mixed. Such a defect is considered a heart defect.

mitral valve

Mitral valve anatomy The mitral valve is located between the left atrium and the left ventricle. It consists of the following elements:

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

If we compare a valve with a door, then the papillary muscles and tendon chords are its spring. Each leaflet has a spring that prevents it from opening towards the atrium.

mitral valve stenosis

Mitral valve stenosis is a heart disease that is associated with a narrowing of the valve lumen between the left atrium and the left ventricle. In this disease, the valve leaflets thicken and grow together. And if the normal area of ​​the hole is about 6 cm, then with stenosis it becomes less than 2 cm.

The reasons

The causes of mitral valve stenosis can be congenital anomalies in the development of the heart and past diseases.

Birth defects:

• fusion of the valve leaflets
• supravalvular membrane
• reduced annulus

Acquired valve defects appear as a result of various diseases:

infectious diseases:

• sepsis
• brucellosis
• syphilis
• angina
• pneumonia

During illness, microorganisms enter the bloodstream: streptococci, staphylococci, enterococci and fungi. They attach to microscopic blood clots on the valve leaflets and begin to multiply there. From above, these colonies are covered with a layer of platelets and fibrin, protecting them from immune cells. As a result, outgrowths similar to polyps form on the valve leaflets, which lead to the destruction of valve cells. The mitral valve becomes inflamed. In response, the connecting cells of the valve begin to multiply actively and the leaflets become thicker.

Rheumatic (autoimmune) diseases cause 80% of mitral valve stenosis

• rheumatism
• scleroderma
• systemic lupus erythematosus
• dermatopolymyositis

Immunity cells attack the connective tissue of the heart and blood vessels, mistaking it for infectious agents. Connective tissue cells are impregnated with calcium salts and grow. The atrioventricular ring and valve leaflets shrink and increase. On average, from the onset of the disease to the appearance of a defect, it takes 20 years.

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

Symptoms

When the mitral valve narrows, pressure rises in the left atrium and in the pulmonary arteries. This explains the disruption of the lungs and the deterioration of oxygen supply to all organs.

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

With a narrowing of the lumen twice to 2 cm 2, the following symptoms appear:

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

When the diameter of the mitral valve opening has reached 1 cm, the following symptoms appear:

• cough and hemoptysis after active loads and at night;
• swelling in the legs;
• pain in the chest and in the region of the heart;
• bronchitis and pneumonia often occur.

Objective symptoms - these are the signs that are visible from the side and what the doctor can notice during the examination.

Mitral valve stenosis symptoms:

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

But the most significant signs by which a doctor can diagnose "mitral valve stenosis" are listening with a medical tube or stethoscope.

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

And with stenosis, the doctor hears 3 tones in one contraction. The third is the sound of the mitral valve opening. This phenomenon is called "quail rhythm".

chest x-ray- allows you to determine the state of the vessels that bring blood from the lungs to the heart. The picture shows that the large veins and arteries that run in the lung are dilated. And small ones, on the contrary, are narrowed and are not visible in the picture. An x-ray makes it possible to determine how enlarged the size of the heart is.

Electrocardiogram (ECG). Reveals an increase in the left atrium and right ventricle. It also makes it possible to assess whether there are heart rhythm disturbances - arrhythmia.

Phonocardiogram (PCG). With mitral valve stenosis, a graphic recording of heart sounds appears:

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

Echocardiogram (ultrasound of the heart). The disease is confirmed by such changes:

• enlargement of the left atrium;
• valve seal;
• the valve leaflets close more slowly than in a healthy person.

Diagnostics

The process of establishing a diagnosis begins with a questioning of the patient. The doctor asks about the manifestations of the disease and conducts an examination.

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

• noise of blood while it fills the ventricles;
• "click" that is heard during the opening of the mitral valve;
• trembling of the chest, which is caused by the passage of blood through the narrow opening of the valve and the vibration of its valves - "cat's purr".

Results confirm the diagnosis instrumental research, which show enlargement of the left atrium and expansion of the branches of the pulmonary artery.

1. X-rays show dilated veins, arteries, and a displaced esophagus to the right.
2. An electrocardiogram shows left atrial enlargement.
3. The phonocardiogram reveals a murmur during diastole (relaxation of the heart muscle) and a click from the closing of the valve.
4. The echocardiogram shows a slowdown in the valve and an increase in the heart.

Treatment

By using medicines it is impossible to eliminate heart disease, but it is possible to improve blood circulation and the general condition of a person. For these purposes, various groups of drugs are used.

• Cardiac glycosides: Digoxin, Celanide
These funds help the heart contract more intensively and slow down the frequency of beats. They are especially necessary for you if the heart cannot cope with the load and starts to hurt. Digoxin is taken 4 times a day, 1 tablet. Celanide - one tablet 1-2 times a day. The course of treatment is 20-40 days.
• Diuretics (diuretics): Furosemide, Veroshpiron
They increase the rate of urine production and help eliminate excess water, reduce pressure in the vessels of the lungs and in the heart. Usually prescribed 1 diuretic tablet in the morning, but the doctor can increase the dose several times if the need arises. The course is 20-30 days, then they take a break. Together with water, useful minerals and vitamins are removed from the body, so it is advisable to take a vitamin-mineral complex, for example, Multi-Tabs.
• Beta-blockers: Atenolol, Propranolol
They help to return the rhythm of the heart to normal if there is atrial fibrillation or other rhythm disturbances. They reduce the pressure in the left atrium during exercise. Take 1 tablet before meals without chewing. The minimum course is 15 days, but usually the doctor prescribes long-term treatment. It is necessary to cancel the drug gradually so as not to cause deterioration.
• Anticoagulants: Warfarin, Nadroparin
You need them if a heart defect has caused left atrial enlargement, atrial fibrillation, which increases the risk of blood clots forming in the atrium. These drugs thin the blood and prevent the formation of blood clots. Take 1 tablet 1 time per day at the same time. For the first 4-5 days, a double dose of 5 mg is prescribed, and then 2.5 mg. Treatment lasts 6-12 months.
• Anti-inflammatory and antirheumatic drugs: Diclofenac, Ibuprofen
  These non-steroidal anti-inflammatory drugs relieve pain, inflammation, swelling, and lower the temperature. They are especially needed for those whose heart disease caused rheumatism. Take 25 mg 2-3 times a day. Course up to 14 days.
  Remember that each drug has its own contraindications and can cause serious side effects. Therefore, do not self-medicate and do not take drugs that have helped your friends. Only an experienced doctor can decide which medicines you need. At the same time, it takes into account whether the drugs you are taking will be combined.

Types of operations for mitral valve stenosis

Surgery in childhood

Whether surgery is needed for congenital mitral valve stenosis, the doctor decides depending on the condition of the child. If the cardiologist has determined that it is impossible to do without urgent elimination of the problem, then the baby can be operated on immediately after birth. If there is no danger to life, and there is no developmental delay, then the operation can be performed at the age of up to three years or postponed for more late deadline. Such treatment will allow the baby to develop normally and in no way lag behind their peers.

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

Mitral valve replacement. If the valve is severely damaged or there are developmental anomalies, the surgeon will put a silicone prosthesis in its place. But after 6-8 years, the valve will need to be replaced.

Indications for surgery for congenital mitral valve stenosis in children

• the area of ​​the opening in the mitral valve is less than 1.2 cm 2 ;
• severe developmental delay;
• strong rise pressure in the vessels of the lungs (pulmonary circulation);
• deterioration of well-being, despite the constant use of drugs.

Contraindications for surgery

• severe heart failure;
• thrombosis of the left atrium (you must first dissolve the blood clots with anticoagulants);
• severe damage to several valves;
• infective endocarditis inflammation of the inner lining of the heart;
• exacerbation of rheumatism.

Types of operations for acquired mitral valve stenosis in adults

Balloon valvuloplasty

This operation is performed through a small incision in femoral vein or arteries. A balloon is inserted through it into the heart. When it is in the mitral valve opening, the doctor inflates it sharply. The operation is carried out under X-ray and ultrasound control.

• the area of ​​the mitral valve opening is less than 1.5 cm 2;
• coarse deformation of the valve leaflets;
• sashes retain their mobility;
• there is no significant thickening and calcification of the valves.

Advantages of the operation

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

Disadvantages of the operation

• cannot eliminate serious changes in the valve (calcification, deformation of the valves);
• should not be performed with severe damage to several heart valves and left atrial thrombosis;
• the risk that a second operation will be required reaches 40%.

Commissurotomy

Transthoracic commissurotomy. This is an operation that allows you to cut the adhesions on the valve leaflets, which narrow the lumen between the left atrium and ventricle. The operation can be performed through the femoral vessels using a special flexible catheter that reaches the valve. Another option is to make a small incision on the chest and lead to the mitral valve through the interatrial groove surgical instrument, which expand the opening of the valve. This operation is performed without a heart-lung machine.

Indications for this type of operation

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

Advantages of the operation

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

Disadvantages of the operation

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

Open commissurotomy

Indications for this type of operation

• the diameter of the mitral valve opening is less than 1.2 cm;
• mild to moderate mitral insufficiency;
• calcification and low mobility of the valve.

Advantages of the operation

• gives good results of treatment;
• allows you to reduce pressure in the atrium and pulmonary veins;
• the doctor sees what changes have occurred in the structures of the valve;
• if during the operation it turns out that the valve is badly damaged, then you can immediately put an artificial one;
• can be performed if there is a thrombus in the left atrium or several valves are affected;
• effective when balloon valvuloplasty and transthoracic commissurotomy failed.

Disadvantages of the operation

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

Mitral valve replacement

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

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

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

Indications for valve replacement

• narrowing of the valve (less than 1 cm in diameter) if for some reason it is impossible to cut the adhesions between its petals;
• wrinkling of the valves and tendon threads;
• a thick layer of connective tissue (fibrosis) has formed on the valve flaps and they do not close well;
• there are large deposits of calcium on the valve leaflets.

Advantages of the operation

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

Disadvantages of the operation

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

Mitral valve prolapse

Mitral valve prolapse(PMC) or Barlow's syndrome is a heart disease in which the leaflets of the mitral valve bend into the left atrium during the contraction of the left ventricle. In this case, a small amount of blood returns to the atrium. She joins a new portion, which comes from two pulmonary veins. This phenomenon is called "regurgitation" or "reverse reflux".

This disease is present in 2.5-5% of people and most of them do not even know about it. If the changes in the valve are minor, then there are no symptoms of the disease. In this case, doctors consider mitral valve prolapse to be a variant of the norm - a feature of the development of the heart. Most often it is found in young people under 30 years old, and in women several times more often.

It is believed that with age, changes in the valve may disappear on their own. But in any case, if you have mitral valve prolapse, then you need to visit a cardiologist at least once a year and do an ultrasound of the heart. This will help to avoid heart rhythm disturbances and infective endocarditis.

Reasons for the appearance of PMK

Doctors identify congenital and acquired causes of prolapse.

Congenital

• disturbed structure of the mitral valve cusps;
• weakness of the connective tissue that makes up the valve;
• too long tendon chords;
• violations of the structure of the papillary muscles, to which the chords are attached, fixing the valve.

The chords or tendon threads that are supposed to hold the leaflets of the mitral valve are stretched. The doors do not close tightly enough, under the pressure of blood during the contraction of the ventricle, they protrude towards the atrium.

infectious diseases

• angina
• scarlet fever
• sepsis

In infectious diseases, bacteria enter the bloodstream. They penetrate the heart, linger on its membranes and multiply there, causing inflammation of different layers of the organ. For example, angina and scarlet fever caused by streptococcus are often complicated after 2 weeks by inflammation of the connective tissue that makes up the valve leaflets and chorda.

Autoimmune pathologies

• rheumatism
• scleroderma
• red systemic lupus

These diseases affect the connective tissue and disrupt the functioning of the immune system. As a result immune cells attack the joints, the inner lining of the heart and its valves. Connecting cells in response begin to multiply rapidly, causing thickening and the appearance of nodules. The sashes are deformed and sag.

Other reasons

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

Symptoms

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

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

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

• pain in the region of the heart;
• strong heartbeat;
• weakness and faintness;
• bouts of dizziness;
• fatigue;
• bouts of fear and anxiety;
• heavy sweating;
• shortness of breath and feeling short of breath;
• fever not associated with infectious diseases.

Objective symptoms- signs of MVP, which the doctor detects during the examination. If you asked for help during an attack, the doctor will notice the following changes:

• tachycardia - the heart beats faster than 90 beats per minute;
• arrhythmia - the appearance of extraordinary "unplanned" heart contractions against the background of a normal rhythm;
• rapid breathing;
• systolic trembling - trembling of the chest, which the doctor feels at hand during probing. It is created by vibrating valve flaps, when through a narrow gap between them under high pressure a stream of blood breaks out. This happens at the moment when the ventricles contract and the blood, through small defects in the valves, returns to the atrium;
• tapping (percussion) may reveal that the heart is constricted.
  Listening to the heart with a stethoscope gives the doctor the opportunity to identify such violations:
• systolic murmur. It is produced by blood leaking through the valve back into the atrium during ventricular contraction;
• instead of two tones during heart contraction (I - the sound from the contraction of the ventricles, II - the sound from the closing of the valves of the aorta and pulmonary arteries), as in people with a healthy heart, you can hear three tones - “quail rhythm”. The third element of the melody is the click of the mitral valve petals at the moment of closing;

These changes are not permanent, depending on the position of the body and breathing of a person. And after the attack they disappear. Between attacks, the condition normalizes and the manifestations of the disease are not noticeable.

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

Instrumental survey data

Electrocardiogram. With MVP, Holter monitoring is often used, when a small sensor continuously records the cardiogram of the heart for several days while you are doing your usual activities. It can detect heart rhythm disturbances (arrhythmia) and untimely contraction of the ventricles (ventricular extrasystoles).

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

Chest x-ray. May show that the heart is normal or reduced in size, sometimes there is an expansion of the initial section of the pulmonary artery.

Diagnostics

In order to correctly diagnose the doctor listens to the heart. Characteristic signs of mitral valve prolapse:

• click of the valve leaflets during the contraction of the heart;
• the sound of blood passing through a narrow gap between the valve leaflets in the direction of the atrium.

The main method for diagnosing MVP is echocardiography. It detects changes that confirm the diagnosis:

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

Treatment

There are no drugs that can cure mitral valve prolapse. If the form is not severe, then treatment is not required at all. It is advisable to avoid situations that provoke palpitations, use in moderate amount tea, coffee, alcoholic drinks.

Medical treatment prescribed if your health has worsened.

• Calming drugs (sedatives)
Preparations based on medicinal herbs: tinctures of valerian, hawthorn or peony. They not only calm the nervous system, but also improve the functioning of blood vessels. These drugs help to get rid of the manifestations of vegetative-vascular dystonia, which affects all those who have mitral valve prolapse. Tinctures can be taken for a long time, 25-50 drops 2-3 times a day.

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

• Tranquilizers: Diazepam
Helps relieve anxiety, fear and irritability. It improves sleep and slows down the heart rate. Take half a tablet or a whole 2-4 times a day. The duration of treatment is 10-14 days. The drug can not be combined with other sedatives and alcohol, so as not to overload the nervous system.
• B-blockers: Atenolol
Reduces the effect of adrenaline on nerve receptors, thereby reducing the effect of stress on blood vessels and the heart. It balances the effect on the heart of the sympathetic and parasympathetic nervous systems that control the frequency of contractions, and at the same time the pressure in the vessels decreases. Relieves arrhythmias, palpitations, dizziness and migraines. Take 1 tablet (25 mg) once a day before meals. If this is not enough, the doctor will increase the dose. The course of treatment is 2 weeks or more.
• Antiarrhythmic drugs: Magnesium orotate
Magnesium in its composition improves the production of collagen and thereby strengthens the connective tissue that makes up the valve. It also improves the ratio of potassium, calcium and sodium, and this leads to a normal heart rate. Take 1 g daily for a week. Then the dose is halved to 0.5 g and continue to drink for 4-5 weeks. Should not be taken by people with kidney disease and children under 18 years of age.
• Means for lowering pressure: Prestarium, Captopril
  Inhibit the action of a specific enzyme, causing an increase pressure. Restore the elasticity of large vessels. Do not allow the atria and ventricles to stretch from increased blood pressure. Improve the condition of the connective tissue of the heart and blood vessels. Prestarium take 1 tablet (4 mg) 1 time per day in the morning. After a month, the dose can be increased to 8 mg and taken with diuretics. Treatment, if necessary, can continue for years.

Surgery for mitral valve prolapse

Surgery for MVP is extremely rare. Depending on your state of health, age and degree of valve damage, the surgeon will suggest one of the existing techniques.

Balloon valvuloplasty

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

Indications for this type of operation

• a large volume of blood that returns to the left atrium;
• constant deterioration of well-being;
• drugs do not help relieve the symptoms of the disease;
• high blood pressure in the left atrium by more than 40 mm Hg.

Advantages of the operation

• carried out under local anesthesia;
• easier to bear than surgery open heart;
• no need to stop the heart for the period of the operation and connect the heart-lung machine;
• faster and easier recovery period.

Disadvantages of the operation

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

Heart valve replacement

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

Indications for this type of operation

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

Advantages of the operation

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

Disadvantages of the operation

• it may be necessary to replace the valve after 6-8 years, especially with a biological prosthesis;
• increases the risk of blood clots in the heart - blood clots;
• Open heart surgery (incision between the ribs) will take up to 1-1.5 months to recover.

Degrees of mitral valve prolapse

The word "prolapse" means "sagging". With MVP, the mitral valve leaflets are slightly stretched and this prevents them from closing tightly at the right time. In some people, MVP is a small structural feature of the heart, almost the norm, and there are no signs of illness. And others have to regularly take medication and even undergo heart surgery. Appoint proper treatment helps to determine the degree of mitral valve prolapse.

Degrees of prolapse

• I degree - both valves bend towards the atrium by more than 2-5 mm;
• II degree - the valves bulge by 6-8 mm;
• III degree - the sashes bend more than 9 mm.

How to determine the degree of prolapse

Helps to determine the degree of MVP ultrasound procedure hearts - echocardiography. On the monitor screen, the doctor sees how much the valve leaflets bend inside the atrium, and measures the degree of deviation in millimeters. This feature underlies the division into degrees.

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

Main diagnostic criteria

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

Bulging and regurgitation are independent of each other. For example, the III degree of development of prolapse does not mean at all that a lot of blood is thrown into the left atrium. It is regurgitation that causes the main symptoms of the disease. And its volume is used to determine whether treatment is necessary.

results listening to the heart (auscultation) help to distinguish the disease from an atrial septal aneurysm or myocarditis. PMK is characterized by:

• clicks that are heard during the closing of the mitral valve;
• noises that blood creates, under pressure, breaking through a narrow gap between the valve leaflets.

Feelings experienced by a sick person, results ECG and x-ray help to clarify the diagnosis, but leading role in this case do not play.

mitral valve insufficiency

Mitral insufficiency valve or mitral insufficiency - one of the acquired heart defects. With this disease, the leaflets of the mitral valve do not close completely - a gap remains between them. Each time the left ventricle contracts, some of the blood returns to the left atrium.

What then happens in the heart? The volume of blood in the left atrium increases, and it swells and thickens. The fibrous ring - the basis of the mitral valve, stretches and weakens. As a result, the condition of the valve gradually deteriorates. The left ventricle is also stretched, into which, after atrial contraction, too much blood enters. There is increased pressure and stagnation in the vessels going from the lungs to the heart.

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

The reasons

The disease can appear during the formation of the heart during pregnancy or be the result of an illness.

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

• underdevelopment of the left half of the heart;
• too small leaflets of the mitral valve;
• bifurcation of the valves;
• too short tendon chords that prevent the valve from closing completely.

Acquired mitral regurgitation appears after an illness.

infectious diseases

• pharyngitis
• bronchitis
• pneumonia
• periodontal disease

These diseases, caused by streptococci and staphylococci, can cause a serious complication - septic endocarditis. Inflammation of the valve leaflets causes them to shrink and shorten, become thicker and deformed.

Autoimmune pathologies

• rheumatism
• systemic lupus erythematosus
• multiple sclerosis

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

Other reasons

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

All of these reasons can cause violations in the structure of the valve. Regardless of what caused the disturbance, the symptoms of mitral valve insufficiency are similar in all people.

Symptoms

In some people, mitral valve insufficiency does not worsen well-being and is detected incidentally. But when the disease progresses, the heart can no longer compensate for blood flow disturbances. The severity of the disease depends on two factors:

1. how much clearance remains between the valve leaflets at the moment of closing;
2. how much blood returns to the left atrium when the ventricle contracts.

well-being a person with mitral valve insufficiency:

• shortness of breath on exertion and at rest;
• weakness, fatigue;
• cough that gets worse when lying down
• sometimes there is blood in the sputum;
• aching and pressing pains in the region of the heart;
• swelling of the legs;
• heaviness in the abdomen under the right rib, caused by an enlarged liver;
• accumulation of fluid in the abdomen - ascites.

During the examination, the doctor detects objective symptoms mitral insufficiency:

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

A doctor receives a lot of information during auscultation - this is listening to the heart with a stethoscope.

• the sound from the contraction of the ventricles is weakened or not heard at all;
• you can hear the mitral valve closing;
• the most characteristic sign is the noise that is heard during systole - contractions of the ventricles. It is called "systolic murmur". It arises from the fact that blood under pressure breaks back into the atrium through loosely closed valve leaflets during ventricular contraction.

Data instrumental research clarify changes in the heart and pulmonary vessels.

chest x-ray. The picture shows:

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

Electrocardiogram. The cardiogram may remain normal, but if the pressure in the chambers of the heart and pulmonary veins is increased, then changes appear. These may be signs of enlargement and overload of the left atrium and left ventricle. If the defect is strongly developed, then the right ventricle is enlarged.

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

• the sound from the contraction of the ventricles is heard faintly. This is due to the fact that the ventricles almost do not close;
• murmur of blood rushing from the left stomach into the left atrium. The louder the noise, the more severe mitral insufficiency;
• an additional click is heard when the valve closes. This sound is created by the papillary muscles, valve cusps and the chords that hold them.

echocardiography(ultrasound of the heart) indirectly confirms mitral valve insufficiency:

• an increase in the size of the left atrium;
• stretching of the left ventricle;
• incomplete closure of the valve leaflets.

Doppler study doppler echocardiography- Ultrasound of the heart, which captures the movement of blood cells. It helps to determine if there is a backflow of blood, and to establish how much of it is in the atrium during each contraction.

Diagnostics

In order to make a diagnosis, the doctor pays attention to characteristics mitral valve insufficiency.

1. echocardiography- reveals the weakening of the sound from the contraction of the ventricles and the noise that creates the backflow of blood. Changes in the valve leaflets are also visible.
2. Electrocardiogram shows an increase in the left atrium, left and right ventricles.
3. x-ray. On the x-ray dilated vessels are visible over the entire surface of the lungs with an indistinct edge and expansion of the heart to the left.

Treatment

Mitral valve insufficiency cannot be cured with medication. There are no drugs that could restore the valve leaflets and force them to close tightly. But with the help of drugs, you can improve the functioning of the heart and unload it.

• Diuretics: Indapamide
It is a diuretic drug that is prescribed to rid the lungs of stagnant blood. It speeds up the production of urine and helps to remove excess water from the body. As a result, the pressure in the chambers of the heart and the vessels of the lungs decreases. Take 1 tablet in the morning. The course of treatment is 2 weeks. Your doctor may recommend taking diuretics every day for a long time. It must be remembered that the minerals potassium, sodium, and calcium necessary for the proper functioning of the heart are excreted in the urine. Therefore, it is necessary to take mineral supplements with the permission of a doctor.
• ACE inhibitors: Captopril
Reduces the load on the heart and pressure in the vessels of the lungs, improves blood circulation. In addition, it reduces the size of the heart and allows it to more efficiently eject blood into the arteries. Helps to better carry loads. Take one hour before meals, 1 tablet 2 times a day. If necessary, after 2 weeks the dose can be doubled.
• Beta blockers: Atenolol
Blocks the action of receptors that cause an acceleration of the heart rate. Reduces the impact of the sympathetic nervous system, and it is she who makes the heart contract faster. Atenolol reduces the contractility of the heart muscle, makes the heart beat smoothly, in the right rhythm and lowers blood pressure. The first week the drug is taken half an hour before meals at 25 mg / day, for the second dose it is increased to 50 mg / day, for the third week it is adjusted to 100 mg / day. It is also necessary to cancel this medicine gradually, otherwise the state of health may deteriorate sharply and myocardial infarction will occur.
• Cardiac glycosides: Digoxin
Increases the concentration of sodium in the cells of the heart. Improves the conduction system of the heart, which is responsible for the rhythm of its contractions. The beats become more rare, and the pauses between them lengthen, and the heart has the opportunity to rest. Improves lung and kidney function. You need digoxin especially if mitral valve insufficiency is accompanied by atrial fibrillation. The first days of treatment should be taken at 1 mg / day. The dose is divided into 2 parts and drunk in the morning and evening. After a few days, they switch to a maintenance dose, which is 0.5 mg / day. But remember that for each person the amount of the drug is prescribed individually.
• Antiplatelet agents: Aspirin
  This medicine prevents platelets and red blood cells from sticking together and forming clots. In addition, antiplatelet agents help red blood cells become more flexible and pass through the narrowest capillaries. This improves blood circulation and nutrition of all tissues and organs. Aspirin is essential for people who have an increased risk of blood clots. Take 1 time per day before meals, 100 mg / day. To reduce the risk of damage to the lining of the stomach, you can drink aspirin with meals or take the tablet with milk.

Remember that all these drugs should not be taken by people with severe kidney disease, pregnant women and nursing mothers, as well as those who have an individual intolerance to any component of the drug. Be sure to tell your doctor about all comorbidities and medicines you are already taking. During treatment, you will have to periodically take a blood test so that the doctor determines whether the treatment is harmful and can, if necessary, change the dosage.

Operation types

In order to assess whether the heart needs surgery, the stage of mitral valve insufficiency is determined.

Grade 1 - back reflux of blood into the left atrium is not more than 15% of the volume of blood in the left ventricle.
Grade 2 - reverse blood flow 15-30%, the left atrium is not expanded.
Grade 3 - the left atrium is moderately dilated, 50% of the blood volume from the ventricle returns to it.
Grade 4 - the reverse blood flow is more than 50%, the left atrium is enlarged, but its walls are not thicker than in other chambers of the heart.

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

clipping method

Through the artery on the thigh, with the help of a flexible cable, a special clip is delivered to the heart. This device is attached in the middle of the mitral valve. Thanks to its special design, it passes blood from the atrium to the ventricle and prevents it from moving in the opposite direction. In order to control everything that happens during the operation, the doctor uses an ultrasound probe placed in the esophagus. The procedure takes place under general anesthesia.

Indications for this type of operation

• stage 2 mitral insufficiency;
• reflux of blood into the left atrium reaches 30%;
• No major changes tendon chords and papillary muscles.

Advantages of the operation

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

Disadvantages of the operation

• not suitable for severe valve damage.

Mitral valve reconstruction

Modern doctors try to save the valve whenever possible: if there is no severe deformation of the valves or significant calcium deposits on them. Reconstructive mitral valve repair is performed more than mild patients any age. To correct valve defects, the doctor cuts the chest and, using a scalpel, corrects damage to the valves and aligns them. Sometimes a rigid support ring is inserted into the valve to narrow it, or the tendon chords are shortened. The operation takes place under general anesthesia and requires connection to a machine that works like an artificial heart.

Indications for this type of operation

• 2nd and 3rd stage of mitral insufficiency
• return of blood from the left ventricle to the left atrium more than 30%;
• moderate deformation of the valve leaflets, caused by any causes.

Advantages over valve replacement

• retains the "native" valve and improves its operation;
• less likely to have heart failure;
• lower mortality after surgery;
• fewer complications.

Disadvantages of the operation

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

Mitral valve replacement

The surgeon removes the affected valve leaflets and puts a prosthesis in their place.

Indications for this type of operation

• 3-4 stages of mitral valve insufficiency;
• the amount of blood that is thrown back into the atrium is 30-50% of the volume of blood in the ventricle;
• the operation is carried out even if there are no tangible symptoms of the disease, but the left ventricle is greatly enlarged and there is stagnation in the lungs;
• severe violation left ventricular functions;
• significant deposits of calcium or connective tissue on the valve petals.

Advantages of the operation

• allows you to correct any violations in the valve apparatus;
• immediately after the operation, blood circulation normalizes and stagnation of blood in the lungs disappears;
• allows you to help patients with 4 degrees of mitral insufficiency, when other methods are no longer effective.

Disadvantages of the operation

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

The choice of the type of operation depends on the age, degree of valve damage, acute and chronic diseases, the wishes of the patient and his financial capabilities.

After any open heart surgery, the first day will have to be spent in intensive care and about 7-10 more days in cardiology department. After that, another 1-1.5 months will be needed for rehabilitation at home or in a sanatorium, and you can return to normal life. It takes six months to fully restore the body. Proper nutrition, good rest and physiotherapy will allow you to fully restore health and live a long and happy life.

The well-coordinated work of the heart valves ensures proper blood flow in the body. The valvular apparatus is represented by two atrioventricular (tricuspid in the right sections, mitral in the left sections of the heart), pulmonary and aortic valves. Mitral valve defects - what is it? This will be discussed in our material.

Normally, the heart beats rhythmically. In one cardiac cycle of work, systole (contraction) and diastole (relaxation) of the heart muscle occur. Atrial contractions start the flow of blood through the open valves, and it enters the ventricles. The period of contractions of the ventricles coincides with the relaxation of the atria, the atrioventricular valves close, preventing the flow of blood back. Through the open aortic and pulmonary valves, blood is carried through the vessels of all organs. In diastole, there is a decrease in pressure in the cavities of the heart, which contributes to the filling of the right and left atrium with blood, and the cycle begins anew. In case of violation of the functioning of the valves, defects develop - insufficiency, stenosis, prolapse of the valves.

mitral valve insufficiency

Mitral insufficiency is a defect of the mitral valve, leading to abnormal blood flow during the contraction of the heart from the ventricle to the atrium. Statistically, it is observed high frequency diagnosing this pathology. Very rarely isolated (0.6% intrauterine malformations). Diagnosis of mitral insufficiency at birth must exclude damage to other structures. Stenosis and insufficiency, occurring simultaneously in one patient, is called combined mitral heart disease. Often there is a combination of aortic defects with mitral valve insufficiency.

Symptoms

With minimal structural changes in the valve, patients feel well. Pathology is diagnosed when visiting a doctor. With moderate damage, fatigue, palpitations, a feeling of incomplete inhalation / exhalation, blood when coughing, pain in the heart area occur. Some patients have attacks of cardiac asthma, more often at night. With decompensation, heart failure develops according to the right ventricular type. Its signs include peripheral edema, cyanosis of the earlobes, fingertips, nose, the liver enlarges, ascites is formed, and neck veins swell. The heart muscle can also suffer and manifest itself in the form of rhythm disturbances (atrial fibrillation).

Forms

Distinguish between congenital and acquired insufficiency, as well as organic (changes in its structure) and functional (expansion of the ventricular cavity with other pathology of the heart). Given the amount of blood returning to the atria (regurgitation), a certain degree is distinguished:

• 1 (with mild mitral regurgitation) less than 20% stroke volume;
• 2 (moderate) 20 - 40% of stroke volume;
• 3 (pronounced) 40 - 60% of stroke volume;
• 4 (severe) greater than 60% of stroke volume.

Depending on the clinical picture, 3 stages are distinguished - compensation, subcompensation, decompensation.

According to ICD X ( International classification diseases) with mitral insufficiency, the code is I05.8 for non-rheumatic lesions and I05.1 if the disease is rheumatic.

The reasons

Mitral valve pathology occurs as a result of other heart lesions, which include:

• anomalies in the development of the fetus (defects of the partitions);
• arterial hypertension;

• acute rheumatic fever(old name "rheumatism");
• carditis of the inner wall of the heart (endocardium) of infectious origin;
• cardiosclerosis, myocardial infarction;
• myocarditis;
• heart injury;
• autoimmune pathology.

Mitral valve prolapse refers to the bulging of the leaflets during the contraction of the ventricles into the atrium. More often found in preventive examination child's pediatrician, less often in adults. There is a predominance of the development of prolapse in women, in comparison with men. Among the general population, the frequency of occurrence varies from 15 to 25%.

The causes of primary prolapse may be anomalies in the development of the fetus. In the secondary - as a result of past or chronic diseases, it includes:

• cardiodilation;
• chest injury;
• hereditary diseases and chromosomal mutations;
• anomalies in the development of the fetus;
• rheumatic lesion

Patients usually have no complaints. But there may be a feeling of lack of air, an increase in body temperature for no reason, dizziness, fainting, frequent headaches, tachy / bradycardia, chest pain. These symptoms are not specific, but they can help the doctor make the correct diagnosis.

Stenosis - what is it, causes of development

Mitral stenosis is a heart disease in which there is a decrease in the area of ​​the atrioventricular orifice on the left. The valves change, they become thicker or grow together.
In 80%, rheumatic mitral valve disease is the main cause of prolapse. Other reasons include:

• atherosclerosis, a large blood clot in the cavity of the heart;
• syphilis;
• infective endocarditis;
• heart injury;
• neoplasms of the heart muscle (myxoma);
• as a complication of rheumatic diseases.

Symptoms

The clinical picture of valve damage is manifested when the area of ​​​​its opening changes by less than 2 cm. The presence of stenosis can be suspected by the following symptoms:

• shortness of breath during exercise, with the progression of the disease - at rest;
• fatigue;
• pain in the region of the heart;
• hemoptysis;
• feeling of heartbeat;
• arrhythmia.

With a severe course of the disease, attacks of cardiac asthma develop. They can be provoked by psycho-emotional stress.

Quite specific description appearance patient with advanced disease. It is characterized by blushing of the cheeks with bluish coloration of the nails and the tip of the nose. With the progression of the disease, signs of right ventricular failure (enlargement of the liver, ascites, edema) join.

Diagnostic methods and principles of treatment of mitral defects

When examining a patient with damage to the mitral valve, the doctor performs auscultation. At the same time, he draws attention to the specific auscultatory noise in the region of the heart. Heart murmur, as a symptom of its defeat, is an indication for the appointment comprehensive survey. If mitral valve disease is suspected, conduct:

• chest x-ray;
• echocardioscopy;
• consultation of narrow specialists (cardiac surgeon, cardiologist).

Other studies may also be prescribed, depending on the degree of valve damage and the presence of other diseases in the patient.

If a defect is detected - mitral insufficiency or stenosis, at the stage of minimal changes, conservative therapy and dynamic monitoring of the patient's condition. Medical treatment must be combined with surgery. The therapy uses antiarrhythmic drugs, anticoagulants (for the prevention of thromboembolic complications), as well as drugs that help eliminate the root cause of the disease.

Isolated and combined mitral heart defects always need surgery - the only question is when. Indications for surgical treatment are:

• signs of heart failure III - IV functional class, which developed against the background of the defect;
• 2 - 3 stage of regurgitation;
• severe sclerosis, deformation of the valve leaflets;
• ineffective treatment of rheumatic heart disease, infective endocarditis.

Among the options surgical interventions allocate valve-preserving (comisosotomy in case of stenosis, comessuroplasty in case of insufficiency) and valve prosthetics.

After surgical treatment, the affected valve is sent to the pathology department for examination. A macropreparation in case of insufficiency contains foci of fibrosis, proliferation of vegetations, in case of stenosis - fibrosis and thickening of the walls of the mitral annulus.

For mitral valve prolapse mild degree treatment is not required, with severe prolapse of the valves, beta-blockers are prescribed. These patients are annually examined with a mandatory ultrasound of the heart.

Prevention and prognosis of the disease

With early detection of mitral valve defects, a favorable course of the disease is observed. Preventive measures are aimed at timely treatment isolated and combined defects of the mitral valve, as well as the prevention of diseases leading to its development. The presence of a diagnosed defect provides for the correction of the regime of work and rest, diet and water regime.

Therefore, the timely diagnosis of heart defects of the mitral or other valves, as well as their treatment, helps to reduce the number of complications and improve the patient's life. Be healthy!

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Heart disease in the fetus in the womb

The unknown is always, at least, alarming or they begin to be afraid of him, and fear paralyzes a person. On a negative wave, wrong and hasty decisions are made, their consequences worsen the situation. Then again fear and - again wrong decisions. In medicine, such a "loopback" situation is called circulus mortum, vicious circle. How to get out of it? Let shallow, but true knowledge of the basics of the problem, help to solve it adequately and on time.

What is a heart defect?

Each organ of our body is designed to function rationally in the system for which it is intended. The heart belongs to circulatory system, helps the movement of blood and its saturation with oxygen (O2) and carbon dioxide (CO2). Filling and contracting, it "pushes" the blood further, into large, and then into small vessels. If the usual (normal) structure of the heart and its large vessels is broken - either before birth, or after birth as a complication of the disease, then we can talk about a defect. That is, a heart disease is a deviation from the norm that interferes with the movement of blood, or changes its filling with oxygen and carbon dioxide. Of course, as a result, problems arise for the whole organism, more or less pronounced and varying degrees danger.

A little about the physiology of blood circulation

The human heart, like all mammals, is divided into two parts by a dense partition. The left one pumps arterial blood, it is bright red in color and rich in oxygen. The right one - venous blood, it is darker and saturated with carbon dioxide. Normally, the septum (it is called interventricular) has no holes, and the blood in the cavities of the heart ( atrium and ventricles) does not mix.

Venous blood from the whole body enters the right atrium and ventricle, then to the lungs, where it releases CO2 and receives O2. There she turns into arterial, passes the left atrium and ventricle, reaches the organs through the vascular system, gives them oxygen and takes carbon dioxide, turning into venous. Then - again to the right side of the heart and so on.

The circulatory system is closed, so it is called " circle of blood circulation". There are two such circles, both involve the heart. The circle "right ventricle - lungs - left atrium" is called small, or pulmonary: in the lungs, venous blood becomes arterial and is transmitted further. The circle "left ventricle - organs - right atrium" is called big, passing along its route, the blood from arterial again turns into venous.

functional left atrium and ventricle experience a high load, because the large circle is “longer” than the small one. Therefore, on the left, the normal muscular wall of the heart is always somewhat thicker than on the right. The large vessels that enter the heart are called veins. Outgoing - arteries. Normally, they do not communicate with each other at all, isolating the flows of venous and arterial blood.

valves hearts are located between atria and ventricles, and at the border of the entrance and exit of large vessels. The most common problems are with mitral valve (bicuspid, between the left atrium and ventricle), in second place - aortic(at the exit of the aorta from the left ventricle), then tricuspid(tricuspid, between the right atrium and ventricle), and in "outsiders" - pulmonary valve, at its exit from the right ventricle. The valves are mainly involved in the manifestations of acquired heart defects.

Video: principles of blood circulation and heart function

What are heart defects?

Let's consider the classification adapted for patients according to the presentation.

1. Congenital and acquired - changes in the normal building and position heart and his large vessels appeared either before or after birth.
2. Isolated and combined - changes are either single or multiple.
3. C (so-called "blue") - the skin changes its normal color to a bluish tint, or without cyanosis. Distinguish cyanosis generalized(common) and acrocyanosis(fingers and toes, lips and tip of the nose, ears).

I. Congenital heart disease (CHD)

Violations in the anatomical structure of the child's heart are formed more in utero(during pregnancy), but appear only after birth. To get a more complete picture of the problem - see pictures of heart defects.

For convenience, they were classified based on the blood flow through the lungs, that is small circle.

• CHD with an increase in pulmonary blood flow - with cyanosis and without it;
• CHD with normal pulmonary blood flow;
• CHD with reduced blood flow through the lungs - with cyanosis and without it.

Ventricular septal defect (VSD)

Depending on the degree of defect and disturbance of blood flow, the concepts compensated(due to thickening of the walls of the heart and increased contractions, the blood passes in normal volumes) and decompensated(heart enlarges too much, muscle fibers do not receive the necessary nutrition, the strength of contractions falls) of acquired vices.

mitral valve insufficiency

The work of healthy (top) and affected (bottom) valves

Incomplete closure of the valves is the result of their inflammation and consequences in the form sclerosis(replacement of "working" elastic tissues with rigid connective fibers). Blood on contraction left ventricle thrown in the opposite direction left atrium. As a result, a greater force of contractions is needed to “return” the blood flow to the side. aorta, and hypertrophied(thickens) all left side hearts. Gradually develops failure in a small circle, and then - a violation of the outflow venous blood from the systemic circulation, the so-called.

Signs: mitral blush(pinkish-blue color of lips and cheeks). Trembling of the chest, felt even by hand - it is called cat's purr, and acrocyanosis(bluish hue of the hands and toes, nose, ears and lips). Such picturesque symptoms are possible only when decompensated vice, and compensated they don't happen.

Treatment and prognosis: in advanced cases, for prevention , required . Patients live a long time, many are not even aware of the disease if it is in compensation stages. It is important to treat all inflammatory diseases in time.

figure: mitral valve replacement

Mitral stenosis (narrowing of the valve between the left atrium and ventricle)

Signs: if vice decompensated, when measuring blood pressure lower digit ( diastolic pressure ) can drop to almost zero. Patients complain of dizziness, if the position of the body changes rapidly (lay down - got up), asthma attacks at night. The skin is pale, the pulsation of the arteries in the neck is visible ( dance carotid) and shaking the head. Pupils eye and capillaries under the nails (visible when pressing on nail plate) also pulsate.

Treatment: prophylactic - compensated vice, radical - artificial aortic valve.

Forecast: isolated vice in about 30% they are found by chance, during a routine examination. If defect valve small and not pronounced, people do not even suspect about the vice and live a full life.

Consequences of aortic disease - heart failure, stagnation of blood in the ventricle

Aortic stenosis, isolated defect

Difficulty in getting blood out of left ventricle in aorta: more effort is required for this, and the muscular walls of the heart thicken. The less aortic orifice, the more pronounced hypertrophy left ventricle.

Signs: associated with a decrease in income arterial blood to the brain and other organs. Paleness, dizziness and fainting heart hump(if the defect developed in childhood), attacks of pain in the heart ().

Treatment: we reduce physical activity, we carry out general strengthening treatment - if there is no pronounced circulatory failure. At severe cases- only surgery, valve replacement or dissection of its leaflets ( commissurotomy).

Combined aortic defect

Two in one: failure valves+ constriction aortic mouth. Such aortic defect heart is much more common than isolated. Signs are the same as for aortic stenosis, only less noticeable. In severe cases, stagnation begins in small circle, accompanied by cardiac asthma and pulmonary edema.

Treatment: symptomatic and prophylactic - in mild cases, in severe cases - surgery, replacement aortic valve or dissection of its "fused" valves. The prognosis for life is favorable, with adequate and timely treatment.

Video: causes, diagnosis and treatment of aortic stenosis

Tricuspid (tricuspid) valve insufficiency

Due to loose closure valve, blood from right ventricle thrown back into right atrium. His ability compensate for a vice low, so it starts quickly stagnation venous blood in big circle.

Signs: cyanosis, veins necks full and throbbing, arterial pressure slightly lowered. In severe cases, swelling and ascites(accumulation of fluid in abdominal cavity ). Treatment is conservative, mainly to eliminate venous congestion. Forecast - depending on the severity of the condition.

Stenosis of the right atrioventricular (between the right atrium and ventricle) orifice

Difficulty draining blood from right atrium in right ventricle. venous congestion rapidly spreading to liver, it increases, then develops cardiac fibrosis of the liver- active tissue is replaced connective(scar). Appears ascites, general edema.

Signs: pain and a feeling of heaviness hypochondrium on right, cyanosis With yellow tint, always - ripple neck veins. Arterial pressure reduced; liver enlarged, pulsating.

Treatment: aimed at reducing edema, but it is better not to delay the operation.

Forecast: normal state of health possible with moderate physical. activity. If appeared and cyanosis– quickly to the cardiosurgeon.

Summary: acquired- mostly rheumatic heart defects. Their treatment is aimed both at the underlying disease and at reducing the consequences of the defect. In case of severe circulatory decompensation, only surgery is effective.

Important! Treatment for heart defects may have a better chance of success if people get to the doctor on time. Moreover, malaise, as the reason for going to the doctor, is not at all necessary: ​​you can simply ask for advice and, if necessary, undergo elementary examinations. A smart doctor does not allow his patients to get sick. An important note: the age of the doctor does not really matter. Really important are his professional level, ability to analyze and synthesize, intuition.