Aortic valve and its defects. Aortic valve insufficiency is a congenital or acquired heart disease

Aortic insufficiency refers to acquired heart defects. The essence of the disease comes down to a disruption of normal hemodynamics and associated pathological changes in the structure of the heart valve. The disease can be treated quite well; surgery is prescribed only in extreme cases.

According to medical statistics, this disease ranks second in prevalence after mitral regurgitation. And as usually happens in such cases, the biggest problem is not the violation itself, but the changes that it causes.

Clinical picture of the disease

Normal heart function is ensured by the uninterrupted functioning of the atrium and ventricle. An indispensable condition is the passage of blood in one direction.

Oxygenated blood from the left atrium is pushed into the left ventricle. The valve flaps between these parts of the heart close tightly. When the ventricle contracts, the flaps of the semilunar valve open, and blood is pushed into the aorta, and from there moves through the diverging arteries.

• Aortic valve insufficiency is expressed in a malfunction of the valve leaflet: after compression of the stomach, when blood moves into the aorta, the leaflets do not close completely and some of the blood flows back. With the next compression, the ventricle tries to push out the blood that has returned along with a new portion. However, some of the blood returns again.
• As a result, the left ventricle constantly works with additional load and is constantly experiencing pressure from the blood remaining in it. To compensate for the additional load, this area hypertrophies, its muscles become denser, and the ventricle increases in volume.

But this is only one side of the violation. Since part of the blood constantly returns back, a lack of blood is formed in the systemic circulation from the very beginning. Accordingly, the body does not receive enough oxygen and nutrients with completely normal, sufficient functioning of the respiratory system.

At the same time, diastolic pressure decreases, which serves as a signal for the heart to switch to intensive mode.

Since the main burden of compensation low pressure lies on the left ventricle, for a long time the circulatory disturbance is insignificant. There are practically no symptoms.

Often a person is unaware of the disease, especially when aortic insufficiency is chronic.

• However, when the reverse blood flow reaches a significant volume - more than 50%, all cardiac muscles undergo hypertrophy. The heart expands, and the opening between the left ventricle and the atrium stretches and forms.
• At this stage, decompensation occurs. Disturbances of the left ventricular type cause the development of asthma, and pulmonary edema can be provoked. Decompensation of the right ventricular type occurs later and, as a rule, develops much faster.

If at the stage of compensation symptoms may not have appeared at all - patients did not even experience shortness of breath when playing sports, then with the onset of decompensation, aortic insufficiency acquires very formidable signs.

In severe stages of the disease, the prognosis of life depends on surgical intervention.

Chronic and acute forms

Aortic valve insufficiency can be chronic, but can also become acute form. As a rule, the course of the disease is determined by the cause. Traumatic impact with a blunt instrument, of course, will cause an acute form, while lupus erythematosus suffered in childhood will “leave” behind a chronic form.

Symptoms may not be observed at all, especially if the patient is in good physical condition. The heart compensates for some lack of blood, so signs of the disease do not cause due concern.

Aortic insufficiency in chronic form has the following symptoms:

• frequent headaches, concentrated mainly in the frontal lobe, accompanied by noise and a sensation of pulsation;
• rapid fatigue, fainting and loss of consciousness with a sudden change of position;
• pain in the heart at rest;
• pulsation of the arteries - “dancing of the arteries”, as well as the sensation of pulsation - are the most characteristic symptoms of the defect. Ripple is noticeable when visual inspection and is caused by the high pressure with which the left ventricle pumps blood into the aorta. But if aortic insufficiency is accompanied by other heart diseases, this characteristic picture may not be observed.

Dyspnea, unlike mitral valve insufficiency, for example, appears only at the stage of decompensation, when blood circulation in the lungs is disrupted and symptoms of asthma appear.

Acute aortic valve insufficiency is characterized by pulmonary edema and arterial hypotension. Treatment operative method in most cases, it is carried out only in cases of pronounced symptoms and a severe stage of the disease.

Classification of the disease

Two methods of classification are being considered: by the length of the regurgitant blood stream, that is, returning from the aorta to the left ventricle, and by the amount of returned blood. The second classification is used more often during examinations and conversations with patients, as it is more understandable.

• The disease of the first severity is characterized by a volume of regurgitant blood of no more than 15%. If the disease is at the stage of compensation, then treatment is not prescribed. The patient is prescribed constant monitoring by a cardiologist and regular ultrasound scans.
• Aortic insufficiency with a volume of returned blood from 15 to 30% is called grade 2 and, as a rule, severe symptoms not accompanied. At the compensation stage, no treatment is carried out.
• At grade 3, the volume of blood that the aorta does not receive reaches 50%. It is characterized by all the symptoms described above, which excludes physical activity and has a significant impact on lifestyle. The treatment is therapeutic. Constant monitoring is necessary, since such an increase in the volume of regurgitant blood impairs hemodynamics.
• At grade 4, aortic valve insufficiency exceeds 50%, that is, half of the blood returns to the ventricle. The disease is characterized severe shortness of breath, tachycardia, pulmonary edema. Both medical and surgical treatment are undertaken.

For a long time, the course of the disease can be quite favorable. However, with the formation of heart failure, the life prognosis is worse than with lesions of the mitral valve - on average 4 years.

Reasons for appearance

Aortic insufficiency can be congenital: if instead of a 3-leaf valve, a 1-, 2-, or 4-leaf valve is formed.

However, the more common causes of the disease are the following:

• rheumatism - or rather, rheumatoid arthritis, is the cause of the defect in 60-80 cases. Since the beginning of the disease is transferred back to adolescence rheumatic fever, diagnosing aortic insufficiency can be difficult;
• infectious myocarditis - inflammatory lesion heart muscle;
• syphilitic damage to the aortic valve - here there is a possibility of the process transferring from the aorta to the valve, treatment is difficult;
• atherosclerosis - can also pass from the aorta, although less frequently;
• injury chest;
• systemic diseases connective tissue, for example lupus erythematosus.

Treatment of a disease of grade 3, 4 requires first establishing the real cause of the disease and, if surgical intervention is not indicated, proceeding with its treatment, since the defect is secondary.

Diagnostics

The main methods for establishing a diagnosis are physical examination data:

• the described symptoms are a tendency to faint, a feeling of pulsation, pain in the heart, etc.;
• characteristic pulsation of arteries - carotid, subclavian, and so on;
• very high systolic and extremely low diastolic pressure;
• high pulse, formation of pseudocapillary pulse;
• weakening of the first tone - the apex of the heart, and pouring diastolic murmur after the second tone.

The diagnosis is aortic valve insufficiency, clarified by instrumental methods:

• ECG - it is used to detect;
• Echocardiography helps to determine the absence or presence of flutter of the mitral valve leaflet. This phenomenon is caused by the impact of the jet during regurgitation of blood;
• X-ray examination - allows you to evaluate the shape of the heart and detect the expansion of the ventricle;
• - makes it possible to evaluate diastolic murmur.

Treatment of the disease

For diseases of 1st and 2nd severity, treatment is usually not carried out. Only observation and routine examination are prescribed.

Treatment for grades 3 and 4 is determined by the form of the disease, symptoms and primary cause. Medicines are prescribed taking into account the main treatment being carried out.

• Vasodilators - hydralazine, ACE inhibitor. The drugs slow down left ventricular dysfunction. This group of medications is necessarily prescribed for contraindications to surgery.
• Cardiac glycosides - isolanide, strophanthin.
• Nitrates and beta blockers are prescribed for dilatation of the aortic root.
• Antiplatelet agents are included in the course of treatment if thromboembolic complications are observed.

Surgery is indicated for very severe disease and usually involves implantation of the aortic valve.

Aortic valve insufficiency is quite difficult to prevent, since the primary impetus for its development is inflammatory processes. However, hardening and timely treatment of infectious diseases, especially those associated with hemodynamic disorders, allows you to get rid of most threatening factors.

Reason aortic insufficiency there may be damage to the valve leaflets, aortic root and ascending aorta.

Chronic and chronic are very different diseases; they differ in etiology, clinical picture, prognosis and treatment.

Etiology

Damage to the valve leaflets can lead to their non-closure, perforation and prolapse. The most common causes of chronic aortic insufficiency, caused by damage to the leaflets or root of the aorta, are listed in the table.

Another cause of chronic aortic insufficiency is wear and tear of the aortic valve bioprostheses.

Acute aortic insufficiency

Acute aortic regurgitation can also occur when the valve leaflets or aortic root are damaged. The causes of acute aortic insufficiency are less varied.

Hemodynamics

Chronic aortic insufficiency

Aortic regurgitation results in a portion of the stroke volume being dumped back into the left ventricle. This leads to an increase in the end-diastolic volume of the left ventricle and, according to Laplace's law, tension in its wall. In response to this, eccentric hypertrophy of the left ventricle develops. While aortic insufficiency remains compensated, diastolic pressure in the left ventricle, despite the large end-diastolic volume, almost does not increase. Normal cardiac output is maintained by a sharp increase in stroke volume. However, myocardial fibrosis gradually reduces left ventricular compliance and decompensation occurs. Due to constant volume overload, the systolic function of the left ventricle decreases, the end-diastolic pressure in the left ventricle increases, its dilatation occurs, the ejection fraction decreases, and cardiac output decreases.

Acute aortic insufficiency

Acute aortic insufficiency quickly leads to hemodynamic disturbances, since the left ventricle does not have time to adapt to a sharp increase in end-diastolic volume. Effective stroke volume and cardiac output fall, leading to hypotension and cardiogenic shock. A sharp increase in diastolic pressure in the left ventricle leads to early closure of the mitral valve at the beginning of diastole, this prevents an increase in diastolic pressure in the pulmonary veins. However, further dilatation of the left ventricle increases and diastolic mitral regurgitation develops, leading to an increase in diastolic pressure in the pulmonary veins and congestion in the lungs. Compensatory tachycardia leads to shortening of diastole, resulting in a decrease in the period of diastolic filling and the opening time of the mitral valve.

Clinical picture

Chronic aortic insufficiency

usually remains asymptomatic for a long time. After the development of left ventricular dysfunction, complaints appear caused by venous congestion in the pulmonary circulation: shortness of breath during exercise, orthopnea, nocturnal attacks of cardiac asthma. Dilatation of the left ventricle often leads to unpleasant sensations in the chest, which can intensify with extrasystole and in the supine position. not typical for aortic insufficiency, but possible, in addition to the lesion coronary arteries it is predisposed to a decrease in diastolic perfusion pressure in the coronary arteries, nocturnal bradycardia and a decrease in diastolic blood pressure, severe left ventricular hypertrophy.

Acute aortic insufficiency.

Acute severe aortic insufficiency leads to a sharp disruption of hemodynamics, which is manifested by weakness, impaired consciousness, severe shortness of breath and fainting. Without treatment, shock quickly develops. If acute aortic insufficiency is accompanied by chest pain, it is necessary to exclude dissecting aortic aneurysm.

Diagnostics

Chronic aortic insufficiency

The most valuable information is provided by palpation of the pulse and auscultation of the heart. In addition, certain physical signs may indicate the cause of aortic regurgitation. In case of aortic insufficiency, be sure to look for signs infective endocarditis, Marfan syndrome, dissecting aortic aneurysm and collagenosis.

Pulse

An increase in stroke volume in chronic aortic insufficiency leads to a sharp increase in blood pressure in systole, followed by a sharp drop in diastole. High pulse pressure is responsible for many physical signs of aortic insufficiency (see table).

In chronic aortic insufficiency, there may be a double pulse, characterized by two high systolic peaks. Signs of high cardiac output are not specific for aortic insufficiency, they are also possible in heart failure with high cardiac output caused by sepsis, anemia, thyrotoxicosis, beriberi and arteriovenous fistulas.

Palpation of the heart area

In severe aortic insufficiency, the apical impulse is usually diffuse; it is palpated in the fifth intercostal space lateral to the midclavicular line, which is caused by dilatation of the left ventricle. It is possible to increase the strength and duration of the apical impulse. In addition, the apical impulse can be triple: waves are palpated due to the filling of the left ventricle in early diastole (corresponding to the Sh tone) and in atrial systole (corresponding to the IV sound and wave A of the jugular venous pulse). In the second intercostal space on the left, diastolic tremor may be palpated, in addition, systolic tremor is possible, due to the acceleration of antegrade blood flow through the aortic valve.

Auscultation

The main auscultatory signs are shown in the figure.

Auscultatory picture of aortic insufficiency. I, II, III - heart sounds; A 2 - aortic component of the II tone; P 2 - pulmonary component of tone II.

Heart sounds.

The volume of the first sound may decrease with prolongation of the PQ interval, left ventricular systolic dysfunction and early closure of the mitral valve. The second sound may be quiet, there is no splitting (the pulmonary component is drowned out by diastolic murmur) or it becomes paradoxical. The third tone appears with severe left ventricular dysfunction. The IV sound occurs frequently; it is caused by the filling of the recalcitrant left ventricle during atrial systole.

Diastolic murmur.

The classic sign of aortic insufficiency is a blowing diastolic murmur that begins immediately after the aortic component of the second sound. It is best heard from above at the left edge of the sternum at maximum exhalation, when the patient sits slightly leaning forward. The severity of aortic regurgitation is better correlated with the duration of the murmur than with its loudness. At the onset of the disease, the noise is usually short. As it progresses, it becomes longer and longer and eventually occupies the entire diastole. With extremely severe aortic insufficiency, the murmur shortens again, which is due to the rapid equalization of pressures in the aorta and left ventricle due to an increase in end-diastolic pressure in the latter. In this case, the severity of aortic insufficiency can be assessed by other signs.

In severe aortic regurgitation, another diastolic murmur may appear at the apex. This is a Flint murmur, which appears in the middle of diastole or towards its end and is believed to be formed due to vibration of the anterior leaflet of the mitral valve under the influence of a jet of aortic regurgitation or due to turbulent blood flow through the mitral valve slightly covered by this jet. Unlike the murmur of true mitral stenosis, Flint's murmur is not accompanied by a loud first sound and an opening click.

A brief mesosystolic murmur may be heard at the base of the heart and extend to the vessels of the neck. It occurs due to increased stroke volume and high blood flow through the aortic valve (relative aortic stenosis).

The change in the noise of aortic insufficiency during functional tests is described in the table.

Acute aortic insufficiency

Physical findings between acute and chronic aortic regurgitation vary greatly. In acute aortic insufficiency, signs of hemodynamic disturbances come to the fore: arterial hypotension, tachycardia, pallor, cyanosis, sweating, cold extremities and pulmonary congestion.

Palpation

Signs of high cardiac output characteristic of chronic aortic insufficiency are often absent. Pulse pressure may be normal or only slightly elevated. The size of the heart often remains within normal limits, the apex beat is not shifted to the left.

Heart sounds

The first sound is weakened due to early closure of the mitral valve. Pulmonary hypertension may manifest itself as an increase in the pulmonary component of the second tone. III tone indicates decompensation.

Noises

Early diastolic murmur in acute aortic insufficiency is shorter and lower in timbre than in chronic aortic insufficiency. In severe acute aortic regurgitation, there may be no murmur as left ventricular diastolic pressure and aortic pressure equalize. The systolic murmur of accelerated blood flow through the aortic valve is sometimes present, but is usually quiet. Flint noise is usually short or not heard at all

ECG

In chronic aortic insufficiency, the ECG usually shows signs of left ventricular hypertrophy and left atrium enlargement, deviation electrical axis hearts to the left. There are usually no conduction abnormalities, but they may appear with left ventricular dysfunction. Atrial and ventricular extrasystoles are often visible. Sustained supraventricular and ventricular tachycardia It is rare, especially with normal left ventricular function and in the absence of concomitant mitral valve disease.

In acute aortic insufficiency, the ECG may show only nonspecific changes in the ST segment and T wave.

Chest X-ray

In chronic aortic insufficiency, severe cardiomegaly is possible with a displacement of the cardiac shadow down and to the left, expansion of the arch and root of the aorta. In acute aortic insufficiency, the size of the left chambers of the heart is usually not enlarged, and venous congestion in the lungs is noted.

EchoCG

The cause of aortic insufficiency can be determined, the aortic root can be examined, and the size and function of the left ventricle can be assessed. Doppler ultrasound can detect aortic insufficiency and assess its severity. There are several ways to assess the severity of aortic regurgitation using color, pulsed and continuous wave Doppler studies.

2D mode and M-modal study

In two-dimensional mode, the cause of aortic insufficiency can be determined. With rheumatic damage to the aortic valve, the leaflets are thickened and wrinkled and, as a result, do not close. With infective endocarditis, compaction, wrinkling and perforation of the leaflets occur, and a threshing leaflet may appear; Infectious endocarditis should be suspected when vegetation is detected.

Aortic valve leaflet prolapse can occur in many conditions, including infective endocarditis, bicuspid aortic valve, myxomatous degeneration, and Marfan syndrome. Pathology of the aortic root is clearly visible along the parasternal long axis of the left ventricle. Aortic root dilatation is most often idiopathic, but other causes include Marfan syndrome, Ehlers-Danlos syndrome, ankylosing spondylitis, Reiter's syndrome, rheumatoid arthritis, syphilis, and giant cell arteritis. With symmetrical dilation of the aortic root, the regurgitation jet is directed centrally, and with bulging of any one wall, it is directed eccentrically. To examine the ascending aorta, the ultrasound probe is moved one intercostal space higher relative to the parasternal long axis of the left ventricle. Sometimes transthoracic examination can reveal infectious endarteritis of the ascending aorta and its dissection. In severe acute aortic regurgitation, early closure of the mitral valve can be seen in the M-modal mode. In both acute and chronic aortic insufficiency, the regurgitant jet can hit the anterior leaflet of the mitral valve, causing its diastolic flutter. On two-dimensional examination, the anterior mitral valve leaflet may bulge toward the atrium in a dome-shaped manner, indicating moderate to severe aortic regurgitation.

Doppler study

Doppler ultrasound is used to detect aortic regurgitation and assess its severity. With a pulsed study, high-speed pan-diastolic blood flow is determined directly below the aortic valve. With a color Doppler study, you can see the source of the regurgitation jet, its size and direction. Constant-wave research gives an idea of ​​the speed of the jet and its temporal characteristics. The depth of penetration of the regurgitant jet into the left ventricle on color Doppler examination does not correlate well with the severity of aortic insufficiency (as determined by aortography). To assess the severity of aortic insufficiency, a number of Doppler indices are used (see table).

The ratio of the width of the aortic regurgitation jet to the diameter of the left ventricular outflow tract is measured along the parasternal long axis of the left ventricle, and the ratio of the cross-sectional area of ​​the regurgitation jet to the cross-sectional area of ​​the left ventricular outflow tract is measured along the parasternal short axis. Both of these indicators correlate well with the severity of aortic regurgitation on aortography. Another indicator is the half-life of the diastolic pressure gradient between the aorta and the left ventricle. The shorter the half-life, the more severe the aortic insufficiency, however, it is impossible to distinguish mild from moderate aortic insufficiency, and moderate from severe aortic insufficiency only by this indicator. The best indicators that correlate with aortography data are the volume of regurgitation and the regurgitation fraction. Regurgitant volume is the difference between the stroke volume of blood flow in the left ventricular outflow tract and the stroke volume of blood flow through the mitral valve (assuming there is no significant mitral regurgitation). The stroke volume of blood flow through the aortic valve is the sum of the effective stroke volume and the volume of regurgitation, and the stroke volume of blood flow through the mitral valve is the effective stroke volume. Regurgitation fraction is the ratio of the volume of regurgitation to the volume of systolic blood flow in the outflow tract of the left ventricle.

The equations for calculating these indicators are given below.

To assess the severity of aortic insufficiency, the proximal zone of regurgitation is also examined. It is used to calculate the area of ​​the regurgitation lumen. An area of ​​0.3 cm2 and above indicates severe aortic insufficiency. Using continuous wave Doppler, the presence of retrograde diastolic blood flow in the descending aorta is determined. Retrograde blood flow, occupying the entire diastole, indicates severe aortic insufficiency.

Transesophageal echocardiography

Transesophageal echocardiography is performed to exclude vegetation and abscess of the valve ring if infective endocarditis is suspected. In isolated aortic insufficiency, vegetations on the aortic valve are located on the ventricular side. In addition, transesophageal echocardiography is used to detect congenital aortic valve defects (eg, bicuspid aortic valve) and to exclude dissecting aortic aneurysm.

Stress EchoCG

Stress echocardiography is used to assess exercise tolerance. Unlike mitral regurgitation in aortic regurgitation, a decrease in left ventricular ejection fraction during exercise does not allow a confident conclusion about hidden systolic dysfunction. The drop in ejection fraction during exercise in this case is due to a sharp increase in afterload and in itself does not serve as an indication for surgical treatment.

Cardiac catheterization

All patients over 50 years of age with severe aortic insufficiency undergo coronary angiography before surgical treatment. In younger patients, the question of performing coronary angiography is decided individually, taking into account risk factors for atherosclerosis. Dilatation of the aortic root in aortic regurgitation may complicate coronary catheterization. In Marfan syndrome and aortic medianecrosis, the catheter must be manipulated very carefully so as not to damage the aortic wall. In addition to coronary angiography, aortography is performed to assess the severity of aortic regurgitation.

Right heart catheterization may be necessary, for example, in cases of rapidly developing heart failure or a combination of aortic insufficiency and aortic stenosis.

Forecast

In asymptomatic moderate aortic regurgitation, the prognosis in the absence of left ventricular dysfunction and dilatation is usually favorable. With an asymptomatic course and normal left ventricular function, aortic valve replacement is required in 4% of patients per year. Within 3 years after diagnosis, complaints appear in only 10% of patients, within 5 years - in 19%, within 7 years - in 25%. For mild to moderate aortic insufficiency, the ten-year survival rate is 85-95%. With moderate aortic insufficiency, the five-year survival rate with drug treatment is 75%, and the ten-year survival rate is 50%. After left ventricular dysfunction develops, complaints appear very quickly, within a year - in 25% of patients. Once complaints appear, the condition quickly worsens. Without surgical treatment patients usually die within 4 years after the onset of angina and within 2 years after the development of heart failure. In severe clinically obvious aortic insufficiency, sudden death is possible. Its cause is usually ventricular arrhythmias arising due to hypertrophy and dysfunction of the left ventricle or myocardial ischemia.

Treatment

Drug treatment

Chronic aortic insufficiency

Prevention of infective endocarditis

Once the diagnosis is made, patients must be explained the need to prevent infective endocarditis.

For chronic aortic insufficiency, vasodilators are used - hydralazine, ACE inhibitors and calcium antagonists. The main goal of treatment is to slow the progression of left ventricular dysfunction and stop its dilatation. Drug treatment does not eliminate the need to consult surgeons if complaints or left ventricular dysfunction occur. Recommendations from the American College of Cardiology and the American Heart Association for drug treatment of chronic aortic regurgitation are shown in the table.

Vasodilators are absolutely necessary for patients with severe chronic aortic insufficiency and heart failure who for some reason cannot undergo surgery. In asymptomatic cases, continuous use of vasodilators is indicated for patients with severe aortic insufficiency, normal left ventricular systolic function and incipient dilatation of the left ventricle, as well as for any aortic insufficiency associated with arterial hypertension. In addition, vasodilators (usually IV) are used in preparation for surgery in patients with severe heart failure and left ventricular systolic dysfunction. In asymptomatic mild or moderate aortic regurgitation with normal left ventricular systolic function, vasodilators are not needed.

In the presence of complaints or systolic dysfunction of the left ventricle, the prescription of vasodilators is justified, but surgical treatment is indicated for these patients. After aortic valve replacement, vasodilators are needed only if left ventricular systolic dysfunction persists. There is no convincing data in favor of any specific drug. Some studies have shown that hydralazine improves left ventricular systolic function and reduces left ventricular volume. Nifedipine reduced left ventricular volume and increased ejection fraction in asymptomatic patients followed for a year. In a non-blinded, randomized study lasting 6 years, nifedipine compared with digoxin slowed the progression of left ventricular dysfunction and prolonged time to surgical treatment. Some studies suggest that ACE inhibitors reduce left ventricular volume. However, the benefit of ACE inhibitors was observed only if they significantly reduced blood pressure. More informed recommendations for the use of vasodilators in chronic aortic insufficiency are needed. further research. In practice, ACE inhibitors are most often used.

In cases of severe enlargement of the aortic root due to medial necrosis or other connective tissue pathology, beta-blockers are indicated. They help slow down the expansion of the aortic root. These data were obtained in patients with Marfan syndrome. In severe aortic insufficiency and aortic root diameter greater than 5 cm, replacement of the aortic valve and aortic root is indicated. For Marfan syndrome, surgery is indicated even if the diameter of the aortic root is smaller.

Acute aortic insufficiency

Target drug treatment in case of acute aortic insufficiency - stabilization of hemodynamics before surgery. For cardiogenic shock, IV vasodilators are used; they reduce afterload on the left ventricle, reduce end-diastolic pressure in it and increase cardiac output. In severe cases, inotropic infusion is required. For aortic insufficiency caused by dissecting aortic aneurysm, beta-blockers can be used cautiously. They reduce the rate of increase in blood pressure in systole, which is very important in aortic dissection, but at the same time they reduce heart rate and thereby prolong diastole, which can increase aortic regurgitation and aggravate arterial hypotension.

For aortic insufficiency caused by dissecting aortic aneurysm or trauma, it is necessary urgent solution question about surgical treatment. Drug treatment in this case is intended to increase effective cardiac output and slow down dissection.

In case of aortic insufficiency due to infective endocarditis, antimicrobial therapy is started immediately after blood is taken for culture.

Endovascular methods

Intra-aortic balloon counterpulsation is contraindicated for moderate and severe aortic insufficiency, as well as for dissecting aortic aneurysm. Aortic insufficiency serves relative contraindication and to balloon valvuloplasty for aortic stenosis, since after this intervention the insufficiency worsens.

Surgery

Chronic aortic insufficiency

Indications for aortic valve replacement, formulated in the recommendations of the American College of Cardiology and the American Heart Association, are shown in the table.

With normal systolic function of the left ventricle (ejection fraction at rest more than 50%), aortic valve replacement is indicated for heart failure of functional class III-IV or angina pectoris of functional class II-IV. In addition, aortic valve replacement is indicated in the presence of complaints and mild to moderate left ventricular dysfunction (ejection fraction 25-49%). In the presence of complaints and severe left ventricular systolic dysfunction (ejection fraction less than 25% or end-diastolic size more than 60 mm), the perioperative risk is high, and left ventricular dysfunction may persist after surgery. However, even these patients usually require surgery; before its implementation, intensive drug treatment is carried out.

In asymptomatic cases, indications for surgery are a controversial issue. However, with mild to moderate left ventricular systolic dysfunction (resting ejection fraction 25 to 49%), heart failure very often develops within 2-3 years, so these patients are usually indicated elective surgery. With normal systolic function of the left ventricle, but pronounced dilatation (end-diastolic size more than 70 mm, end-systolic size more than 55 mm), the risk is increased sudden death. After valve replacement, the prognosis for these patients improves dramatically, so surgery is also indicated for them. Once left ventricular dilatation is accompanied by systolic dysfunction or symptoms of heart failure appear, perioperative risk increases significantly. In case of asymptomatic disease, normal systolic function of the left ventricle at rest and normal or slightly enlarged size of the left ventricle (end-diastolic size less than 70 mm, end-systolic size less than 50 mm), surgery is not indicated.

Sometimes aortic valve repair is possible. It is preferable if aortic insufficiency is caused by prolapse of the bicuspid or tricuspid aortic valve. If the valve leaflet is perforated due to infective endocarditis, it can be repaired using a pericardial patch.

Important Notes

In case of chronic aortic insufficiency, it is necessary to carefully monitor the function of the left ventricle; for this, echocardiography is regularly performed. If systolic dysfunction occurs, even in the absence of complaints, surgery should be considered.

Acute severe aortic insufficiency requires emergency surgery. Heart failure and early mitral valve closure in acute aortic insufficiency are very ominous signs.

In infective endocarditis, even if antimicrobial therapy has only recently been started, valve replacement does not lead to infection of the prosthesis. In infective endocarditis, preference is given to aortic valve allografts.

Aortic dissection should always be suspected in the setting of aortic regurgitation and chest pain.

In cases of left ventricular systolic dysfunction lasting up to one and a half years, left ventricular function is often restored after surgery.

Heart rate remains normal for a long time, tachycardia develops as a compensatory reaction with low effective stroke volume, this is a sign of an advanced disease.

Frequent atrial or ventricular pacing may be useful as a temporary measure to increase cardiac output in acute aortic regurgitation caused by infective endocarditis or trauma. An increase in heart rate shortens diastole, and with it reduces aortic regurgitation

Aortic insufficiency is a pathology in which the aortic valve leaflets do not close completely, as a result of which the return flow of blood into the left ventricle of the heart from the aorta is disrupted.

This disease causes many unpleasant symptoms - chest pain, dizziness, shortness of breath, malfunctions heart rate and other.

The aortic valve is a valve in the aorta, which consists of 3 leaflets. Designed to separate the aorta and left ventricle. IN in good condition, when blood flows from this ventricle into the aortic cavity, the valve closes tightly, creating pressure due to which ensures the flow of blood through thin arteries to all organs of the body, without the possibility of reverse outflow.

If the structure of this valve is damaged, it closes only partially, which leads to the backflow of blood into the left ventricle. Wherein organs stop receiving the required amount of blood for normal functioning, and the heart has to contract more intensely to compensate for the lack of blood.

As a result of these processes, aortic insufficiency is formed.

According to statistics, this Aortic valve insufficiency occurs in approximately 15% of people having any heart defects and often accompanies diseases such as the mitral valve. As an independent disease, this pathology occurs in 5% of patients with heart defects. Most often it affects males, as a result of exposure to internal or external factors.

Useful video about aortic valve insufficiency:

Causes and risk factors

Aortic insufficiency occurs when the aortic valve is damaged. The reasons that lead to its damage may be the following:

Other causes of the disease, which are much less common, may include: connective tissue diseases, rheumatoid arthritis, ankylosing spondylitis, diseases immune system, long radiation therapy when tumors form in the chest area.

Types and forms of the disease

Aortic insufficiency is divided into several types and forms. Depending on the period of formation of the pathology, the disease can be:

• congenital- arises due to bad genetics or adverse effects of harmful factors on a pregnant woman;
• acquired– appears as a result of various diseases, tumors or injuries.

The acquired form, in turn, is divided into functional and organic.

• functional– formed when the aorta or left ventricle dilates;
• organic– occurs due to damage to valve tissue.

1, 2, 3, 4 and 5 degrees

Depending on the clinical picture diseases, aortic insufficiency has several stages:

1. First stage. It is characterized by the absence of symptoms, a slight enlargement of the heart walls on the left side, with a moderate increase in the size of the left ventricular cavity.
2. Second stage. The period of latent decompensation, when pronounced symptoms are not yet observed, but the walls and cavity of the left ventricle are already quite enlarged in size.
3. Third stage. The formation of coronary insufficiency, when partial reflux of blood from the aorta back into the ventricle already occurs. Characterized by frequent painful sensations in the area of ​​the heart.
4. Fourth stage. The left ventricle contracts weakly, which leads to congestion in the blood vessels. Symptoms such as shortness of breath, lack of air, swelling of the lungs, heart failure are observed.
5. Fifth stage. It is considered the pre-mortem stage, when it is almost impossible to save the patient’s life. The heart contracts very weakly, resulting in blood stagnation in the internal organs.

Danger and complications

If treatment does not begin in a timely manner, or the disease occurs in an acute form, pathology can lead to the development the following complications:

• – a disease in which an inflammatory process forms in the heart valves as a result of the impact of pathogenic microorganisms on the damaged valve structures;
• lungs;
• heart rhythm disturbances - ventricular or atrial extrasystole, atrial fibrillation; ventricular fibrillation;
• thromboembolism – the formation of blood clots in the brain and other organs, which can lead to strokes and heart attacks.

In the treatment of aortic insufficiency surgically, there is a risk of developing complications such as implant destruction, endocarditis. Surgical patients often have to take medications for life to prevent complications.

Symptoms

Symptoms of the disease depend on its stage. IN initial stages the patient may not experience any discomfort, since only the left ventricle is subject to stress - a fairly powerful part of the heart that can withstand disruptions in the circulatory system for a very long time.

As the pathology develops, the following symptoms begin to appear:

• Pulsating sensations in the head, neck, increased heart rate , especially in a supine position. These signs arise due to the fact that a larger volume of blood enters the aorta than usual - the blood that returned to the aorta through a loosely closed valve is added to the normal amount.
• Pain in the area of ​​the heart. They can be compressive or squeezing and appear due to impaired blood flow through the arteries.
• Cardiopalmus. It is formed as a result of a lack of blood in the organs, as a result of which the heart is forced to work at an accelerated rhythm to compensate for the required volume of blood.
• Dizziness, fainting, severe headaches, vision problems, ringing in the ears. Characteristic of stages 3 and 4, when blood circulation in the brain is disrupted.
• Weakness in the body, increased fatigue, shortness of breath, heart rhythm disturbances, increased sweating e. At the beginning of the disease, these symptoms occur only when physical activity, later they begin to bother the patient even in a calm state. The appearance of these signs is associated with impaired blood flow to the organs.

The acute form of the disease can lead to overload of the left ventricle and the formation of pulmonary edema, coupled with a sharp decrease in blood pressure. If surgical care is not provided during this period, the patient may die.

When to see a doctor and which one

This pathology requires timely medical attention. If you notice the first signs - increased fatigue, throbbing in the neck or head, pressing pain in the sternum and shortness of breath - you should consult a doctor as soon as possible. This disease is treated therapist, cardiologist.

Diagnostics

To make a diagnosis, the doctor examines the patient’s complaints, his lifestyle, anamnesis, then the following examinations are carried out:

• Physical examination. Allows you to identify such signs of aortic insufficiency as: pulsation of the arteries, dilated pupils, dilation of the heart in left side, enlargement of the aorta in its initial section, low pressure.
• Urine and blood analysis. With its help, you can determine the presence of concomitant disorders and inflammatory processes in the body.
• Biochemical blood test. Shows the level of cholesterol, protein, sugar, uric acid. Necessary to detect organ damage.
• ECG to determine heart rate and heart size. Find out everything about.
• Echocardiography. Allows you to determine the diameter of the aorta and pathologies in the structure of the aortic valve.
• Radiography. Shows the location, shape and size of the heart.
• Phonocardiogram for the study of heart murmurs.
• CT, MRI, CCG- to study blood flow.

Treatment methods

In the initial stages, when the pathology is mild, patients are prescribed regular visits to a cardiologist, an ECG examination and an echocardiogram. Moderate form of aortic insufficiency is treated with medication, the goal of therapy is to reduce the likelihood of damage to the aortic valve and the walls of the left ventricle.

First of all, drugs are prescribed that eliminate the cause of the pathology. For example, if the cause is rheumatism, antibiotics may be indicated. The following are prescribed as additional means:

• diuretics;
• ACE inhibitors – Lisinopril, Elanopril, Captopril;
• beta blockers - Anaprilin, Tranzikor, Atenolol;
• angiotensin receptor blockers - Naviten, Valsartan, Losartan;
• calcium blockers – Nifedipine, Corinfar;
• drugs to eliminate complications resulting from aortic insufficiency.

At severe forms surgery may be prescribed. There are several types of surgery for aortic insufficiency:

• aortic valve plastic surgery;
• aortic valve replacement;
• implantation;
• heart transplantation is performed when severe lesions hearts.

If aortic valve implantation has been performed, patients are prescribed Lifelong use of anticoagulants - Aspirin, Warfarin. If the valve was replaced with a prosthesis made of biological materials, anticoagulants will need to be taken in short courses (up to 3 months). Plastic surgery does not require taking these medications.

To prevent relapses, antibiotic therapy, strengthening the immune system, and timely treatment of infectious diseases may be prescribed.

Forecasts and preventive measures

The prognosis for aortic insufficiency depends on the severity of the disease, as well as on what disease caused the development of the pathology. Survival of patients with severe aortic insufficiency without symptoms of decompensation approximately equals 5-10 years.

The stage of decompensation does not give such comforting prognoses– drug therapy is ineffective and most patients, without timely surgical intervention, die within the next 2-3 years.

Measures to prevent this disease are:

• prevention of diseases that cause damage to the aortic valve - rheumatism, endocarditis;
• hardening of the body;
• timely treatment of chronic inflammatory diseases.

Aortic valve insufficiency – an extremely serious disease that cannot be left to chance. Folk remedies this won't help matters. Without proper drug treatment and constant monitoring by doctors, the disease can lead to severe complications, including death.

A malfunctioning aortic valve causes the left ventricle to experience increased strain as the volume of blood exceeds normal. Because of this, the heart hypertrophies, causing it to function worse.

The disease is accompanied by dizziness, fainting, chest pain, shortness of breath, frequent and irregular heartbeat. Used to treat aortic insufficiency conservative methods; in severe cases, plastic surgery or replacement of the aortic valve is indicated.

Aortic valve insufficiency is more often diagnosed in men. Depending on the factors of occurrence, this disorder becomes primary and secondary. Development factors become congenital pathologies or past illnesses. Aortic insufficiency in 80% of patients of rheumatic etiology.

Causes of aortic insufficiency

Disturbances in the structure of the valve

• post-infectious complication of pharyngitis or tonsillitis: rheumatic fever;
• degenerative and senile calcific aortic stenosis;
• damage to heart valve tissue by infections: infective endocarditis;
• traumatic effects on heart tissue;
• congenital pathology of the valve structure: bicuspid valve;
• myxomatous degeneration: stretching and thickening of the aortic valve leaflets, preventing complete closure.

Pathologies in the structure of the aortic root

• enlargement and stretching of the aorta due to age-related changes;
• systematically increasing blood pressure;
• dissection of the aortic walls;
• rheumatic diseases that deform connective tissue;
• heart pathologies;
• use of drugs that suppress food cravings.

Hereditary diseases affecting connective tissue

• Marfan syndrome;
• aortoannular ectasia;
• Ehlers-Danlos syndrome;
• Erdheim's disease;
• congenital osteoporosis.

Degrees of aortic insufficiency

1st degree - initial

The volume of regurgitant blood does not exceed 15% of the volume ejected from the ventricle during the first contraction. Initial aortic insufficiency does not provoke symptoms; a slight increase in the density of the walls of the ventricle and valve is determined. The disease is diagnosed by echography.

Aortic insufficiency of the 1st degree is dangerous because if the development of the disease is not prevented in time, the disease progresses to the last stage, at which irreversible processes begin.

2nd degree - hidden aortic insufficiency

The volume of regurgitation reaches 30%. Most patients do not show signs of cardiac dysfunction, but ultrasonography reveals left ventricular hypertrophy. A congenital defect reveals an aortic valve with the wrong number of leaflets. The magnitude of the ejection is determined by probing the cavities of the heart. Sometimes patients with stage 2 aortic valve insufficiency experience increased fatigue and shortness of breath during physical exertion.

Grade 3 - relative aortic insufficiency

The left ventricle receives 50% of the blood that enters the aorta. People feel pain in the chest area. Electrocardiography and echocardiography reveal significant thickening of the left ventricle. When performing a chest x-ray, signs of stagnation of venous blood in the lungs are determined.

4th degree - decompensation

More than half of the blood volume returns back to the ventricle. Characteristic symptoms include shortness of breath, acute left ventricular failure, pulmonary edema, enlarged liver size, and the addition of mitral insufficiency. The patient requires urgent hospitalization.

5th degree - pre-mortem

Heart failure progresses, blood stagnation and degenerative processes in organs occur. The result of this degree is the death of a person.

Symptoms of aortic insufficiency

The first symptoms are the following:

• feeling of increased heart contractions in the chest;
• sensation of pulse in the head, limbs, along the spine, usually lying on the left side.

Subsequently, other symptoms appear:

• angina pectoris;
• interruptions in heart function;
• dizziness when changing body position;
• fainting.

Depending on the stage of aortic insufficiency, the following symptoms are possible:

• fatigue;
• cardiopalmus;
• weakness;
• heartache;
• pale skin;
• nervous tic;
• cardiac asthma;
• sweating

Treatment of aortic insufficiency

Treatment tactics for the disease directly depend on the stage. For stages 1 and 2 of aortic insufficiency, there is no need for treatment: the patient should regularly consult a cardiologist. In the treatment of aortic insufficiency, medical and surgical methods are used.

Drug treatment

Moderate aortic insufficiency requires drug correction - the prescription of the following groups of drugs:

• peripheral vasodilators: nitroglycerin, apressin, adelfan;
• glycosides: isolanide, strophanthin, digoxin: reduce systole;
• antihypertensive drugs: perindopril, captopril - prevent the development of hypertension;
• blockers calcium channels: verapamil, diltiazem, nifedipine - reduce the load on the heart and improve coronary blood flow;
• diuretics: lasix, indapamide - prevent swelling and congestion in the lungs.

For warning sharp decline blood pressure in acute aortic insufficiency, these drugs are used in combination with dopamine.

Surgery

If the disease poses a threat of complications, the decision is made in favor of cardio surgical operation- aortic valve replacement with mechanical or biological implant. The operation provides 10-year survival in 75% of patients with aortic valve insufficiency.

Valve replacement is an open cardiac surgery that lasts at least 2 hours. Aortic valve replacement occurs under constant monitoring: transesophageal echocardiography and cardiac monitoring. In the first year after surgery, the risk of complications is high, so patients who have undergone prosthetics are prescribed anticoagulants.

Complications of aortic insufficiency

Complications that occur with aortic insufficiency if treatment is not effective:

• acute myocardial infarction;
• mitral valve insufficiency;
• secondary infective endocarditis;
• arrhythmia.

Severe left ventricular dilatation typically results in episodic pulmonary edema, heart failure, and sudden death. Manifested angina leads to the death of the patient within up to 4 years, and heart failure kills within 2 years if surgical treatment is not carried out in time. Aortic insufficiency in its acute form leads to severe left ventricular failure and, as a consequence, early death.

Additionally, the following diagnostic measures are carried out:

• ECG: identifying signs of left ventricular hypertrophy;
• phonocardiography: determination of pathological heart murmurs;
• echocardiography: identifying symptoms of aortic valve insufficiency, anatomical defect and enlargement of the left ventricle;
• chest x-ray: shows dilatation of the left ventricle and signs of blood congestion;
• probing of the cardiac cavities: determination of cardiac output.

In addition, the patient is required to undergo blood and urine tests to determine the presence of concomitant diseases.

Classification of aortic insufficiency

Flow

• chronic failure: for a long time the patient does not develop any signs or symptoms, but then shortness of breath appears, the pulse increases, normal life becomes impossible. If you suspect chronic failure should be examined as soon as possible;
• acute deficiency: appears unexpectedly and depends on the person’s lifestyle, the patient experiences constant weakness, shortness of breath, increased fatigue.

Etiology

• congenital: transmitted from parents to child, formed in the fetus;
• acquired – formed under the influence of diseases.

Development factors

• organic: the outflow of blood into the left ventricle is caused by damage to the valve;
• moderate: the outflow of blood into the left ventricle occurs with a healthy valve structure; disturbances in blood flow are associated with dilation of the aorta or left ventricle;
• rheumatic insufficiency: develops against the background of rheumatism.

Prognosis for aortic insufficiency

In the initial stages, the prognosis in the absence of dysfunction and dilatation of the left ventricle is usually favorable. Once complaints appear, the condition quickly worsens. Within 3 years after diagnosis, complaints appear in 10% of patients, within 5 years - in 19%, within 7 years - in 25%.

For mild to moderate aortic insufficiency, the ten-year survival rate is 85-95%. With moderate aortic insufficiency, the five-year survival rate with drug treatment is 75%, and the ten-year survival rate is 50%.

The rapid development of heart failure occurs with severe aortic valve insufficiency. Without surgical treatment, patients usually die within 4 years after the onset of angina and within 2 years after the development of heart failure.

But if aortic valve insufficiency is cured by prosthetics, the life prognosis will improve, but only if you follow the recommendations of the cardiac surgeon to limit the risk of postoperative complications.

Prevention of aortic insufficiency

Primary prevention of aortic insufficiency includes the following measures:

• hardening;
• undergoing examination by a cardiologist once a year;
• See a doctor if you experience heart pain;
• healthy lifestyle;
• proper nutrition.

In addition, prevention and treatment of diseases in which aortic insufficiency occurs becomes a preventive measure:

Secondary prevention measures:

• in case of chronic aortic insufficiency, it is necessary to carefully monitor the function of the left ventricle; for this, echocardiography is regularly performed;
• When systolic dysfunction occurs, even in the absence of complaints, surgery should be considered.

Questions and answers on the topic "Aortic insufficiency"

Question: Good afternoon (or evening). Could the cause of aortic insufficiency on ultrasound be dysfunction of the autonomic nervous system with episodes of paroxysmal anxiety? Thank you very much.

Question: Hello. Aortic regurgitation grade 2 with FB 83%. Ultrasound from five years ago. Even earlier, ultrasound showed moderate dilatation of the left ventricle. with FB 59%. I am 60 years old. In his youth he ran long distances. They say that this can also be the cause of “problems” with l. and. further. What could be the prognosis? Currently, there is almost always a high “lower” pressure (more than 90) with an almost normal “upper” pressure. It is problematic to undergo a second ultrasound (there is a war, Donbass, Debaltsevo). Thank you.

Question: Hello. Woman, 41 years old. Mild aortic valve insufficiency with grade 1-2 regurgitation. Mitral, tricuspid and pulmonary regurgitation of the 1st degree. The cavities of the heart are not dilated. Zones of violation local contractility the myocardium is not located. Based on the profile of the IVS movement, it is impossible to exclude a conduction disorder along the bundle branches. Left ventricular systolic function was not changed. The diastolic function of the left ventricle is changed according to the pseudonormal type. This is the conclusion. Please tell me what is the prognosis in my situation and is all this horror curable?

Question: Can aortic regurgitation last for a year or more? Does regurgitation affect blood pressure readings and the difference between diastolic and systolic pressure (for example, 130 to 115).

Question: Hello. Male 54 years old. Bicuspid aortic valve. Slight stenosis of the AC. Aortic regurgitation stage 3. Dilatation of the left ventricle. Hypertrophy of the walls of the left ventricle. Is it necessary to have surgery to replace the valve? If you don't, what are the consequences?

Question: Hello. Male 21 years old. Congenital defect of bicuspid aortic valve. The valves are focally compacted. Regurgitation stage 2 central. Aortic insufficiency of the 2nd degree. The diagnosis was made for the first time. Is valve repair possible? Should I have surgery or wait for stage 3-4?

Question: Hello. Child 15 years old! Diagnosis of aortic insufficiency, stage 1. Is a professional sports career possible?

Question: Hello. If the aortic valve is insufficient, surgery is performed to insert an artificial valve. If aortic insufficiency is grade 1, do surgery or wait until grade 4? Should I have surgery before the baby is born or give birth first? How to support your heart during childbirth? Woman, 38 years old. Left ventricular hypertrophy is also present. Medicines other than herbs and viburnum are not suitable, as they cause migraines.

Question: Hello. 31 year. I recently had an ultrasound of the heart and was diagnosed with aortic valve insufficiency, MVP with grade 1 regurgitation. I serve in the army as a pilot. Tell me, is he fit to fly with this diagnosis?

Aortic insufficiency: treatment, classification, causes

Aortic insufficiency refers to acquired heart defects. The essence of the disease comes down to a disruption of normal hemodynamics and associated pathological changes in the structure of the heart valve. The disease can be treated quite well; surgery is prescribed only in extreme cases.

According to medical statistics, this disease ranks second in prevalence after mitral regurgitation. And as usually happens in such cases, the biggest problem is not the violation itself, but the changes that it causes.

Clinical picture of the disease

Normal heart function is ensured by the uninterrupted functioning of the atrium and ventricle. An indispensable condition is the passage of blood in one direction.

Oxygenated blood from the left atrium is pushed into the left ventricle. The valve flaps between these parts of the heart close tightly. When the ventricle contracts, the flaps of the semilunar valve open, and blood is pushed into the aorta, and from there moves through the diverging arteries.

• Aortic valve insufficiency is expressed in a malfunction of the valve leaflet: after compression of the stomach, when blood moves into the aorta, the leaflets do not close completely and some of the blood flows back. With the next compression, the ventricle tries to push out the blood that has returned along with a new portion. However, some of the blood returns again.
• As a result, the left ventricle constantly works with additional load and is constantly experiencing pressure from the blood remaining in it. To compensate for the additional load, this area hypertrophies, its muscles become denser, and the ventricle increases in volume.

But this is only one side of the violation. Since part of the blood constantly returns back, a lack of blood is formed in the systemic circulation from the very beginning. Accordingly, the body does not receive enough oxygen and nutrients despite completely normal, sufficient functioning of the respiratory organs.

At the same time, diastolic pressure decreases, which serves as a signal for the heart to switch to intensive mode.

Since the main burden of compensating for low pressure falls on the left ventricle, circulatory disturbances for a long time are insignificant. There are practically no symptoms.

Often a person is unaware of the disease, especially when aortic insufficiency is chronic.

• However, when the reverse blood flow reaches a significant volume - more than 50%, all cardiac muscles undergo hypertrophy. The heart dilates, stretching the opening between the left ventricle and the atrium and causing mitral valve insufficiency.
• At this stage, decompensation occurs. Disturbances of the left ventricular type cause the development of asthma, and pulmonary edema can be provoked. Decompensation of the right ventricular type occurs later and, as a rule, develops much faster.

If at the stage of compensation symptoms may not have appeared at all - patients did not even experience shortness of breath when playing sports, then with the onset of decompensation, aortic insufficiency acquires very formidable signs.

In severe stages of the disease, the prognosis of life depends on surgical intervention.

Chronic and acute forms

Aortic valve insufficiency can be chronic, but it can also take an acute form. As a rule, the course of the disease is determined by the cause. Traumatic impact with a blunt instrument, of course, will cause an acute form, while lupus erythematosus suffered in childhood will “leave” behind a chronic form.

Symptoms may not be observed at all, especially if the patient is in good physical condition. The heart compensates for some lack of blood, so signs of the disease do not cause due concern.

Aortic insufficiency in chronic form has the following symptoms:

• frequent headaches, concentrated mainly in the frontal lobe, accompanied by noise and a sensation of pulsation;
• rapid fatigue, fainting and loss of consciousness with a sudden change of position;
• pain in the heart at rest;
• pulsation of the arteries – “dancing of the arteries”, as well as the sensation of pulsation – are the most characteristic symptoms of the defect. The pulsation is noticeable upon visual inspection and is caused by the high pressure with which the left ventricle pumps blood into the aorta. But if aortic insufficiency is accompanied by other heart diseases, this characteristic picture may not be observed.

Dyspnea, unlike mitral valve insufficiency, for example, appears only at the stage of decompensation, when blood circulation in the lungs is disrupted and symptoms of asthma appear.

Acute aortic valve insufficiency is characterized by pulmonary edema and arterial hypotension. Surgical treatment in most cases is carried out only in cases of pronounced symptoms and a severe stage of the disease.

Classification of the disease

Two methods of classification are being considered: by the length of the regurgitant blood stream, that is, returning from the aorta to the left ventricle, and by the amount of returned blood. The second classification is used more often during examinations and conversations with patients, as it is more understandable.

• The disease of the first severity is characterized by a volume of regurgitant blood of no more than 15%. If the disease is at the stage of compensation, then treatment is not prescribed. The patient is prescribed constant monitoring by a cardiologist and regular ultrasound scans.
• Aortic insufficiency with a volume of returned blood from 15 to 30% is called grade 2 and, as a rule, is not accompanied by severe symptoms. At the compensation stage, no treatment is carried out.
• At grade 3, the volume of blood that the aorta does not receive reaches 50%. It is characterized by all the symptoms described above, which excludes physical activity and significantly affects lifestyle. The treatment is therapeutic. Constant monitoring is necessary, since such an increase in the volume of regurgitant blood impairs hemodynamics.
• At grade 4, aortic valve insufficiency exceeds 50%, that is, half of the blood returns to the ventricle. The disease is characterized by severe shortness of breath, tachycardia, and pulmonary edema. Both medical and surgical treatment are undertaken.

For a long time, the course of the disease can be quite favorable. However, with the formation of heart failure, the life prognosis is worse than with lesions of the mitral valve - on average 4 years.

Reasons for appearance

Aortic insufficiency can be congenital: if instead of a 3-leaf valve, a 1-, 2-, or 4-leaf valve is formed.

However, the more common causes of the disease are the following:

• Rheumatism, or rather rheumatoid arthritis, is the cause of the defect in 60–80 cases. Since the onset of the disease is rheumatic fever suffered in adolescence, diagnosing aortic insufficiency can be difficult;
• infectious myocarditis - inflammatory damage to the heart muscle;
• syphilitic damage to the aortic valve - here there is a possibility of the process transferring from the aorta to the valve, treatment is difficult;
• atherosclerosis - can also pass from the aorta, although less frequently;
• chest injury;
• systemic connective tissue diseases, such as lupus erythematosus.

Treatment of a disease of grade 3, 4 requires first establishing the real cause of the disease and, if surgical intervention is not indicated, proceeding with its treatment, since the defect is secondary.

Diagnostics

The main methods for establishing a diagnosis are physical examination data:

• the described symptoms are a tendency to faint, a feeling of pulsation, pain in the heart, etc.;
• characteristic pulsation of arteries - carotid, subclavian, and so on;
• very high systolic and extremely low diastolic pressure;
• high pulse, formation of pseudocapillary pulse;
• weakening of the first sound - the apex of the heart, and pouring diastolic murmur after the second sound.

The diagnosis is aortic valve insufficiency, clarified by instrumental methods:

• ECG - it helps to detect left ventricular hypertrophy;
• Echocardiography helps determine the absence or presence of flutter of the mitral valve leaflet. This phenomenon is caused by the impact of the jet during regurgitation of blood;
• X-ray examination - allows you to evaluate the shape of the heart and detect the expansion of the ventricle;
• phonocardiography – makes it possible to evaluate diastolic murmur.

Treatment of the disease

For diseases of 1st and 2nd severity, treatment is usually not carried out. Only observation and routine examination are prescribed.

Treatment for grades 3 and 4 is determined by the form of the disease, symptoms and primary cause. Medicines are prescribed taking into account the main treatment being carried out.

• Vasodilators – hydralazine, ACE inhibitor. The drugs slow down left ventricular dysfunction. This group of medications is necessarily prescribed for contraindications to surgery.
• Cardiac glycosides – isolanide, strophanthin.
• Nitrates and beta blockers are prescribed for dilatation of the aortic root.
• Antiplatelet agents are included in the course of treatment if thromboembolic complications are observed.

Surgery is indicated for very severe disease and usually involves implantation of the aortic valve.

Aortic valve insufficiency is quite difficult to prevent, since the primary impetus for its development is inflammatory processes. However, hardening and timely treatment of infectious diseases, especially those associated with hemodynamic disorders, allows you to get rid of most threatening factors.

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Aortic insufficiency: symptoms and timely heart care

Many people believe that heart problems only affect older or very sensitive people. Some people remember diseases of this organ only with the appearance of chest pain. However, the symptoms of the disease can be much more varied, and the causes that cause it are not limited to old age alone. One of the insidious heart diseases is aortic insufficiency, which can go undetected for a long time. About how to recognize yourself and your loved ones dangerous disease– read on.

What is aortic insufficiency

Aortic insufficiency is an acquired heart defect characterized by impaired hemodynamics (blood flow) due to loose closure of the aortic valve. tricuspid valve. With this pathology, due to a defect in the closure of the valve leaflets, part of the blood pushed out by the heart is thrown back into the left ventricle. Depending on the severity of the defect, the disease may be accompanied by symptoms of varying severity - from dizziness to cardiac arrhythmias and loss of consciousness.

The danger of aortic insufficiency is the increased load on the left ventricle of the heart. Due to constant regurgitation (backflow) of blood, the walls of the ventricle become deformed and thicken. Disturbances in the structure of the heart lead to insufficient blood circulation in the body, and as a result, a lack of oxygen in the tissues. According to statistics, in more than half of the cases this disease in patients is combined with aortic stenosis or mitral insufficiency, which is a consequence of deformation of the heart walls. In addition, insufficient blood supply can lead to tissue necrosis and the addition of infections and sepsis to the main symptoms of the disease.

In childhood and mild degree severity in adults, this heart defect can occur without any unpleasant symptoms. Aortic insufficiency begins to manifest itself only with medium degree heaviness during physical activity - shortness of breath appears, chest pain is possible. As the disease develops, the patient's condition worsens; due to the increased load on the heart, its structure is deformed, developing into total heart failure. The patient experiences severe symptoms due to complications that have arisen, and without timely treatment may come death. Changes in the morphology of the heart that occur during severe disease are irreversible and interfere with the patient’s normal functioning even after surgery.

Aortic insufficiency is an acquired defect in the anatomy of the heart, which has various degrees severity and leading to structural and functional changes in the organ.

Timely detection of the disease helps prevent irreversible consequences for the cardiovascular system and the body as a whole.

Causes of pathology: various ways of development of aortic insufficiency

Despite the fact that aortic valve insufficiency is considered an acquired heart defect, congenital characteristics of the body can also lead to it. In some genetic diseases, including Marfan syndrome, the patient's aorta is dilated and is under more high pressure blood than normal in humans. This leads to the development of the disease, since gradually this disruption of blood flow deforms the aortic valve. There is also an inverse relationship - in children who have had an aortic valve defect since birth, pathology develops over time.

In addition, there are other congenital anatomical features that lead to the development of this heart defect. This may be a ventricular septal defect, aorto-left ventricular tunnel, subvalvular or aortic stenosis. By themselves, they have almost no effect on hemodynamics and do not lead to backflow of blood, however, adaptive deformations of the heart under the influence of these diseases can lead to illness. However, it should be noted that these reasons occupy a rather small share in the development of aortic valve insufficiency; the main ones are lifetime diseases.

However, the causes of congenital aortic insufficiency may include:

• negative effects on the fetus, especially in the early trimesters of pregnancy
• development in the fetus is not a tricuspid (normal), but a one-, two-, four-leaf aortic valve
• atrial septal anomaly
• aortic dilatation
• connective tissue dysplasia syndrome

Among the lifetime causes of the development of pathology are rheumatitis, atherosclerosis, systemic connective tissue diseases, infectious myocarditis, as well as syphilis or chest trauma. But despite the many listed probable causes of aortic valve insufficiency, acute rheumatic fever and infectious myocarditis are considered the main ones. Due to the influence of these causes, aortic insufficiency can be organic and functional.

The danger of acute rheumatic fever as main reason development of aortic insufficiency consists of irreversible structural changes hearts. The disease affects both the myocardium itself and the aortic valve, resulting in rapid development of heart failure. Together with other damage to organs and tissues - skin, joints, nervous system - the disease leaves a dubious prognosis for the patient regarding a full, long life.

Organic aortic valve insufficiency is a disease that develops as a result of a defect in the structure of the valve itself.

This may be a rheumatoid or sclerotic lesion, as a result of which the valve thickens and ceases to fully close. Or it could be an infection that causes perforation or erosion in the valve. In case of functional failure, damage to the valve itself does not occur - it ceases to close tightly due to the expansion of the left ventricle or aorta.

Possible reasons for the development of functional aortic insufficiency:

• arterial hypertension (chronic sustained increase in blood pressure)
• myocardial infarction
• aortic aneurysm

Thus, aortic valve insufficiency can be caused by many congenital and acquired characteristics and diseases of the body. They can influence both directly the structure of the valve and indirectly cause disruption of its operation.

Circulatory disorders in aortic insufficiency

What happens to blood circulation

The cause of circulatory disorders in aortic valve insufficiency, as already noted, is the reverse flow of blood into the left ventricle. Depending on the degree of valve deformation, the volume of such “extra” blood can be up to 75% of the cardiac output. Such operating conditions of the heart cause adaptive changes in its structure: the walls of the left ventricle are stretched, the heart muscle hypertrophies and consumes more energy and oxygen than in normal conditions. At this stage, the valve defect is compensated by these changes. Gradually, the body’s resources begin to deplete, and the heart muscle begins to weaken. A mitral valve defect is formed.

Due to cardiac dysfunction, the patient's diastolic pressure decreases. In the pulmonary circulation (pulmonary artery), stagnation of blood flow occurs, as a result of which the pressure in this section increases. As a consequence, a pathological enlargement of the right ventricle develops. Meanwhile, ischemia develops in the weakened left ventricular muscle—insufficient blood supply. Ultimately, this can lead to necrosis of the heart muscle (infarction).

An inflammatory-sclerotic process develops in the area of ​​the valve leaflets, resulting in tissue deformation and the valve leaflets shrink. Next, a septic lesion (infection) may occur, which has a destructive effect on the heart muscle, leading to its inflammation and further necrosis. Additional defects in the morphology of the heart are formed.

The circulatory disorders characteristic of aortic insufficiency cause the same consequences as other types of heart failure.

Over time, due to impaired distribution of fluid in the body, the patient begins to suffer from edema, the most dangerous of which is pulmonary edema. Despite the absence of disturbances directly in the respiratory system, the tissues do not receive a sufficient amount of oxygen, which is why trophic changes appear in the skin (especially the lower extremities).

Due to a violation of the outflow of blood from the left ventricle, blood pressure is redistributed in all chambers of the heart, which leads to adaptive changes in its structure. This negatively affects blood circulation in the body and can lead to the development of additional defects.

Classification of pathology

Aortic insufficiency is classified into 5 stages depending on the compensatory capabilities of the body and the severity of blood flow disorders. In this case, the patient’s complaints are not taken into account - the degree of violation is determined by objective indicators of diagnostic equipment. Below are the stages along with the most common symptoms to make it easier to understand.

5 stages of deficiency

1. Full compensation stage. The patient does not experience any symptoms, the pathology is discovered during the diagnosis of another disease or on scheduled inspection. Small murmurs are heard in the heart.
2. Stage of latent heart failure. The patient experiences fatigue with moderate physical exertion, and shortness of breath is possible. The ECG reveals signs of left ventricular hypertrophy.
3. Subcompensation stage. The patient is unable to withstand moderate physical activity: climbing stairs, long walks. Frequent pain in the chest area. The ECG shows signs of secondary coronary insufficiency.
4. Stage of decompensation. The patient has shortness of breath at rest, attacks of suffocation, difficulty breathing, the skin is pale, the fingers of the extremities may have cyanosis. An ultrasound shows an enlarged liver.
5. Terminal stage. In vital important organs processes of deep tissue destruction are expressed in the patient, infections may occur. Total heart failure progresses.

In addition to this classification, there are also degrees of aortic valve insufficiency, distinguished based on the length of the regurgitant blood stream and the amount of blood thrown back. These classifications are usually used to decipher hardware diagnostic readings and serve as a guide for the attending physician. When probing the chambers of the heart, the volume of “extra” blood thrown out is assessed, which serves as a criterion for making a decision about surgery.

Thus, the classification of aortic valve regurgitation uses different approaches that serve different purposes and reflect different indicators of patient health.

The first classification reflects the general condition of the body, while the other two are more specialized and serve as an indicator for the doctor’s actions.

Clinical manifestations of aortic insufficiency

The presence of subjective symptoms (complaints) of the patient is determined primarily by the type of course of the disease and the stage of its development. Usually the disease progresses slowly, the compensation stage sometimes lasts several years and goes unnoticed by the patient’s well-being. An exception is the fulminant development of the disease caused by a dissecting aortic aneurysm or cardiac infection, as well as some other intravital causes of the disease (see earlier). Some of the symptoms were also mentioned earlier, along with the classification given.

Usually the first alarming sensations for the patient are increased or rapid heartbeat, a feeling of pulsation in the head. Gradually, they are joined by shortness of breath during significant physical exertion, a feeling of coldness in the fingers and toes, and swelling. As the defect progresses, so-called “brain-wide” symptoms appear, which are common to almost all neurological and some systemic diseases. These include headaches (especially with mental stress), tinnitus, dizziness, “spots” or dark spots in the eyes, sudden darkening of the eyes when moving from sitting and lying positions to standing.

Next, the patient experiences pronounced violation heart rate, excessive sweating (« cold sweat"), shortness of breath at rest or with minor physical exertion. If the structure of the right ventricle is disturbed, severe swelling of the legs appears (especially in the afternoon), a feeling of heaviness or nagging pain in the right half of the chest.

In the case of fulminant aortic valve insufficiency, the symptoms are similar to pulmonary edema. The patient wheezes, coughs frequently, and has difficulty breathing (cannot exhale or inhale). As the condition worsens, the patient's consciousness becomes confused, the pulse increases to 200 beats per minute, the patient breaks out in cold sweat and experiences a panicky fear of death.

At the same time, his diastolic (lower) pressure decreases, the patient is practically immobilized and disoriented. In this case, the person needs to receive immediate cardiac surgery in a specialized department, otherwise there is a high probability of death of the patient.

At the first sign of illness not directly related to colds or overwork and lasting for a long time, you need to make sure that you do not have cardiovascular disease. A person who has difficulty breathing but is not suffering bronchial asthma, it is necessary to immediately call an ambulance, which will transport him to a specialized building for further medical measures.

Diagnosis of aortic insufficiency

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Aortic valve insufficiency is diagnosed by a cardiologist at various levels– starting from patient examination and ending with hardware methods. First of all, the patient is examined and his subjective symptoms are analyzed. On early stages heart failure, the patient may be pale, complain of dizziness and fainting, later the skin color may have a bluish tint (acrocyanosis) and the patient will experience noticeable difficulty breathing.

Next, the doctor listens (auscultate) the patient’s chest through a phonendoscope. He evaluates the frequency and rhythm of the pulse, the presence of noise, characteristic “gurgling” and makes a preliminary conclusion based on these observations. In addition, the cardiologist pays attention to visual signs of heart failure, such as pulsation of the pupils, carotid arteries, rhythmic shaking of the patient's head.

After examining and listening to the patient, the doctor refers him to instrumental (hardware) diagnostics. The choice of specific instruments depends on the preliminary conclusion of the doctor, because not all changes in the heart are visible in the early stages of failure.

Nevertheless, great importance It is precisely auscultation and examination by a cardiologist, since even if the patient has no complaints, an experienced specialist can listen to the characteristic murmurs in the heart.

Using an ECG, you can detect signs of enlargement of the left ventricle, and in some cases, of the left atrium. Phonocardiography allows you to clarify heart murmurs that are not clearly distinguishable human ear. EchoCG allows to identify morphological changes in the heart and the aortic valve itself. An x-ray may reveal a shift in the position of the heart and signs of stagnation of blood in the pulmonary vein. MRI and MSCT are techniques that allow more accurately visualizing morphological disorders and tracking them over time. Catheterization (probing) of the heart is necessary to assess the magnitude of cardiac output and the volume of regurgitation.

Of course, none of the listed methods by themselves can provide sufficient information for the doctor about the patient’s health status. They are used in combination, complementing each other.

Prevention of the disease and possible consequences

Predict the patient's condition without going into details of each individual case, impossible. The life expectancy of each individual patient is determined by a number of factors. First of all, the stage of the disease at the time of diagnosis. Severe aortic insufficiency is usually detected no earlier than at the stage of subcompensation, and the life expectancy of such patients averages from 5 to 10 years. Patients who received medical assistance already at the stage of decompensation, they usually do not live longer than 2 years.

The second important factor in prognosis is the determination of etiology. Matters here accompanying illnesses, the presence of infections and autoimmune disorders. Then you should pay attention to the general condition of the patient - his age, conscientious attitude to treatment, readiness to change his lifestyle. But, unfortunately, even the most optimistic forecasts today do not give patients with aortic valve disease more than 10 years.

Prevention of pathology includes timely detection possible reasons diseases. Among them are the prevention of atherosclerosis, timely detection and treatment of rheumatism, syphilis, and autoimmune diseases. Indirect prevention may include fighting hypertension and quitting smoking and alcohol, because these bad habits increase the likelihood of heart and vascular diseases.

The most important measure What a person who wants to live a long working life can do is undergo regular examinations with doctors (at least once every two years) and take a responsible approach to their well-being. If you notice the first signs of heart failure, consult your doctor immediately.

How to treat aortic insufficiency

Patients with aortic insufficiency without negative symptoms do not require special treatment. However, such patients should visit a cardiologist once a year and undergo echocardiography to monitor the dynamics of the disease. In addition, before undergoing dental or surgical procedures, such patients are recommended to take a course of antibiotics to avoid the development of infective endocarditis. Also, patients with the initial stage of insufficiency are advised to limit physical activity.

Patients with moderate aortic valve insufficiency are prescribed conservative (drug) therapy. The treatment strategy depends on the path of development of the disease.

For example, if the cause of the disease lies in infection, the patient is prescribed antibiotics. In addition, patients are usually prescribed the same medications as patients with other types of heart disease. There is no specific drug treatment to correct aortic insufficiency.

For patients suffering from severe pathology, surgery is recommended. Depending on the indications for a particular patient, various types of surgical intervention may be used. The heart surgeon can correct the valve itself, or it can be replaced with a biological or mechanical analogue. In such operations, minimally invasive methods can be used, i.e. manipulations are performed not on an open heart, but by inserting a special catheter into the aorta.

It should be noted that after the operation the prognosis for the patient’s future life is more favorable.

Life expectancy increases greatly after correction of the cause of the pathology. However, there are also severe cases in which the operation can no longer be performed. This usually concerns the fulminant course of the disease, in which the patient’s blood pressure drops sharply and he is in critical condition. Such a patient can be saved only by stabilizing his condition, and only then sending him to the surgeon’s table.

Thus, the condition of patients with aortic insufficiency can be maintained for quite a long time. medications, however, this is not a treatment. The only way To solve the problem of valve deformation is to perform an operation to restore or replace it.

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Aortic insufficiency- this is pathological wrong movement connective tissue cusps of the aortic valve, as a result of which the development of a pronounced reverse flow of blood under a high pressure gradient into the cavity of the left ventricle from the lumen of the aortic vessel is detected during diastole.

Aortic insufficiency syndrome, as an isolated acquired cardiac defect, is extremely rare. Much more often in different age category Patients experience a combination of damaged valvular apparatus of the heart in the form of stenosis of the aortic mouth and insufficiency, and men suffer from this form of the defect much more often.

Aortic insufficiency in pediatric practice occurs in less than 3% as an isolated variant, but unfortunately they are established only at the stage of formation of pronounced cardiohemodynamic disorders.

Causes of aortic insufficiency

Aortic insufficiency, as an isolated cardiac defect, belongs to the category of polyetiological pathologies, since the process of its development and formation can be influenced by a wide range of factors.

Congenital aortic insufficiency develops with aortoannular ectasia, hereditary osteoporosis, and Erdheim's disease. In this case, instead of three connective tissue cusps of the aortic valve, one, two or four cusps are formed, which inevitably provokes changes in the cardiohemodynamics of the heart. If there is an abnormal number of leaflets, either they prolapse into the cavity of the left ventricle or they are incompletely closed.

Organic aortic insufficiency of secondary or acquired origin can form against the background of various diseases of an infectious, bacterial, or immunodeficiency nature, of which 80% of cases are rheumatic heart disease. Rheumatic changes in the aortic valve are represented by deformation and thickening of the valves, which are no longer able to adequately perform their function. It should be taken into account that rheumatism in to a greater extent affects the mitral valve, therefore, if changes in the aortic valve are detected, one should think about a combined lesion of the valvular apparatus of the heart.

In addition, various infectious lesions hearts in the form of bacteria can also cause the development of aortic insufficiency. Availability infectious inflammation provokes not only a change in the shape and thickness of the valves, but can also cause a violation of their integrity in the form of perforation and erosion.

Relative moderate aortic insufficiency is observed with pathological changes not the valve leaflets, but the walls of the aorta itself, which is observed with aneurysmal dilatation of the aorta with signs of dissection. A pronounced expansion of the fibrous ring of the aortic valve in this situation can provoke complete separation (divergence) of the connective tissue cusps of the aortic valve, which is an extremely unfavorable sign for the patient.

Symptoms of aortic insufficiency

In a situation where cardiohemodynamic disorders in a person with aortic insufficiency are in a compensated state, the patient may absolutely not notice changes in his own health status and not seek treatment. medical care. In some cases, this asymptomatic course of aortic insufficiency continues for a long period of time. An acute increase in clinical symptoms is observed exclusively in cases that have undergone dissection, as well as in infective endocarditis.

Debut clinical manifestations with aortic insufficiency, it is manifested by a feeling of throbbing pain in the head and neck, a feeling of acceleration and increased intensity of the heartbeat. The pulse with aortic insufficiency is not always increased, but most patients note the appearance of this symptom.

In a situation where a person has a significant defect in the aortic valve leaflets, there is an increase in hemodynamic disturbances, which is manifested by the appearance of symptoms indicating a violation cerebral circulation. “Brain” signs of aortic insufficiency manifest themselves in the form of pulsating headaches, tinnitus, visual impairment and short-term episodes of loss of consciousness such as syncope, which has a clear connection with a sharp change in the position of the body in space.

Minimal aortic insufficiency, as a rule, is not accompanied by the appearance of cardiovascular manifestations, however, with severe hemodynamic disturbances, the patient experiences cardiac signs. Manifestations in this case are the appearance of angina pectoris pain syndrome, cardiac arrhythmias, respiratory disorders. In the initial stages of aortic insufficiency, the above symptoms are short-term in nature and bother the patient only after excessive physical or psycho-emotional activity. With severe cardiohemodynamic disorders, signs of heart failure appear constantly and significantly worsen the prognosis of life with aortic insufficiency.

The acute course of aortic insufficiency is characterized by a lightning-fast increase in symptoms of left ventricular failure and severe respiratory distress. Manifestations of alveolar disease are often combined with a sharp decrease in blood pressure, so this category of patients requires the immediate use of a full range of emergency resuscitation measures.

Degrees of aortic insufficiency

The development of the clinical picture of aortic insufficiency occurs slowly, regardless of etiology and pathogenesis. Each of the etiopathogenetic stages of development is accompanied by the appearance of certain cardiohemodynamic disorders, which inevitably affects the patient’s health. The classification of aortic insufficiency by severity is used by cardiologists and cardiac surgeons in daily medical practice, because for each of these stages of disease development there are indications various techniques correction of the defect. The cardiovascular classification is based not only on clinical criteria, but also data from an instrumental examination of the patient, so passing a full range of examinations is the main guarantee successful treatment aortic insufficiency.

Taking into account the worldwide cardiological classification, aortic insufficiency is usually divided into four degrees of severity.

The earliest stage of development of the defect is characterized by a long latent course and compensated hemodynamic disturbances. The main instrumental indicator that allows one to suspect aortic insufficiency of the 1st degree of development is the registration of a regurgitating minimum blood volume (less than 15%) on the aortic valve leaflets according to the “blue flow” type during Doppler mapping with a length of no more than 5 mm near the aortic valve leaflets. Establishment of aortic insufficiency of the 1st degree is not subject to surgical correction of the defect.

Grade 2 aortic insufficiency is accompanied by the appearance of nonspecific symptoms that occur only after increased physical or psychoemotional activity. During electrocardiographic recording of heart activity, patients exhibit signs indicating the presence of hypertrophic changes in the left ventricular myocardium. The volume of regurgitant blood flow with Doppler mapping is less than 30%, and the parameters of the “blue blood flow” are 10 mm.

Stage 3 aortic insufficiency is characterized by a significant decrease in performance, as well as the appearance of specific anginal pain and changes in blood pressure. During an electrocardiographic study, signs of ischemia are recorded simultaneously with signs of left ventricular hypertrophy. Echocardiographic indicators are the registration of the so-called “blue flow” on the aortic valve leaflets exceeding 10 mm.

4 or extreme degree of aortic insufficiency is characterized by the appearance of pronounced cardiohemodynamic disorders in the form of the development of a strong regurgitant blood flow, a volume of more than 50%. Aortic insufficiency stage 4 is accompanied by pronounced dilatation of all cavity structures of the heart and the development of relative.

Treatment of aortic insufficiency

Cardiologists and especially cardiac surgeons around the world adhere to the principles of expediency and continuity in the use of one or another method of treating aortic insufficiency. Patients suffering from the initial degree of aortic insufficiency are not subject to the use of any method of treatment, in addition to compliance with the basic criteria for modifying the work and rest regime (minimal restriction of physical and psycho-emotional activity). Drug therapy for aortic insufficiency involves the use of drugs whose pharmacological effect is aimed at leveling the manifestations, namely: diuretics (Furosemide in a daily dosage of 40 mg), ACE inhibitors (Enap in a minimum daily dose of 5 mg), cardiac glycosides (Digoxin in daily dose 0.25 mg).

Despite the positive effect of drug treatment, the most effective way to eliminate aortic insufficiency is surgical correction of the defect. Surgical assistance in one modification or another for aortic insufficiency is absolutely indicated in the development of manifestations of left ventricular failure, severe regurgitation on the aortic valve leaflets and expansion of the size of the left ventricle. In case of acute aortic insufficiency, surgical correction is necessary in any situation.

If aortic insufficiency develops against the background of damage to the connective tissue cusps of the aortic valve themselves, surgical treatment involves excision of the affected biological material and replacing it with a mechanical or biological prosthesis. For aneurysmal dilatation of the aortic sinus, plastic surgery is used to preserve the valve structures as much as possible. The mortality rate in the postoperative period is less than 4%.

It should be taken into account that in the complete absence of therapeutic measures, complications of aortic insufficiency of inflammatory, thromboembolic and ischemic profiles develop.

Aortic insufficiency - which doctor will help?? If you have or suspect the development of aortic insufficiency, you should immediately seek advice from doctors such as a cardiologist and cardiac surgeon.