28.04.2019

Tricuspid (three-leaf) valve insufficiency: what it is, symptoms, treatment, causes, signs. What does mitral and tricuspid valve insufficiency mean?

In medicine, mitral insufficiency is understood as incomplete closure of the valve at the time of systole, as a result, part of the blood flows back into the left atrium, while the blood volume and pressure in it increase. Blood then flows from the left atrium into the left ventricle, where its volume and pressure also increase. As a result, mitral valve insufficiency leads to increased pressure and the formation of congestion in the pulmonary vessels. The movement of blood in the opposite direction is called regurgitation.

In its pure form, mitral insufficiency is rare and accounts for only 5% of cases. It is observed less frequently in adults than in children. As a rule, the disease is combined with other heart defects, such as mitral stenosis and aortic defects.

Classification

There are three degrees mitral insufficiency depending on how severe the rigurgitation is.

At grade 1, the blood flow into the left atrium is insignificant (about 25%) and is observed only at the valve. Due to compensation of the defect, the patient feels normal, there are no symptoms or complaints. The ECG does not show any changes; examination reveals murmurs during systole and the borders of the heart are slightly expanded to the left.
At stage 2, the reverse blood flow reaches the middle of the atrium, more blood is thrown in - from 25 to 50%. The atrium cannot pump out blood without increasing pressure. Pulmonary hypertension develops. During this period, shortness of breath appears, rapid heartbeat during exercise and at rest, cough. The ECG shows changes in the atrium; examination reveals systolic murmurs and expansion of the cardiac boundaries: to the left - up to 2 cm, up and to the right - by 0.5 cm.
At grade 3, blood reaches the posterior wall of the atrium and can account for up to 90% of the systolic volume. This is the stage of decompensation. There is hypertrophy of the left atrium, which cannot push out the entire amount of blood. Swelling appears, the liver enlarges, and venous pressure increases. An ECG shows the presence of left ventricular hypertrophy and mitral wave. A pronounced systolic murmur is heard, the boundaries of the heart are significantly expanded.

Symptoms

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

With mitral regurgitation, the left ventricle gradually increases in size as it is forced to pump more blood. As a result, every heartbeat, and the person experiences palpitations, especially when lying on the left side.

To accommodate the extra blood coming from the left ventricle, the left atrium increases in size and begins to contract abnormally and too quickly due to atrial fibrillation. The pumping function of the heart muscle in mitral insufficiency is impaired due to an abnormal rhythm. The atria do not contract, but tremble. Impaired blood flow leads to thrombus formation. With severe regurgitation, heart failure develops.

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

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

Causes

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

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

Diagnostics

The main diagnostic methods for mitral regurgitation include:

examination and conversation with the patient;
electrocardiography;
radiography chest;
echocardiography.

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

Treatment

Treatment of mitral regurgitation depends on the severity of the defect and the causes of its occurrence. Medicines are used for atrial fibrillation, arrhythmia, and to reduce heart rate. Mild and moderate mitral regurgitation requires limiting emotional and physical stress. Required healthy image life, smoking and drinking alcohol must be stopped.

In case of severe urinary tract injury, surgical treatment is prescribed. Surgery to restore the valve should be performed as early as possible, before irreversible changes in the left ventricle appear.

At surgical treatment Mitral valve insufficiency is restored. This operation is indicated if changes in the heart valve are minor. This can be plastic surgery of the ring, plastic surgery of the valves, narrowing of the ring, or replacement of valves.

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

Forecast

The prognosis depends on the severity of the valve damage and the condition of the myocardium. Severe insufficiency and unsatisfactory condition of the myocardium quickly lead to severe circulatory disorders. An unfavorable prognosis can be said in the case of chronic heart failure. At the same time, the mortality rate during the year is 28%. With relative insufficiency of uric acid, the outcome of the disease is determined by the severity of the circulatory disorder and the disease that led to the defect.

With mild to moderate mitral regurgitation, a person may long time maintain working capacity if you see a cardiologist and follow his advice. The disease at these stages is not a contraindication for having a child.

Aortic valve insufficiency: symptoms, diagnosis, treatment

Insufficiency aortic valve is a heart defect in which the valve leaflets cannot fully close and prevent the return of blood from the aorta to the left ventricle when the walls of the ventricles relax. As a result of constant regurgitation of blood, the left ventricle experiences constant stress, its walls stretch and thicken, and the organs and tissues of the body suffer from insufficient blood circulation.

In the compensation stage, aortic valve insufficiency may not manifest itself, but when the reserves are exhausted, the heart experiences everything heavy load, and the patient’s health condition worsens, because changes in the structure of the heart become irreversible and total heart failure develops. Such severe manifestations of this valve defect can lead to the development of severe complications and death.

According to statistics, aortic insufficiency is found in every seventh patient with heart defects, and in 50-60% of cases it is combined with aortic stenosis and/or mitral insufficiency or stenosis. In isolated form, this defect is observed in every twentieth patient with heart defects. Aortic insufficiency occurs predominantly in men and in most cases is acquired.

Kinds

Depending on the time of formation of the defect, aortic insufficiency can be:

congenital: develops as a result hereditary causes or the negative impact of various factors on the body of the expectant mother;
acquired: develops as a result of the effects on the heart of various diseases, injuries and oncological pathologies appearing in a child or adult after birth.

Acquired aortic valve insufficiency can be:

organic: develops due to damage to the valve structure;
functional: develops due to expansion of the left ventricle or aorta.

Depending on the volume of blood pumped into the left ventricle from the aorta, four degrees of this heart defect are distinguished:

I degree – no more than 15%;
II degree – about 15-30%;
III degree – up to 50%;
IV degree – more than 50%.

According to the speed of development of the disease, aortic insufficiency can be:

chronic: develops over many years;
acute: the stage of decompensation occurs within a few days (with aortic dissection, severe endocarditis or chest injuries).

Causes

Congenital aortic valve insufficiency is rarely detected. It can be called:

negative effects on the body of a pregnant infection, X-ray or radiation radiation, etc.;
congenital defects of heart structures (development of 1-2- or 4-leaf aortic valves, anomalies of the interatrial septum);
dilatations of the aorta, frolicking due to Marfan syndrome;
connective tissue dysplasia syndrome, which leads to thickening and degeneration of the valve leaflets.

Acquired organic insufficiency of the aortic valve can be caused by the following diseases and pathologies:

atherosclerosis of the aorta;
rheumatic fever;
infective endocarditis;
syphilis;
systemic lupus erythematosus;
traumatic damage to the aortic valve;
Takayasu's disease.

Acquired functional aortic insufficiency develops as a result of the following pathologies:

arterial hypertension, causing an increase in the size of the left ventricle;
myocardial infarction leading to the formation of a left ventricular aneurysm;
aortic aneurysm developing against the background of sudden and significant hypertension, aortic atherosclerosis or aortic inferiority due to Marfan syndrome.

Symptoms

A constant feeling of pulsation in the head and dizziness disrupts normal rhythm patients' lives.

During compensation of aortic valve insufficiency (with grades I-II), in most cases patients have no complaints. After the exhaustion of compensatory mechanisms (in grades III-IV) and a reduction in the contractility of the left ventricle, which is under constant load, the following symptoms appear in the patient:

sensations of pulsation in the vessels of the neck and head (especially when lying down);
cardialgia (pain) of a pressing and squeezing nature;
general weakness and decreased tolerance to physical activity;
increased sweating;
heartbeat;
dyspnea;
tachycardia;
arrhythmias;
noise in ears;
dizziness;
visual impairment;
fainting states.

When examining the skin, pallor is noted, and in the later stages of the disease acrocyanosis is observed. Patients with this defect experience Musset's symptom:

shaking the head to the rhythm of the pulse;
abnormal pulsation of general carotid arteries on the neck.

When palpating (feeling) the heart in the VI-VII intercostal space, a strong dome-shaped apical impulse is determined, and aortic pulsation is felt in the area of the xiphoid process.

When percussing (tapping) the heart, the configuration of the heart with a clearly defined waist (a “boot” or “duck” shaped heart) characteristic of aortic insufficiency is determined. Subsequently, in the later stages of the disease, the patient’s heart increases significantly in size and takes on a spherical shape (“bull heart”).

Auscultation (listening) of the heart determines:

quiet I tone;
weakening of the second tone;
protosystolic murmur in the aorta;
pathological III tone in the area of the apex of the heart.

Auscultation of the vessels determines:

double Vinogradov-Durozier noise;
Traube double tone.

The patient has an increased systolic, decreased diastolic and high pulse pressure, high and rapid pulse.

Complications

Long-term aortic insufficiency can be complicated by infective endocarditis.

With prolonged aortic insufficiency and lack of adequate treatment, the patient may develop the following complications:

left ventricular failure;
mitral valve insufficiency;
coronary circulation disorders (myocardial infarction, ischemic heart disease);
secondary infective endocarditis;
atrial fibrillation;
aortic rupture.

Diagnostics

To detect aortic valve insufficiency in the complex diagnostic studies include:

analysis of medical history and life;
fiscal examination of the patient;
clinical urine and blood tests;
biochemical blood tests (for the level of total cholesterol, LDL, triglycerides, uric acid, creatinine and total protein blood);
immunological blood test (for the content of antibodies to self and foreign structures, C-reactive protein, syphilis);
phonocardiogram;
Echo-CG;
chest x-ray;
coronary angiography;
spiral CT;

If surgical treatment is necessary, catheterization of the cardiac cavities and ascending aortography are prescribed.

Treatment

For patients with asymptomatic aortic insufficiency, an annual examination by a cardiologist with echocardiography is recommended. When planning surgical and dental procedures, such patients are recommended to take a prophylactic course of antibiotics to prevent the development of infective endocarditis. Patients with this heart defect are advised to limit physical activity to prevent possible aortic rupture.

For moderate aortic insufficiency, patients are prescribed drug therapy, which is aimed at slowing down damage to the structure of the left ventricle. Selection medicines and their dosage is determined for each patient individually. The treatment regimen may include the following drugs:

drugs to treat the underlying cause of aortic regurgitation (for example, antibiotics to treat rheumatism);
ACE inhibitors: Captopril, Lisinopril, Enalapril;
angiotensin receptor antagonists: Valsartan, Lorista N, Naviten, Losartan;
beta blockers: Tranzikor, Anaprilin, Atenolol;
calcium antagonists: Corinfar, Nifedipine;
calcium antagonists from the Diltiazem and Verampil group;
drugs for the treatment of complications of aortic insufficiency (heart failure, arrhythmias, etc.).

In cases of severe aortic insufficiency, surgical correction of this heart defect is recommended for patients. To perform the operation, minimally invasive techniques can be used and traditional ways in conditions of providing artificial blood circulation. The following types of interventions can be used to correct aortic valve insufficiency:

Aortic valve plastic surgery (remodeling, resuspension, reimplantation).
Transcatheter aortic valve implantation.
Aortic valve replacement with biological or mechanical prostheses.

If there is significant damage to the heart structures, a donor heart transplant operation may be recommended.

After implantation of a mechanical valve, patients must constantly take medications from the group of anticoagulants (Warfarin with Aspirin). When replacing a valve with a biological prosthesis, anticoagulants are taken in short courses (1-3 months), and when performing valve surgery, anticoagulants are not required.

Forecasts

The prognosis for aortic valve insufficiency depends on the cause of the defect, the condition of the myocardium and the severity of regurgitation from the aorta to the left ventricle:

With moderate aortic insufficiency, the patient’s satisfactory state of health and ability to work remains for several years.
When symptoms of deterioration in myocardial contractility and severe aortic valve insufficiency appear, the progression of heart failure occurs quite quickly.
When aortic valve insufficiency develops as a result of syphilis or infective endocarditis, an unfavorable course of the disease is often observed.
With aortic insufficiency, which occurs against the background of aortic atherosclerosis or rheumatism, the disease progresses more favorably.

The average survival rate of patients with severe aortic insufficiency without signs of decompensation is about 5-10 years, and in the decompensated stage and the presence of total heart failure, taking medications becomes ineffective and patients die within two years. Significantly improves the prognosis of aortic insufficiency when performed in a timely manner surgery to eliminate the defect of the aortic valve.

In Astrakhan, they learned how to replace heart valves in a new way. Cardiac surgeons in Astrakhan, under the guidance of German specialists, mastered a fundamentally new technique for replacing the aortic valve. This operation is carried out…

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Features of tricuspid insufficiency grade 2

Tricuspid valve insufficiency is a failure of the valve apparatus, in which incomplete closure of the leaflets occurs and, as a result, regurgitation occurs. There are several degrees of severity of this pathology. When grade 2 tricuspid insufficiency occurs, characteristic symptoms diseases of the cardiovascular system.

Causes of development of tricuspid valve insufficiency 2nd degree

Tricuspid insufficiency occurs due to various diseases and exposure to damaging factors on the body. Most common reasons are:

Inflammation of a systemic nature - rheumatism.
Infectious lesion of the inner layer of the heart.
Inflammation of the muscle layer of the heart.
Myocardial infarction with predominant defeat right ventricle.
Sclerotic changes in the vessels of the heart muscle.
Carcinoid tumors.
Chest injuries with damage to the valves.
Chronic heart failure.
VSD (ventricular septal defect).
Complications of some heart surgeries.

Classification

Tricuspid insufficiency, depending on various criteria, is divided into numerous forms. Depending on the time of occurrence, congenital and acquired deficiency differs.

Depending on which part of the valve is affected, the following forms are distinguished:

organic failure is characterized by damage to the valves themselves;
the functional (relative) form occurs due to damage to other elements of the valve apparatus.

The degrees of the defect, which depend on the severity of the reflux of blood from the ventricle back into the atrium:

Grade 1 – regurgitation is almost invisible.

Grade 2 - reverse blood flow is noticeable 20 millimeters from the valve apparatus.

Grade 3 – throw is determined more than 20 millimeters from the valve flaps.

Grade 4 – significant regurgitation over a large volume.

This classification is very important. Determining the form of the pathology will help you choose the right treatment.

Symptoms of the defect

Tricuspid insufficiency of the 2nd degree is manifested by hypertension and enlargement of the atrium (compensation of the heart muscle). When the body exhausts the ability to compensate for the heart, decompensatory phenomena develop, due to which symptoms arise.

With a first degree defect, symptoms do not appear due to compensation. The patient does not have any complaints.

Tricuspid valve insufficiency grade 2 leads to noticeable deterioration general condition human, in contrast to pathology of the 1st degree, which in some cases is a variant of the norm. This pathological condition leads to weakening of the right parts of the heart, which is why the course of the disease actually worsens and damage to organs and systems occurs. When transitioning from grade 2 to grade 3, it is necessary to correct the defect (surgery) as quickly as possible.

The clinical picture of this pathology includes the following symptoms:

A person's performance decreases. He complains of weakness and fatigue during physical work.
Patients usually note irregular heartbeat. They feel a heartbeat with irregular rhythm.
There is frequent urination at night (nocturia).
In the afternoon, swelling in the lower extremities becomes noticeable, which may subside slightly the next morning.
A person experiences discomfort due to constant freezing of his feet. They are cold to the touch even in a warm room.
Discomfort and heaviness in the liver.
Violation respiratory function(dyspnea).
Swollen vessels of the neck are revealed, which palpably pulsate.
Complaints of bloating, nausea and vomiting.

All these symptoms are characteristic of the progression of this pathological condition. If treatment is not carried out, then the person experiences complications:

PE (pulmonary embolism). A thrombus, breaking away from its attachment site, can partially or completely block the lumen of the pulmonary vessels. This condition develops acutely, it is very life-threatening for the patient and requires emergency care.
Violations heart rate(eg, atrial fibrillation).
Secondary infection of the endocardium.

Features of the manifestation of this pathology in children

In children, as a rule, this defect does not occur in its pure form. It is combined with pathology of other valves.

If grade 2 tricuspid insufficiency occurs in a newborn, then he experiences rapid development of cardiac and respiratory failure. Very often this condition leads to the death of the baby.

The acquired form of the defect occurs as a complication of previous infectious diseases, injuries and malignant neoplasms.

Tricuspid insufficiency in children leads to congestion in the pulmonary and systemic circulation. This, in turn, is manifested by a violation of the functions of organs and systems of a small organism.

The first degree of pathology is an indication for monitoring the child; in case of a more severe course of the disease, treatment is provided, both medicinal and surgical.

The sooner a pathology of the valve apparatus is detected, the easier it will be to eliminate it. In this case, the child’s chances of managing full life further.

Diagnostic signs of tricuspid valve insufficiency 2 degrees

Diagnostic measures are aimed at identifying pathology and assessing the degree of its severity. When a patient first contacts, it is necessary to collect a thorough medical history. It is necessary to ask about past illnesses both the patient himself and his blood relatives. After which it is necessary to begin a physical examination.

You can visually assess the color of the skin. Noted yellow skin due to pathological effects on the liver. For the same reasons, an increase in the size of the abdomen (ascites) is determined. IN abdominal cavity free fluid accumulates, which affects internal organs. It is also necessary to measure your blood pressure level.

By palpation, you can determine liver enlargement, swelling and irregular heartbeat when palpating the pulse.

Percussion reveals changes in the boundaries of the heart and liver.

Auscultation helps to listen to the characteristic heart murmur and irregular heartbeat.

Laboratory research methods are necessary to detect concomitant pathologies and complications of this defect:

Laboratory examination of urine and blood.
Biochemical blood test.
Immunological analysis.

Instrumental research methods:

An ECG helps assess the size of the heart's chambers and its functionality. According to the results of the electrocardiogram, hypertrophy of the right chambers of the heart and signs of arrhythmia are revealed.
Phonocardiography will help identify the characteristic (systolic murmur).
Ultrasound of the heart muscle is a more accurate and accessible method for diagnosing diseases of the cardiovascular system. Using echocardiography + Doppler, the degree of regurgitation is revealed, that is, the return of blood to the atrium at a distance of less than two centimeters from the valve apparatus. Hypertrophic changes and hypertension of the right heart are determined.
X-ray of the chest organs. Using this research method, pathological changes in the size of the heart and its position are determined.
CT ( CT scan) helps to obtain an image of the heart in different projections.
MRI (magnetic resonance imaging) allows you to evaluate the heart muscle layer by layer and identify concomitant pathology.

Diagnosis of this type of pathology is quite labor-intensive and varied due to the combination of defects and the development of complications in the organs of the systemic circulation.

Treatment of valve insufficiency

Determining the type and tactics of treatment will depend on the severity of the defect, the cause of its occurrence, concomitant pathologies and complications that arise. As a rule, for grade 2 tricuspid valve pathology, two treatment methods are combined:

conservative treatment (medication);
surgical (operative) treatment.

Conservative treatment includes diet therapy and medications. The diet consists of limiting the intake of liquid and salt. It is necessary to avoid selenium, fatty, fried foods and canned foods.

Drug therapy is carried out to treat the disease that caused the pathology of the valve apparatus. Apply antibacterial drugs if the cause is an infection. It is also necessary to eliminate circulatory failure and cardiac pathology (failure, arrhythmias). Groups of drugs used in treatment:

diuretics (diuretics) are used to treat arterial hypertension and eliminate edema;
nitrates help enrich the myocardium with oxygen and relieve spasm of the coronary vessels;
Angiotensin converting enzyme inhibitors are prescribed to treat heart failure;
anticoagulants, used to prevent thrombosis;
Medicines containing potassium help strengthen the heart muscle.

Tricuspid valve insufficiency of the 2nd degree also requires surgical treatment. Operations are performed on an open heart with cardiac arrest. There are 2 types of operations:

plastic surgery (helps preserve the patient’s valve apparatus);
implantation of a prosthesis (replacement of one’s own tricuspid valve with a mechanical or biological one).

Complications arising after surgical treatment:

Thromboembolism. After surgery, blood clots may form on the prosthesis. They can provoke a stroke, pulmonary embolism, kidney and myocardial infarction. For prevention this complication Indirect anticoagulants are prescribed. If the prosthesis is mechanical, then the duration of taking the drugs is up to three months. When a biological prosthesis is implanted, anticoagulants are prescribed for 1 month.
Inflammatory diseases of heart tissue.
Thrombosis of the prosthesis. This complication leads to disruption of blood flow.
Damage to a biological prosthesis.
Calcium deposition on a prosthesis made from animal tissue (biological), which leads to disruption of its functioning.

Patients with this pathology should be constantly monitored by a cardiologist to correct the basic treatment and prescribe additional therapy in case of complications.

The prognosis for patients without proper treatment is disappointing, since with increasing insufficiency of the valve apparatus, the severity of heart failure worsens, which can lead to death.

Preventive actions

Prevention is aimed at preventing the development of the disease and the occurrence of complications:

Prevention and timely treatment of rheumatism and infectious diseases that can cause the development of this pathology.
Compliance with recommendations and prescribed treatment for diseases of the heart muscle and blood vessels prescribed by a cardiologist.
Treatment of chronic foci of infection.
You cannot self-medicate, or change the dosage of prescribed medications yourself or stop taking them.
Follow the principles of proper and dietary nutrition.
Refusal bad habits(smoking, alcohol).
Hardening procedures.
Maintaining a sleep and rest schedule.
Sufficient exposure to fresh air.

Insufficiency is a failure of the valve apparatus, in which incomplete closure of the valves occurs and, as a result, rehydration occurs. There are several degrees of severity of this pathology. When grade 2 tricuspid insufficiency occurs, characteristic symptoms of diseases of the cardiovascular system are observed.

Tricuspid insufficiency occurs due to various diseases and exposure to damaging factors on the body. The most common reasons are:

Inflammation of a systemic nature - rheumatism.
Infectious lesion of the inner layer of the heart.
Inflammation of the muscle layer of the heart.
Myocardial infarction with predominant damage to the right ventricle.
Sclerotic changes in the vessels of the heart muscle.
Carcinoid tumors.
Chest injuries with damage to the valves.
Chronic heart failure.
VSD().
Complications of some heart surgeries.

Classification

Tricuspid insufficiency, depending on various criteria, is divided into numerous forms. Depending on the time of occurrence, congenital and acquired deficiency differs.

Depending on which part of the valve is affected, the following forms are distinguished:

organic failure is characterized by damage to the valves themselves;
the functional (relative) form occurs due to damage to other elements of the valve apparatus.

The degrees of the defect, which depend on the severity of the reflux of blood from the ventricle back into the atrium:

Grade 1 – regurgitation is almost invisible.

Grade 2 - reverse blood flow is noticeable 20 millimeters from the valve apparatus.

Grade 3 – throw is determined more than 20 millimeters from the valve flaps.

Grade 4 – significant regurgitation over a large volume.

This classification is very important. Determining the form of the pathology will help you choose the right treatment.

Symptoms of the defect

With a first degree defect, symptoms do not appear due to compensation. The patient does not have any complaints.

Tricuspid valve insufficiency of the 2nd degree leads to a noticeable deterioration in the general condition of a person, in contrast to pathology of the 1st degree, which in some cases is a variant of the norm. This pathological condition leads to weakening of the right parts of the heart, which is why the course of the disease actually worsens and damage to organs and systems occurs. When transitioning from grade 2 to grade 3, it is necessary to correct the defect (surgery) as quickly as possible.

The clinical picture of this pathology includes the following symptoms:

A person's performance decreases. He complains of weakness and fatigue during physical work.
Patients usually note irregular heartbeat. They feel a heartbeat with irregular rhythm.
There is frequent urination at night (nocturia).
In the afternoon, swelling in the lower extremities becomes noticeable, which may subside slightly the next morning.
A person experiences discomfort due to constant freezing of his feet. They are cold to the touch even in a warm room.
Discomfort and heaviness in the liver.
Impaired respiratory function (shortness of breath).
Swollen vessels of the neck are revealed, which palpably pulsate.
Complaints of bloating, nausea and vomiting.

All these symptoms are characteristic of the progression of this pathological condition. If treatment is not carried out, then the person experiences complications:

PE (pulmonary embolism). A thrombus, breaking away from its attachment site, can partially or completely block the lumen of the pulmonary vessels. This condition develops acutely, it is very life-threatening for the patient and requires emergency care.
Heart rhythm disturbances (eg, atrial fibrillation).
Secondary infection of the endocardium.

Features of the manifestation of this pathology in children

In children, as a rule, this defect does not occur in its pure form. It is combined with pathology of other valves.

If grade 2 tricuspid insufficiency occurs in a newborn, then he experiences rapid development of cardiac and respiratory failure. Very often this condition leads to the death of the baby.

The acquired form of the defect occurs as a complication of previous infectious diseases, injuries and malignant neoplasms.

The first degree of pathology is an indication for monitoring the child; in case of a more severe course of the disease, treatment is provided, both medicinal and surgical.

The sooner a pathology of the valve apparatus is detected, the easier it will be to eliminate it. In this case, the child’s chances of leading a full life in the future increase.

Diagnostic signs of tricuspid valve insufficiency 2 degrees

You can visually assess the color of the skin. There is a yellow color of the skin due to pathological effects on the liver. For the same reasons, an increase in the size of the abdomen (ascites) is determined. Free fluid accumulates in the abdominal cavity, which affects the internal organs. It is also necessary to measure your blood pressure level.

By palpation, you can determine liver enlargement, swelling and irregular heartbeat when palpating the pulse.

Percussion reveals changes in the boundaries of the heart and liver.

Auscultation helps to listen to the characteristic heart murmur and irregular heartbeat.

Laboratory research methods are necessary to detect concomitant pathologies and complications of this defect:

Laboratory examination of urine and blood.
Biochemical blood test.
Immunological analysis.

Instrumental research methods:

An ECG helps assess the size of the heart's chambers and its functionality. According to the results of the electrocardiogram, hypertrophy of the right chambers of the heart and signs of arrhythmia are revealed.
Phonocardiography will help identify the characteristic (systolic murmur).
Ultrasound of the heart muscle is a more accurate and accessible method for diagnosing diseases of the cardiovascular system. Using echocardiography + Doppler, the degree of regurgitation is revealed, that is, the return of blood to the atrium at a distance of less than two centimeters from the valve apparatus. Hypertrophic changes and hypertension of the right heart are determined.
X-ray of the chest organs. Using this research method, pathological changes in the size of the heart and its position are determined.
CT (computed tomography) helps to obtain images of the heart in different projections.
MRI (magnetic resonance imaging) allows you to evaluate the heart muscle layer by layer and identify concomitant pathology.

Diagnosis of this type of pathology is quite labor-intensive and varied due to the combination of defects and the development of complications in the organs of the systemic circulation.

Treatment of valve insufficiency

conservative treatment (medication);
surgical (operative) treatment.

Conservative treatment includes diet therapy and medications. The diet consists of limiting the intake of liquid and salt. It is necessary to avoid selenium, fatty, fried foods and canned foods.

Drug therapy is carried out to treat the disease that caused the pathology of the valve apparatus. Antibacterial drugs are used if the cause is infection. It is also necessary to eliminate circulatory failure and cardiac pathology (failure, arrhythmias). Groups of drugs used in treatment:

diuretics (diuretics) are used to treat arterial hypertension and eliminate edema;
nitrates help enrich the myocardium with oxygen and relieve spasm of the coronary vessels;
Angiotensin converting enzyme inhibitors are prescribed to treat heart failure;
anticoagulants, used to prevent thrombosis;
Medicines containing potassium help strengthen the heart muscle.

Tricuspid valve insufficiency of the 2nd degree also requires surgical treatment. Operations are performed on an open heart with cardiac arrest. There are 2 types of operations:

plastic surgery (helps preserve the patient’s valve apparatus);
implantation of a prosthesis (replacement of one’s own tricuspid valve with a mechanical or biological one).

Complications arising after surgical treatment:

Thromboembolism. After surgery, blood clots may form on the prosthesis. They can provoke a stroke, pulmonary embolism, kidney and myocardial infarction. To prevent this complication, indirect anticoagulants are prescribed. If the prosthesis is mechanical, then the duration of taking the drugs is up to three months. When a biological prosthesis is implanted, anticoagulants are prescribed for 1 month.
Inflammatory diseases of heart tissue.
Thrombosis of the prosthesis. This complication leads to disruption of blood flow.
Damage to a biological prosthesis.
Calcium deposition on a prosthesis made from animal tissue (biological), which leads to disruption of its functioning.

Patients with this pathology should be constantly monitored by a cardiologist to correct the basic treatment and prescribe additional therapy in case of complications.

The tricuspid valve, also known as the tricuspid valve, is located between the atrium and the ventricle on the right. If it is open, blood moves freely from the atrium to the ventricle, and then the valves close. For a number of reasons, the smooth functioning of the valve may be disrupted. In such cases, blood flow is disrupted, and against this background, tricuspid insufficiency may occur.

Classification

Tricuspid valve insufficiency occurs in different ways, and to make the correct diagnosis it is important to determine the form of the pathology. For this, a number of criteria are identified: the period of occurrence, the area of the valve in which the disturbances are detected, the severity of regurgitation.

Congenital and acquired defects

Depending on the period of occurrence, the pathology in question is of two types. Almost always it is acquired and develops due to inflammation. The birth defect is extremely rare. It is characterized by:

valve displacement below normal location;
incorrect structure of the valves (congenital clefts, etc.);
degeneration (thickening of the valves, decrease in their density).

Organic and functional pathologies

Based on which part of the valve is affected, two forms of pathology are also distinguished. Organic failure is accompanied by changes in the valves. They become deformed, wrinkled, and become covered with limescale.

With a functional valve, the valve stops closing completely, and anomalies of the valve apparatus appear.

Degrees of tricuspid insufficiency

The degrees are determined by the severity of regurgitation - reverse blood flow directed from the ventricle to the atrium:

at grade 1 there are no hemodynamic disturbances;
at grade 2, regurgitation is detected 2 cm from the valve;
at grade 3, reverse blood flow passes more than 2 cm from the valve;
at grade 4, pronounced regurgitation is detected over an extended area.

Causes

Congenital form of pathology is extremely rare, it develops in the fetus if the mother encounters exposure during pregnancy harmful factors. It can be infectious diseases, radiation, x-ray exposure.

In most cases, the pathology is acquired, and its causes can be very different - from rheumatism to tumors and heart surgery.

Why do valve leaflets change?

Changes in the valves that characterize the organic form of tricuspid insufficiency occur under the influence of the following factors:

Rheumatism is a systemic inflammation that affects various organs and systems. The most common cause of pathology.
Closed cardiac injury with rupture of valve leaflets.
Carcinoid syndrome is damage to various organs caused by carcinoid. This is a small intestinal tumor. From her active substances enter the blood and attack the endocardium. Then they enter the pulmonary vessels and are destroyed. Under these conditions, the tricuspid valve may not close completely.
Infective endocarditis, characterized by inflamed endocardium.
Mitral commissurotomy is an operation to separate the fused cusps of the mitral valve. As a result of this treatment, blood flow increases, which may manifest symptoms of previously hidden tricuspid insufficiency.

Why does the valve stop closing?

A decrease in the functionality of the valve due to its relative insufficiency occurs when the papillary muscles are damaged or the fibrous ring expands.

The papillary muscles are located inside the ventricles and support the motor ability of the valves. During myocardial infarction, they are damaged, which leads to a decrease in the functionality of the tricuspid valve.

The valve leaflets are connected to the fibrous ring located in the heart walls. Its expansion can be caused by various pathologies:

Myocarditis is an inflammatory disease of the heart muscle.
Dilated cardiomyopathy is a disease with proliferation of the heart cavities and thinning of the myocardium.
Congenital defects that provoke the growth of the right ventricle. For example, with a hole in interventricular septum blood is released from left to right.
Chord ruptures. Due to these tendon threads, the myocardium and papillary muscles in the heart are connected, supporting the motor ability of the valves.
Complicated pulmonary hypertension is a significant increase in blood pressure.
Tumors and other formations that interfere with the free flow of blood from the ventricle.

Symptoms of the disease

In infants, the pathology manifests itself as bluish skin and symptoms of severe heart failure. The following complaints are received from older children and adults:

severe fatigue;
dyspnea;
bluishness of the skin.

25% of patients experience rapid pulse, dizziness and pain in the chest or neck. These are manifestations of supraventricular tachycardia, which indicates.

With secondary valve insufficiency, additional symptoms associated with concomitant pathologies. For example, pain may be present with right ventricular infarction or hemoptysis and arrhythmia with mitral valve defects.

Diagnostics

Tricuspid insufficiency is often accompanied by mitral valve pathologies and stenoses, which complicates diagnosis. Therefore, an extensive examination of the patient is carried out using a variety of methods - from taking anamnesis to blood tests, ECG and X-rays.

Interview and examination of the patient

During an oral interview with the patient, the doctor examines his complaints, lifestyle, and finds out what illnesses his close relatives had. It is also important to establish the patient’s profession, since, perhaps, due to the nature of his activity, he encountered pathogens of infectious diseases.

During the examination, the doctor determines the presence of cyanosis of the skin, swelling of the veins in the neck and abdomen (occurs with ascites due to the accumulation of excess fluid).
If a pulsation is detected in the middle of the upper abdomen under the sternum, this indicates rhythmic contractions of an enlarged right ventricle, which healthy person is located higher.
When tapping, the doctor can determine the enlargement of the right side of the heart, and when listening - murmurs.
The doctor also checks the patient’s heart rate and blood pressure (it decreases when measured).

Lab tests

As part of the diagnosis, several laboratory tests are performed:

general blood and urine tests;
blood biochemistry;
immunological analysis.

Thanks to these studies, the presence of inflammation and concurrent diseases is established.

Hardware methods

To clarify the diagnosis you may need:

ECG (detection of blockades, increased volumes of the atrium and ventricle).
Phonocardiogram (demonstrates systolic murmur).
EchoCG (the main method, shows deformation and thinning of the valves, the formation of new structures on them, etc.).
Spiral computed tomography (provides an informative image of the heart).
X-ray (detects heart parameters, blood stagnation).
Catheterization of the cardiac cavities (confirms that the pressure in the atrium has reached the level of the ventricular pressure).
Coronarocardiography (performed before surgery; by introducing contrast into the vessels, a clear image of them is obtained, blood flow is assessed).

Treatment

Many forms of tricuspid regurgitation can be treated with medications, so surgery can be avoided. Surgery is used only in extreme cases when medications do not work or there is a threat to the patient's life.

Conservative therapy

If there are no signs of pulmonary hypertension, even severe tricuspid regurgitation can be treated with medication. Patients are usually prescribed:

diuretics;
nitrates (orally and in the form of patches);
ACE inhibitors and ionotropes (for refractory failure).

If pulmonary hypertension is diagnosed, diuretics and vasodilators can sometimes help reduce blood pressure in preparation for surgery. For infective endocarditis, the patient is prescribed antibiotics. Sometimes this helps avoid surgery.

Surgical intervention

The operation is prescribed for patients with 3-4 degrees of pathology, with gross deformations of the valves or pronounced violations functionality. Also, indications for surgical intervention include severe concomitant illness that poses a threat to life, and circulatory failure at the last stage.

In case of primary pathology and preservation of the valve apparatus, annuloplasty is used. It consists in applying U-shaped sutures to the damaged area. If the operation is ineffective, there are gross structural changes valve, infective endocarditis or Ebstein anomaly, the patient is given a biological artificial valve.

Complications

If the pathology is not treated, it will progress, leading to serious complications. Among them:

Pulmonary embolism. The resulting thrombus will gradually block the lumen of the artery, and ultimately come off.
Atrial fibrillation and other forms of heart rhythm abnormalities.
Atrioventricular block with difficulty moving the impulse.
Atresia of the aorta (blocking of the mouth of its ascending part).
Secondary development of infective endocarditis.

Some of these complications can also be caused by surgery.

Thus, blood clots often form in the operated areas. If the patient has had a biological prosthesis installed, it can provoke calcification, which causes a decrease in the patient’s mobility. Thrombosis or destruction of the installed valve is also possible, which often requires reoperation.

Prevention of tricuspid insufficiency

The best way to protect yourself from this disease is to regularly see a cardiologist and promptly treat diseases that affect the functioning of the heart. Since the most common cause of pathology is rheumatism, it is important to prevent relapses of this disease.

Doctors also give their patients several tips that help maintain the functionality of the heart and all its parts:

Stick to healthy eating, rich in vitamins and minerals.
Monitor salt and fluid intake to prevent edema.
Quit smoking and alcohol.
Avoid dynamic and excessive physical activity.
Avoid hypothermia.
Deal with stress.

The main muscle of the human body is the heart. This is a complex mechanism, the components of which are valves. The tricuspid valve is located on the right side. It separates the atrium and ventricle. When it malfunctions, the blood flow in that part of the muscle is disrupted. The result is a life-threatening condition. In medical practice, it is also known as tricuspid valve insufficiency. Today's article will discuss the main causes, symptoms and treatments for this disease.

Anatomical certificate

The human heart is a muscular organ. Its cavity is divided into 2 atria and 2 ventricles. Communication between these structures occurs through valves. They are responsible for blood flow in one direction.

On the right side they are connected through the tricuspid valve. It consists of the following anatomical formations:

three valves (septal, anterior and posterior);
tendon tract;
papillary muscles;
fibrous ring.

During contraction of one atrium, the tricuspid valve opens. Gradually, blood fills the ventricle. After this, the myocardium begins to alternately contract, while the valve leaflets are under strong pressure slam shut. Such a well-functioning mechanism prevents the reverse flow (regurgitation) of blood. Under the influence of certain factors, sometimes its operation fails. In this case, they say that they are experiencing tricuspid valve insufficiency. However, he can no longer fully perform his functions.

With this pathology, blood from the right ventricle returns to the atrium. A slight increase in fluid volumes has virtually no effect on the functioning of the main muscle of the body. With severe insufficiency, the chambers of the heart are subject to deformation, and their pressure changes sharply. It can increase up to 8 times compared to natural values.

Brief description of the disease

Tricuspid insufficiency is a heart defect that develops due to inadequate closure of the valve leaflets, backflow of blood from the right ventricle into the atrium. Against the background of constant regurgitation, diastolic volume and pressure in this heart structure increase. This entails hypertrophy and dilatation of its walls. As a result of disruption of the compensatory mechanisms, the patient develops stagnation in the body.

Tricuspid insufficiency is often accompanied by others, for example, or an atrial septal defect.

Main causes and forms of pathology

Tricuspid valve insufficiency always has a different course. To make an accurate diagnosis, it is first necessary to determine the form of the pathological process. For this purpose, various criteria are used in medical practice: period of occurrence, localization of the damaged area of the valve, severity of regurgitation.

Depending on the time of development, the disease in question is of two types. As a rule, in all cases it is not acquired, but occurs after an inflammatory process. The congenital defect is diagnosed extremely rarely and develops in the womb. Its appearance is influenced by the action negative factors on the pregnant woman's body. It could be radiation infectious disease or x-ray exposure.

Based on the part of the tricuspid valve that is damaged, insufficiency can be of two forms. The organic version is accompanied by a physiological change in the valves. They gradually become deformed and become covered with plaque. In the functional form of the disease, the valve does not close completely.

The development of acquired organic tricuspid insufficiency occurs under the influence of the following reasons:

Rheumatism is an inflammation that spreads to the internal organ systems.
Carcinoid syndrome is damage to various organs caused by a small intestinal tumor. Pathogenic elements from the neoplasm enter the blood and begin to attack the endocardium. They then penetrate the pulmonary vessels.
Infective endocarditis is an inflammatory lesion
Mitral commissurotomy. This is an operation that is used to treat stenosis.

Acquired functional (relative) insufficiency of the tricuspid valve develops due to damage to the papillary muscles or expansion of the fibrous ring. In the first case, the structures presented are responsible for maintaining the motor ability of the valves. During myocardial infarction, the papillary muscles are damaged. This leads to disruption of the functionality of the tricuspid valve.

Pathologies of the annulus fibrosus can cause various disorders. These include myocarditis, chordal ruptures, tumors and neoplasms that prevent blood from flowing out of the ventricle.

Stages of development of deficiency

Based on the severity of the regurgitation process, it is customary to distinguish several stages during the disease:

Degree 1. Reverse blood flow remains minimal and is not accompanied by hemodynamic disorder.
Degree 2. At this stage, the pathology is accompanied by the advancement of a reverse blood stream over a distance that does not exceed 2 cm.
Grade 3. Blood flow moves into the atrium more than 2 cm from the valve surface.
Degree 4. At the time of regurgitation, blood penetrates into the upper zone of the atrium, passing throughout the chamber.

The symptoms that accompany each stage of the disease will be discussed below.

Signs of tricuspid valve insufficiency

On initial stage heart disease practically does not manifest itself. Sometimes after physical activity, patients note the appearance of strong pulsation of the veins in the neck. The pathological process can only be detected using Doppler ultrasound. A regular ECG does not show significant changes in the functioning of the heart.

Tricuspid valve insufficiency of the 2nd degree is accompanied by an increase in the volume of reverse blood flow. Right ventricular disorder leads to an increase in heart size. As a result clinical picture accompanied by the following symptoms:

loss of strength, decreased physical and mental activity;
frequent urination at night;
severe swelling of the lower extremities;
dyspnea;
feeling of heaviness under the ribs;
dyspeptic disorders.

When listening to the heart, pansystolic murmurs and atrial fibrillation are detected.

As the pathology progresses, the number of symptoms displayed increases. It is not recommended to ignore their occurrence. It is better to seek qualified advice at the initial stage of development of the disease. medical care. Tricuspid valve insufficiency of 1-2 degrees can still be treated with medication. The transition of the disease to the next stage always requires surgical intervention. Even after the operation, complications cannot be ruled out.

Features of the disease in children

Newborn babies with severe regurgitation and the presence of concomitant cardiac pathologies are susceptible to rapid development. Very often it ends in death.

The acquired form of the disease develops against the background of complications of other diseases. Most often we are talking about streptococcal infection, which entails rheumatic lesions.

Other causes of deficiency in childhood include:

acute form of hypertension;
myocardial diseases;
traumatic injuries;
malignant neoplasms.

At the initial stage, tricuspid valve insufficiency in children is considered as an anatomical feature. The first degree of the pathological process does not require treatment. With age, the disease usually goes away on its own.

Mitral and tricuspid valve insufficiency

Very often, valve malfunction with right side combined with dysfunction of the structures of the left half. In this area, the main burden falls on the so-called Symptoms of the disorder are summed up. The combination of such disorders negatively affects the functioning of the right ventricle, which is complicated by the occurrence of pulmonary hypertension. For patients diagnosed with stage 1 mitral and tricuspid valve insufficiency, surgical intervention is recommended.

Diagnostic methods

Early detection of the disease plays a direct role in the success of treatment and also affects the patient’s life expectancy. Since tricuspid valve insufficiency of the 1st degree is practically asymptomatic, pathology is detected only after its transition to the next stage of development.

Diagnosis begins with interviewing the patient, studying his medical history and physical examination. By asking various questions to the patient, the doctor determines the clinical picture and the time of onset of the first symptoms. He also needs to know what diseases preceded the deficiency. An external examination usually reveals cyanosis of the skin and swelling, and upon auscultation, a disturbance in the heart rhythm.

As part of the diagnosis, several laboratory tests are required. Among them, the most informative is a blood test and a study of the patient’s immunological status. Based on the results of laboratory tests, one can judge the presence of inflammatory processes in the body and parallel illnesses.

To clarify the diagnosis, the doctor can use hardware examination methods. These include:

ECG. It is carried out to detect an increase in atrium volumes.
Phonocardiogram. Demonstrates the presence of systolic murmurs.
Spiral CT. Provides an informative image of the main muscle of the body.
X-ray. Gives an idea of the size of the heart and reveals congestion.
Coronocardiography. Used before surgery and allows you to assess blood flow.
EchoCG. Shows deformation of the valves, the presence of new formations on them.

Based on the results of a complete examination, the doctor gets an idea of the condition of the tricuspid valve. Insufficiency of this structure responds well to treatment only at the initial stage of development. Treatment options for this disease will be discussed in more detail below.

Principles of treatment

Tricuspid valve insufficiency of the 1st degree does not require therapy. If the disease progresses to the next stage of development, the patient is prescribed treatment. It can be either medicinal or surgical. The help of the latter is resorted to in especially serious cases, when the use of tablets and injections does not produce results.

For the entire period of treatment, the patient must adhere to the following rules:

Quit smoking completely.
Avoid hypothermia and stressful situations.
Follow a diet to reduce stress on the heart.
Reduce the intensity and amount of physical activity.

Drug treatment

Moderate tricuspid valve insufficiency is not considered an indication for surgical intervention. In this case, treatment is carried out with the help of medications. The standard treatment regimen involves the use of the following medications:

Diuretics (Britomar, Hydrochlorothiazide). Eliminate congestion in the body, accelerate the process of fluid removal.
Potassium preparations (Panangin, Asparkam). Help the body not accumulate excess fluid.
Venous dilators (Corvaton, Nitrosorbide). Reduce the load on the heart through blood deposition.
Anticoagulants (Warfarex, Warfarin).
Cardiac glycosides (Digoxin, Korglykon). Helps in the fight against arrhythmia.
Beta-blockers (Diltiazem, Carvedilol). Reduce the frequency of contractions of the left ventricle.

The regimen and dosage of drugs are determined in individually taking into account the severity of the disease.

Surgery

Tricuspid valve insufficiency grade 3 is considered the main indication for surgical intervention. Surgery is also recommended for patients with serious deformations of the valves or severe malfunctions in their operation.

If the valve apparatus is preserved, annuloplasty is used. During the operation, the doctor places U-shaped sutures on the damaged area.

If the intervention turns out to be ineffective, there are obvious structural changes, the patient is given an artificial cap. After implantation of the prosthesis, anticoagulant therapy is required. When implanting a biological prosthesis, it is short-term. If it is made of medical alloys, treatment of tricuspid valve insufficiency takes a little longer.

Possible complications and prognosis for recovery

Lack of timely treatment can lead to progression of the disease. The pathological process in this case affects not only the tricuspid valve. Insufficiency gradually leads to the fact that the body begins to look for new compensatory mechanisms. In this way he tries to cope with existing violations. Depending on the severity of the disease, the following disorders may appear:

pneumonia;
increased liver size, cirrhosis;
pulmonary embolism;
ascites.

According to statistics, the listed complications develop in 90% of cases.

As for the prognosis for recovery, it depends solely on the degree of development of the disease. Tricuspid valve insufficiency grade 2 responds well drug treatment, and the likelihood of complications is almost zero. With the third degree of the pathological process, the five-year survival rate is approximately 60-70%. Such figures are typical for patients who have already undergone surgery. In decompensated forms of insufficiency accompanied by chronic pulmonary diseases, the prognosis is disappointing.

When it is open, blood from the right atrium passes into the right ventricle, and after the latter is filled, its valves close, which prevents blood from flowing back into the atrium.

If for some reason the valve begins to function incorrectly, blood flow is disrupted, causing dangerous condition, which doctors call tricuspid valve insufficiency, or tricuspid insufficiency.

Description of the disease

Tricuspid valve insufficiency is a rheumatic heart disease that results in its inability to prevent the backflow of blood from the ventricle into the atrium. For this reason, the pressure in the right atrium and veins increases, and the flow of blood from the organs to the heart becomes significantly more difficult.

Causes and risk factors

Congenital tricuspid valve insufficiency is very rare - most often this defect is acquired, and it can be provoked by unfavorable external factors or diseases.

The organic form of this pathology, which is associated with changes in the valve leaflets, can develop for the following reasons:

closed chest injuries accompanied by rupture of the heart valves;
carcinoid tumor, which is most often localized in the intestinal region. It is capable of producing toxins that are transported through the bloodstream to the heart, damaging its inner lining;
rheumatism is one of the most common causes of the development of the defect, and in in this case it is accompanied by lesions of other valves;
infective endocarditis is a serious inflammatory disease of the intracardiac lining;
a surgical intervention that is performed to treat mitral stenosis (fusion of valve leaflets) - when performing an operation to separate the leaflets of one valve, insufficiency of the other may develop.

Functional failure, or a defect in which the valve leaflets do not undergo changes, occurs in the following cases:

at acute heart attack myocardium, when the pathological process affects the internal muscles of the ventricles;
when the ring inside the heart walls, to which the valve leaflets are attached, expands, this occurs due to myocarditis, chordal ruptures, severe pulmonary hypertension and other diseases or defects.

Classification and grades (1, 2, 3 and 4)

According to the time of occurrence, tricuspid valve insufficiency is divided into congenital and acquired:

a birth defect develops as a result of exposure to unfavorable factors on the expectant mother’s body and can have three variants: Ebstein’s anomaly, congenital cleft and myxomatous degeneration;
acquired failure occurs due to internal pathological processes that affect the inner lining of the heart.

Based on the assessment of the severity of reverse blood flow into the right atrium, the clinical course of the disease is divided into four degrees:

I degree, in which the reverse movement is practically not determined;
II degree, when the reverse movement of blood is detected at a distance of two centimeters from the valve;
III degree, characterized by reverse blood flow, which is determined at a distance of more than two centimeters;
IV degree - reverse blood flow is detected in a large area of the right atrium.

Danger and complications

Patients with this diagnosis are at risk of developing the following complications:

heart rhythm disturbances, occurrence atrial fibrillation, ventricular tachycardia;
pulmonary embolism;
infective endocarditis secondary form accompanied by inflammation of the heart valves;
atrial aneurysm;
pneumonia;
progressive failure of the right atrium and ventricle.

The likelihood of developing complications depends on the degree of decompensation of the defect, the cause of its occurrence, the possibility of surgical intervention and accompanying diseases, however, according to statistics, complications develop in approximately 90% of patients.

Symptoms

Tricuspid regurgitation is usually accompanied by the following symptoms:

shortness of breath, which occurs as a result of poor blood supply to blood vessels;
unpleasant sensations and discomfort in the heart area, including arrhythmia, cardiac arrest, “fluttering”, etc.;
puffiness of the face, yellow-blue coloration of the skin of the face and limbs;
pain and heaviness under the ribs (on the right side) as a result of fluid stagnation in the liver;
manifestations of the disease from the gastrointestinal tract include belching, flatulence, nausea, a feeling of fullness and heaviness in the abdomen, which arise due to the overflow of blood in the abdominal vessels;
frequent urge to urinate at night;
a feeling of pulsation of the vessels of the neck, accompanied by their swelling;
weakness, fatigue and decreased performance.

From this video you can learn more about the disease:

When to see a doctor

Early diagnosis of a defect plays a very important role important role in the success of treatment, and also affects the quality and life expectancy of the patient.

Therefore, if shortness of breath, weakness, increased fatigue and cyanosis of the skin, which are accompanied by unpleasant manifestations from the gastrointestinal tract, a person should immediately consult a cardiologist, therapist and gastroenterologist and undergo a full examination of the body.

Diagnostics

To make a diagnosis, the following tests and studies are performed:

Collection of medical history and complaints. By asking the patient the appropriate questions, the doctor determines how long ago the symptoms appeared. alarming symptoms what causes their occurrence, as well as what diseases preceded the development of the defect;
Visual inspection. When examining the patient, cyanosis of the skin, edema, enlarged liver, swelling of the neck veins, pulsation in the upper abdomen are revealed, and when listening, cardiac arrhythmias and systolic murmurs are detected;
Urine and blood tests. It is carried out in order to determine the pathological process and concomitant organ damage;

ECG. An electrocardiogram allows you to diagnose heart rhythm disturbances, identify enlargement of the right atrium and ventricles, as well as blockade of the legs and trunk of the His bundle;

Phonocardiogram. The study is carried out to identify systolic murmurs in the projection of the tricuspid valve;

EchoCG. The main method for identifying defects of the heart valves, during which their valves are studied for changes in shape, the area of the right atrioventricular orifice, the size of the heart cavities, wall thickness and other factors that are important in making a diagnosis are assessed;

Chest X-ray. It is carried out to assess the size and location of the heart, change its configuration, identify the presence or absence of blood stagnation in the vessels;

Catheterization of the heart cavities. The essence of the method is to introduce catheters into the cavity of the organ to measure pressure in its parts;

Ultrasound of the heart. Ultrasound examination can detect hypertrophy of the heart walls, valve deformation, expansion of the fibrous ring and other changes characteristic of this defect;

SKT. Spiral computed tomography allows you to obtain a fairly clear image of the heart based on a series x-rays carried out at different depths.

Treatment methods

First of all, it is necessary to eliminate the cause that led to the occurrence of the defect, and then proceed to its treatment or elimination. Conservative therapy in this case consists of preventing heart failure and pulmonary hypertension: the patient is prescribed diuretics, cardiac glycosides, ACE inhibitors, potassium supplements, and nitrates.

Surgical treatment of the defect is carried out in cases of II, III and IV degrees of its development and corresponding indications.

plastic surgeries (suture, semicircular or ring annuloplasty) are indicated for II and III degree development of tricuspid valve insufficiency and absence of changes in its valves;
prosthetics are performed in case of pronounced changes in the valves or structures, as well as in cases where plastic surgery did not give the desired result - the patient is fitted with biological prostheses or mechanical valves, which are made from special medical alloys.

Forecasts and preventive measures

The prognosis for patients primarily depends on the degree of development of the defect and concomitant diseases. According to statistics, the five-year survival rate of patients after surgery is about 60-70%.

In decompensated forms of the disease accompanied by chronic pulmonary diseases, the prognosis is usually disappointing.

The basis for the prevention of this defect is the timely treatment of diseases that can cause a negative impact on the functioning of the heart.

Although tricuspid valve insufficiency is a difficult heart defect to treat, timely diagnosis modern medicine can significantly increase the length and quality of life of patients.

Tricuspid valve insufficiency grades 1, 2, 3: clinical picture of heart disease

To the main body circulatory system human - the heart needs blood to move in one direction, otherwise it can become flooded with the same blood that was previously pushed into the arteries. Valves are responsible for the unidirectional flow of blood, the valves of which close and open at the right moment, allowing blood to pass through or preventing it. The valve between the right atrium and the right ventricle consists of three plates and is called tricuspid (or tricuspid). If the function of this valve is impaired, blood flow is obstructed and tricuspid regurgitation occurs. The defect is considered acquired, cases congenital pathology extremely rare.

Tricuspid valve insufficiency is not initially considered a serious life-threatening condition. A person may not experience any symptoms of the disease. Deviations from the norm are discovered accidentally when medical examination or medical procedures. But the problem cannot be left unattended; this will lead to serious consequences requiring surgical intervention.

Right-hand shutter mechanism

When the heart relaxes, the tricuspid valve opens and deoxygenated blood passes from the right atrium to the ventricle. At the moment of contraction of the heart, the valves close again. Due to their loose closure, some of the blood flows back into the right atrium. The volume of blood thrown in is insignificant and actually does not affect the functioning of the heart and blood vessels. But if its quantity increases, it will have a detrimental effect on the cardiovascular system and is fraught with the development of serious complications.

Degrees of valve mechanism malfunction

Tricuspid insufficiency is divided by cardiologists into 4 degrees:

1st degree: the amount of blood thrown back into the atrium is very small and poorly detectable.

2nd degree: the fluid returns moderately and is found two centimeters from the valves.
3rd degree: the distance from the valve leaflets to the blood returning to the right atrium is more than two centimeters.
4th degree: blood already fills a significant volume of the atrium cavity.

Stage 1 deficiency is diagnosed at the initial stage of development of the disease. She does not show any symptoms. The person feels good and lives life to the fullest. After a thorough cardiac examination, the patient is prescribed drug therapy to improve the functioning of the valve apparatus and maintain the heart muscle.

The subsequent 3 degrees of disease development require an individual approach to the choice of treatment.

Depending on the time of education, doctors differ

Congenital tricuspid insufficiency occurs even before the birth of the child - in the womb. It is caused by the wrong size of the valves, their weak density or the valve position is too low. It is quite rare.

Acquired form - occurs due to the influence of various factors on the human body. Chronic inflammatory processes are common culprits of the disease.

According to the type of changes, insufficiency is distinguished

Organic - in this case the valves change in shape and size;
Functional - the valves do not close tightly due to changes in the heart, for example, due to an increase in the size of the right ventricle, changes in the muscle ring, etc.

Factors influencing the development of the disease

Systemic inflammatory process - rheumatism.
Rheumatoid endocarditis promotes thickening and shrinkage of the leaflets.
Myocarditis, heart attacks, cardiomyopathy and other diseases of the heart muscle.
Chronic heart failure.
Pulmonary hypertension.
Rupture of the valve leaflets due to traumatic factors or mechanical damage valve apparatus.
Consequences of surgery to restore mitral valve function.
The development of tumors in the cavity of the heart, interfering with normal blood flow.

Diseases suffered by a person during his life, their complications and severe injuries received contribute to the formation of a pathological condition.

Second degree of disease development

Tricuspid insufficiency of the 2nd degree is characterized by the presence of the following symptoms:

Bloating and bulging of neck vessels;
Irregular heartbeat;
Excessive fatigue and lack of vital energy;
The appearance of shortness of breath even with little physical activity;
Swelling and chilliness of the limbs;
A feeling of heaviness in the liver as a result of its increase in size;
Puffiness of the face and its yellowish-bluish tint;
Extraneous noises and rhythm disturbances when listening to the heart;
Urinary problems;
Vomiting, nausea, diarrhea.

If the patient ignores the first symptoms: fatigue, swelling, false chilliness, the disease progresses. The right ventricle increases in volume, as does the right atrium. At this stage, secondary changes appear in the functioning of organs and systems. If the disease progresses to stage 3, then surgical intervention cannot be avoided.

Diagnostic examination

Tricuspid valve insufficiency of the 1st degree often does not cause any symptoms and is not detected using an electrocardiogram. But the 2nd degree of the disease is already easy to identify when carrying out certain examination methods:

History taking: the doctor collects information about chronic diseases the patient, his lifestyle, complaints about health and the time of their occurrence.
General examination of the patient, listening to the heartbeat.
Electrocardiographic study (ECG) - provides an expanded picture of functional changes. Determines heart rhythm disturbances, overload of the right atrium and ventricle, and their increase in volume.
Echocardiography - gives full information about the condition of the tricuspid valve and heart chambers. Determines the condition of the valves: their thickness, integrity, shape. Shows how deformed the ventricles and atria are, whether there is fluid in the pericardial cavity, etc.
A chest x-ray shows the configuration of the heart and its position. Fixes blood stagnation in the heart vessels.
Catheterization of the cardiac cavities - using a catheter, the pressure in the right atrium and ventricle is determined.
Spiral computed tomography and magnetic resonance imaging provide an informative image of the heart.
A phonocardiogram reveals the presence of extraneous heart murmurs.
Coronarocardiography allows you to assess the patency of the heart vessels.

Methods for treating tricuspid valve defects

Treatment is purely individual and depends on the severity of the disease. It can be medical or surgical. For advanced stages 3 and 4, an integrated approach is used.

As a conservative treatment, doctors usually prescribe:

Diuretics to remove excess fluid from the body;
Nitrates to stabilize pressure in the pulmonary vessels;
Preparations containing potassium to improve the functioning of the heart muscle;
Medicines to prevent heart failure;
Glycosides to optimize heart rate.

Treatment is carried out against the background of a salt-free diet (no more than 3 g per day) and a reduction in fluid intake. This prevents blood stagnation in the heart vessels.

Surgical procedures include:

Plastic modification of the tricuspid valve to narrow the outlet.
Replacing the valve with a mechanical or bioprosthesis. The operation is performed when the valves are severely damaged or the plastic surgery performed previously did not lead to a noticeable improvement.

Preventive actions

As primary prevention occurrence of the disease it is necessary:

Take measures to prevent the development of rheumatism;

Treat inflammatory processes in the body in a timely manner: tonsillitis, carious lesions, enlarged tonsils, etc.
Introduce a healthy lifestyle: toughen up, eat right and be physically active.

As a secondary prevention in the presence of defects in the valve apparatus, physiotherapeutic procedures and strict adherence to taking medications prescribed by the doctor are added to the measures described above.

Self-medication is life-threatening! Changing your medication regimen or dosage on your own is unacceptable. Only a cardiologist can prescribe adequate therapy for this heart disease.

Possible complications

Deterioration of the patient's condition may occur due to neglect of the prescribed treatment, the absence of which entails an increase in symptoms. Atriogastric blockade, pulmonary embolism, atrial fibrillation, and repeated infective endocarditis may occur.

Another type of complication is the consequences of surgery. Blood clots may form after installation of the valve, calcium salts may be deposited on the walls of the bioprosthesis, and the inner lining of the heart may become inflamed.

Tricuspid valve insufficiency of any severity requires mandatory medical supervision and proper treatment to avoid dangerous consequences. During the course of the disease, the functioning of other organs and systems is disrupted. Therefore, you should not let this unpleasant heart disease take its course.

What is tricuspid valve insufficiency

The tricuspid valve is the tricuspid valve located between the right atrium and the ventricle.

In the absence of complete obstruction of the reverse movement from the ventricle into the atrium during its contraction, tricuspid insufficiency is formed.

The presented pathology cannot arise independently, without additional problems. Here, the anomalies also include tricuspid stenosis, as well as mitral and aortic defects, expressed by incomplete closure of the valves.

All information on the site is for informational purposes only and is NOT a guide to action!
Only a DOCTOR can give you an ACCURATE DIAGNOSIS!
We kindly ask you NOT to self-medicate, but to make an appointment with a specialist!
Health to you and your loved ones!

Classification

The pathology under consideration has its own classification, which is expressed in the following forms.

According to the time of development, there are:

Due to the reasons for the formation of insufficiency, the following are distinguished:

Depending on the severity of the reverse movement of blood, the following are distinguished:

According to etiology, tricuspid valve insufficiency is divided into 2 types:

Causes

If congenital tricuspid insufficiency is quite rare and its occurrence is associated with disturbances in fetal development, then acquired tricuspid insufficiency is characterized by external influence or diseases of a person during life.

The most common cause of the development of this pathology is rheumatism. During the period of manifestation of rheumatic endocarditis, the valve leaflets thicken and shrink due to shortening and thickening of the tendon threads. There is practically no separate pathology against the background of rheumatic endocarditis; stenosis is often also diagnosed here.

The second place is divided into traumatic ruptures of capillary muscles, carcinoid syndrome due to the presence of cancerous tumors and other oncological manifestations, as well as infective endocarditis, which affects drug addicts.

The reasons for the formation of secondary failure lie in the following factors:

the person has pulmonary hypertension;
modification of the fibrous ring;
weakening of the myocardium;
myocardial dystrophy;
rupture of capillary muscles after myocardial infarction and other pathologies.

In 90% of cases, tricuspid insufficiency acts as a complication of mitral stenosis.

The presented pathology occurs in newborns due to ischemic dysfunction of the right ventricle due to intrauterine fetal hypoxia, as well as hypoglycemia.

Features of hemodynamics

Tricuspid regurgitation is the return of a certain amount of blood to the right atrium from the right ventricle during its contraction. Here, blood flows from the vena cava, which provokes an increase in flow and, as a result, increased work of the right cavities, which leads to hypertrophy and their expansion.

The right atrium has limited compensation capabilities, so there is a high probability of rapid development of venous stagnation. A large amount of blood entering the right cavities leads to overflow of the systemic hepatic and jugular veins. Such pressure leads to systolic pulsation of large veins.

The normal systolic pressure of the right atrium is no more than 3 mm Hg. Art., which with the functioning of tricuspid insufficiency significantly increases in indicators - domm Hg. Art. At the same time, diastolic pressure also increases.

The presented dilatation of the right atrium leads to the development of thrombosis and atrial fibrillation, which provokes circulatory decompensation and leads to the death of the patient.

Diagnostic measures

If the development of tricuspid insufficiency is suspected, the patient undergoes a full comprehensive examination:

accompanied by palpation of pulsation of veins, detection of jaundice, enlarged abdomen and other signs;
it is important to listen to the work of the heart, because if there is a disturbance, you can listen to a characteristic murmur;
Other characteristic cardiac dysfunctions are also determined here.

basic methods for identifying pathologies of the tricuspid valve;
full measurements of the thickness of the valve leaflets, its shape, displacement of the partitions and other indicators are carried out;
When performing Doppler, reverse blood flow can be diagnosed.

Since tricuspid valve insufficiency is not an individual disease, it is quite difficult to identify. This is why they resort to comprehensive examination sick.

Treatment

As conservative therapy use various drugs, the action of which is aimed at preventing heart failure and pulmonary hypertension. In this case, the patient takes diuretics, anticoagulants, cardiac glycosides and others medications, aimed at facilitating the work of the heart.

If hydrothorax (fluid accumulation) has been diagnosed, then pleural puncture or drainage is performed. When fluid is localized in the abdominal cavity, laparocentesis is used.

Read about the causes of congenital heart defects in children by following the link.

Tricuspid canal insufficiency of the 1st degree is treated only with conservative methods. Surgical intervention is caused by serious disorders in case of insufficiency of 2-4 degrees. Here they resort to plastic surgery or prosthetics using a biological or artificial prosthesis.

Treatment surgically may lead to significant complications such as degeneration of the new biological prosthesis or thrombosis. Prosthetic endocarditis often develops or AV block develops.

If the patient is provided with timely and proper treatment, the probability of recovery is quite high - 2/3 of patients live more than 5 years after diagnosing the pathology of tricuspid valve insufficiency

Prevention

Preventive actions are divided into primary and secondary depending on the situation:

Monitor your health and prevent disease causes that lead to the development of the presented pathology, for example, rheumatism or infective endocarditis.
If a disease that entails the described sad consequences has already been diagnosed, it is necessary to quickly begin treatment to eliminate it.
People should resort to hardening procedures, which is carried out from childhood.
It is necessary to pay careful attention to the treatment of foci of chronic infection. Eg, chronic tonsillitis accepts only surgical removal of the tonsils, and dental caries – timely filling.

Here experts prescribe to patients:

Conservative treatment in the form of the use of medications - diuretics, ACE inhibitors, nitrates, drugs containing potassium and cardiac glycosides to increase the strength of heart contractions.
Methods for preventing the relapse of rheumatism in the form of the use of antibiotics, hardening procedures and timely treatment of chronic infections.

Tricuspid valve insufficiency in children

In children, the pathology in question is always diagnosed together with mitral or aortic valve defects. Newborns may suffer from similar manifestations due to a congenital anomaly, which is detected already in the first months of life with other defects.

The pathology is dangerous in case of severe regurgitation in the case of formed anomalies vitally important body. Newborns quickly begin to suffer from right ventricular failure. This is manifested by breathing disorders and changes in the skin with a blue tint. In the absence of timely treatment, the child dies.

If the pathology is acquired, it means that it is a complication of some disease. Often highlighted here streptococcal infection leading to rheumatic lesions.

The main causes of anatomical and functional abnormalities in children also include various myocardial lesions and severe hypertension. Rarely, the causes lie in injuries and malignant tumors.

If a child has stagnation in the small or large circle, this can cause dysfunction of various internal organs.

When diagnosing a baby with tricuspid valve insufficiency of the 1st degree, doctors do not sound the alarm, since this moderate pathology is regarded as a congenital anomaly that can go away with age.

It is important to diagnose the pathologies in question in a timely manner, since with adequate treatment the baby will lead the most fulfilling lifestyle possible.

Complications

Complications are also divided by specialists into two categories - those that follow due to lack of treatment, and those caused by the operation.

Complications of tricuspid stenosis include:

Is it possible to give birth with a heart defect - the answer is here.

From this article you can find out what dextrocardia is and what its consequences are.

Operated patients often encounter complications such as:

Treatment of tricuspid valve insufficiency depends on the degree of damage, the severity of blood stasis and other factors that should be considered comprehensively.

Heart valve insufficiency: causes, symptoms, treatment, prognosis

Why are we accustomed to considering rheumatism such a dangerous disease? Because the main role in the formation of heart defects (HF) belongs to it; other factors (infections, injuries, tumors, collagenosis) play a much smaller role. In this regard, we most often consider heart valve insufficiency as a complication of this pathology.

rheumatic endocarditis is the main cause of heart valve damage

The inflammatory process of connective tissue caused by β-hemolytic streptococcus, having debuted, quickly reaches the heart, where it causes irreparable damage to its valves, changing their morphological structure. As a result of these transformations, the opening (atrioventricular) narrows, which is called stenosis, or the leaflets of the heart valves shorten (a phenomenon called insufficiency). Most often, the left atrioventricular valve suffers, which is more commonly called the mitral valve (MV). If children predominantly develop aortic or MV stenosis against the background of rheumatism, then in adults to a greater extent Mitral valve insufficiency (MVI) prevails, leading among other acquired heart defects.

Figure: valve apparatus in the structure of the heart

It doesn't have to be the valve.

Mitral valve insufficiency is a condition when its leaflets, for some reason, cease to close completely and, at the moment of contraction (systole) of the ventricles, allow blood to return back to the left atrium (mitral regurgitation). NMC rarely occurs separately from other PS (does not exceed 3% of cases); it is mainly accompanied by mitral stenosis or aortic defects. As an isolated or predominant form, mitral insufficiency prefers the male gender.

In some patients, a variant called relative deficiency may be present. With it, the bicuspid valve remains pathologically unchanged, and mitral regurgitation occurs. It is created by the papillary muscles, the fibrous ring, and chordae tendineae, which disrupt the coordinated functioning of the mitral complex. The formation of relative insufficiency can be caused by diffuse lesions and changes in the contractility of the cardiac muscle of the left ventricle (LV), expansion of its cavity and stretching of the valve ring to a significant extent (narrowing of the ring - forms relative stenosis). Any pathological processes that contribute to LV dilatation (dilated cardiomyopathy, aortic disease, arterial hypertension) can lead to the development of relative insufficiency.

Why is the blood coming back?

Morphological metamorphoses (reduction in length, appearance of wrinkling, destruction of the structure due to calcification (deposition of calcium salts) in the valve tissue, deformation of the valves) lead to the valve losing its ability to close tightly and prevent the reverse flow of blood into the left atrium (valvular insufficiency with mitral regurgitation). Often, along with changes in the valve itself, the tendinous chords and papillary muscles are shortened and deformed, that is, for mitral insufficiency not only cannot be excluded, but the possibility should also be taken into account combination with pathology of the subvalvular apparatus.

The cause of mitral valve insufficiency in the vast majority of cases is rheumatic endocarditis, although sometimes another pathology can give rise to a new serious illness:

Myocardial infarction;
Cardiosclerosis;
Injury;
A heart tumor (myxoma) located in a specific location;
Some of congenital anomalies;
Marfan syndrome;
Diffuse connective tissue diseases (rheumatoid arthritis, SLE, systemic scleroderma).

The current situation creates unfavorable conditions for the functioning of the left ventricle, because a huge load falls on it, but the natural strength of the left ventricle for a long time helps it compensate for the blood flow in the systemic circle, so the patient continues to consider himself healthy for quite a long time.

Of course, the LV will not withstand this state of affairs indefinitely, therefore, after a certain period of time (it’s different for everyone), its contractility begins to fall, which is manifested by symptoms of congestion in the lungs. As a response to increased pressure in the pulmonary circulation (pulmonary hypertension), the mouth of the pulmonary artery (PA) is stretched and against this background, relative insufficiency of the pulmonary artery valve develops. By the way, regarding pulmonary valve: predominantly its insufficiency is relative and caused by expansion of the pulmonary orifice.

In addition to pulmonary hypertension and everything that follows from it, hypertrophy of the right parts of the heart occurs, striving to ensure adequate blood flow. Gradually, the right ventricle hypertrophies, later expands (dilates), and a severe stage of decompensation begins for the systemic circulation.

Degrees, stages, complaints

Mitral valve insufficiency is classified according to the following criteria:

Origin of the disease (rheumatic fever, atherosclerosis, bacterial endocarditis, syphilis);
State of general hemodynamics (compensation due to individual cavities of the heart and decompensation when the heart has exhausted its capabilities);
Degree of severity (impaired intracardiac hemodynamics).

Cardiac surgeons, taking into account the patient’s complaints and objective clinical data, use a finer gradation of severity and divide the course of mitral regurgitation into 5 stages, which we will try to present in relation to the degrees of severity:

At grade 1 (stages 1-2), the defect does not significantly change the hemodynamics inside the heart. At first, the patient does not particularly notice the development of the disease, continues to work and carry out the usual physical activity, but over time he begins to notice the appearance of shortness of breath when doing work, climbing to the floor, or walking quickly. An electrocardiogram taken at the clinic records signs of myocardial hypertrophy in the left chambers of the heart (ventricle and atrium) - they signal that they are still coping and compensating for the defect, but they are working, as they say, for wear and tear.
Moderate failure (grade 2, stage 3) is manifested by the development of dilatation of the hypertrophied left chambers of the heart; the first signs of venous stagnation appear in the pulmonary circle. Among the main complaints, the patient notes constant shortness of breath, decreased ability to work, attacks of rapid heartbeat, and cardialgia.
The appearance of persistent signs of decompensation (tachycardia, edema, congestion not only in the lungs, but also in other organs, hepatomegaly, attacks of cardiac asthma, dry or with a small amount of sputum, sometimes streaked with blood, cough), the formation of relative insufficiency of the tricuspid valve, hypertrophy of the right ventricle – characteristics 3 degrees (stage 4) of severity of NMC. The development of subsequent events (stage 5) leads to irreversible changes (severe circulatory failure, degenerative processes in many organs).

Video: symptoms of mitral valve insufficiency

Treatment of mitral regurgitation depends on the severity and stage of the process. Patients with a similar pathology are registered under the close attention of a cardiorheumatologist, who:

Deals with the prevention of exacerbations of rheumatism (bicillin according to the regimen, anti-inflammatory non-steroidal drugs);
Tries to prevent the development of heart failure (if signs appear, diuretics, ACE inhibitors, beta blockers, etc.);
Treats atrial fibrillation (verapamil, digoxin);
Prevents thromboembolism by prescribing antiplatelet agents.

When severe course CMD, provided that very little time has passed since the onset of hemodynamic disturbances, so they have not yet had time to take hold and cause irreparable harm, the patient has the prospect of solving the problem with the help of surgery (valvuloplasty, heart valve replacement surgery).

Companion or on your own? (tricuspid valve insufficiency)

If the reader noticed, it was noted that in advanced stages of mitral regurgitation, other valves and chambers of the heart begin to become involved in the pathological process. For example, the high incidence of relative tricuspid valve insufficiency is due to its combination with mitral defects in most cases due to the fact that in stage 4 NMC there is a significant increase in the cavity of the right ventricle. This is tricuspid valve insufficiency (TVR), which is easily recognized by the naked eye.

Some appearance features characteristic of severe right ventricular failure usually give the patient away:

Swollen veins in the neck;
A bluish tint to the skin of the upper and lower extremities, the tip of the nose, blue to black lips (acrocyanosis);
Breathing is frequent even with slight exertion (a person almost constantly lacks air);
Loss of appetite (for the patient, food becomes an additional burden), epigastric pain, nausea;
Enlarged abdomen due to the development of ascites.

Relative NTC is quite widespread among patients with problems with the mitral valve (the same cannot be said about organic NTC). Meanwhile, it occurs in an isolated form only in isolated cases.

Dilatation of the right ventricle and enlargement of its cavity against the background of pronounced RV failure (which is why all the fuss) is most often the result of:

Heart defects of rheumatic and congenital origin.
Far advanced arterial hypertension, when vascular changes have already formed heart failure.
Atherosclerotic cardiosclerosis.

Tricuspid valve insufficiency, caused by its organic damage, as noted above, is not a common option. Its development can be provoked by the same rheumatism, endocarditis of infectious origin (sometimes observed in syringe drug addicts who use a vein to inject drugs), a congenital defect called Ebstein's disease (displacement of the tricuspid valve).

The LV fails (aortic valve insufficiency)

Reason wrong movement blood into the aorta after left ventricular systole may become aortic stenosis or insufficiency of the aortic valve at the moment of relaxation of the heart (diastole), which cannot close normally to prevent blood from returning back into the LV (aortic regurgitation). In 50% of cases, these two defects (stenosis and insufficiency) are combined with each other and with mitral valve disease, usually being a consequence of rheumatism. It should be noted that such “happiness” falls to a greater extent on the hearts of males.

Due to the incompetence of the aortic valve leaflets, an impressive volume of blood flows from such a large vessel during relaxation of the heart, which naturally leads to overload, hypertrophy and stretching of the LV, and at the same time to a decrease in blood circulation in the peripheral vessels. True, for many years this problem remains unnoticed, because the LV, which has significant compensatory capabilities, increases systolic output, copes with its main function and maintains the expulsion of blood into the aorta at the proper level. But at the same time he himself suffers. Ultimately, the strength of this “worker” runs out, he begins to give up, which is clearly visible when the manifestations of left ventricular failure come to the surface. All this cannot but affect the condition of the right ventricle, which also begins to fail. However, this is not enough for the disease; coronary circulation, the aortic mouth gradually stretches.

Whose fault?

As already noted, in the development pathological change Aortic valve disease is most often blamed for rheumatic fever. In addition, it is worth recalling other culprits of aortic insufficiency:

Endocarditis of infectious origin, which plays the role of “first violin” in the formation of the disease in its pure form;
Aortitis of various natures and, first of all, syphilitic;
Rheumatoid arthritis;
Ankylosing spondylitis;
Trauma or birth defect in very, very rare cases.

Relative insufficiency of the aortic valve sometimes runs parallel to aortic aneurysm, Marfan syndrome, and hypertension.

Find out and treat?

It is unlikely that the patient will be able to recognize grade 1 aortic valve insufficiency. The existence of a pathology, which has not declared itself for years, allows the patient to continue to bear, if necessary, significant physical activity, as well as engage in sports that require endurance, so it is difficult for a person to even remember when and how the disease began, but one can notice how it begins develop:

The earliest sign of trouble can be considered the appearance of a sensation of pulsation throughout the body (heart contractions reach the head, arms, legs, and spinal column). A person is surprised and discouraged; looking at his watch, he can count the number of beats per minute without unnecessary movements.
Sudden, inexplicable dizziness began to occur, and attacks of tachycardia began to occur even in a calm state;
After some time, these phenomena not only did not disappear, but gained new momentum, and now it became difficult to overcome the flight of stairs, and the night was periodically interrupted by painful attacks of cardiac asthma.
Angina pectoris, previously unknown to man, began to bother him more and more often, despite his young age, and nitroglycerin did not give the expected effect.
Arterial hypertension has appeared, but it only rises upper pressure, the lower one, on the contrary, decreases, sometimes it is difficult to catch it, however, in the later stages of the disease, diastolic pressure tends to increase.

Treatment of aortic insufficiency requires specialized inpatient conditions, but even hospitalization does not always give the results that one would like to see. Traditional therapy for heart failure with diuretics, beta blockers, ACE inhibitors and calcium antagonists helps little; cardiac glycosides in this situation require special caution, because a decrease in heart rate can further impair peripheral circulation.

Replacing a worn-out arterial valve with an artificial one (mechanical or biological SC implant) is more welcome in cases of “pure” defect, when changes affected only the aortic valve, and signs of decompensation have just appeared. Not an easy task for cardiac surgeons...

A few words about children

Among valvular defects in children, the most common is pulmonary valve stenosis, which accounts for 10% of all congenital anomalies; aortic valve stenosis accounts for half as much (5%).

Heart valve insufficiency in children, as in adults, is predominantly a consequence of rheumatic fever, which primarily forms aortic defects in children.

Minor heart anomalies include a well-known, but raising many questions, unique symptom complex, diagnosed mainly in children - mitral valve prolapse (MVP). The essence of this phenomenon is the disruption of the functioning of the heart valve due to flexion (prolapse) of its valves into the LA cavity during ventricular systole. By the way, prolapse can be noticed behind any of the heart valves and even several at once (for example, mitral + tricuspid). Simultaneous bending of several valves aggravates the situation, since in such cases significant hemodynamic disorders are formed.

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