Mitral stenosis with changes in the lungs. Mitral stenosis of the heart valve: what is it, treatment, symptoms, causes, signs. Differential diagnosis of mitral valve stenosis

Pulse frequent, small filling and tension, rhythmic in the early stages of the defect. In later stages, first single atrial extrasystoles appear (this is found on the electrocardiogram), and then, due to the ever-growing overvoltage of the left atrium, followed by a degenerative change in it, attacks of paroxysmal tachycardia or atrial fibrillation may occur; in the future, prolonged atrial fibrillation is sometimes established.

When atrial fibrillation the presystolic murmur disappears, as the atria do not contract, but flicker. In connection with this form of arrhythmia, there is a pulse deficit compared to the number of heartbeats counted when listening to the heart. This indicates a significant weakening of myocardial contractility.

Electrocardiogram reveals a significant predominance of the right ventricle, as well as a high and further biphasic P wave. The T wave is reduced and deformed in cases where a significant dystrophic change in the ventricular myocardium occurs.
Venous pressure rises very early and often reaches very large numbers. The speed of blood flow is slowed down (especially when determined by the ether method).

Employment issues patients with narrowing of the left atrioventricular orifice should be carefully considered, taking into account the severity of this disease and its rheumatic etiology.

ECG training video for atrial and ventricular hypertrophy

Treatment of mitral stenosis

Treatment has its own characteristics, since more often it is necessary to resort to bloodletting and the use of oxygen therapy, mainly due to increased cyanosis and sometimes taking on the character of cardiac asthma. Often, leeches are also prescribed to the liver area, which relieve pain.

Digitalis, blocking the conduction system and suppressing the excitability of the sinus node, contributes to the transition of the tachycardic form of atrial fibrillation to bradycardia. Therefore, during a long diastole, the ventricles are well filled with blood and their contractility is restored: pulse beats in frequency correspond to the number of heart contractions, the pulse deficit disappears, blood circulation is restored.
Otherwise, medicinal Events correspond to those outlined above, and are prescribed in relation to the stages of cardiovascular insufficiency.

Patient R., 32 years old. She suffered from scarlet fever, diphtheria, articular rheumatism - three attacks; after the second attack (at the age of 24) a heart defect was discovered, after the third (at the age of 26) she was hospitalized for 2 months with fever (endocarditis recurrens). Later she recovered and worked, but she experienced shortness of breath when lifting weights. After 2 years (at the age of 28), after hard work, hemoptysis and general weakness appeared. She lay in bed for 4 days, then went back to work. A year ago, the legs began to swell, there was pain in the right hypochondrium, frequent coughing, especially when lying down, sometimes with sputum stained with blood.

Received to the clinic with complaints of severe shortness of breath and tightness in the chest. Objectively: bluish-red (false feverish) cheeks, bluish lips and fingertips. The heart is enlarged to the right and up; fluoroscopy reveals a sharp protrusion of the left atrium; the diameter of the heart is 5.5 + 7.5 cm. Auscultation: mesosystolic murmur with presystolic amplification and a clapping first tone at the apex of the heart and somewhat to the left of it, a bifurcation of the second tone (quail rhythm) in the pulmonary artery. On the electrocardiogram (the same figure), an increase and bifurcation of the atrial P wave (asynergy of atrial activity) is noticeable. Pulse 90 beats per minute, rhythmic, weak filling. Blood pressure 95/60 mm. The liver is enlarged, painful; ascites Legs and lower abdomen are swollen. Negative diuresis. The voice is hoarse. Laryngoscopy: paresis of the left vocal cord.

After appointment digitalis, diuretin, theophylline, mercusal the patient's condition improved (lost 5 kg in weight); ascites decreased, the spleen began to be probed. The cough did not stop, a small amount of sputum was secreted (it contained cells of heart defects). The patient was discharged. After 4 months, dropsy appeared, frequent hemoptysis, and the patient died.

Conclusion. Rheumatic narrowing of the left atrioventricular orifice. Relatively early, a violation of circulation, overflow of the small circle, stretching of the left atrium with compression of the adjacent organs was discovered. The patient was admitted under observation already in the stage of cardiac cirrhosis of the liver and a deep violation of myocardial contractility.

Despite the achievements of modern medicine, heart defects are now a common pathology that requires close attention of cardiologists. This applies even more so to mitral valve stenosis, which can significantly worsen the life of the patient and cause the development of severe complications, up to death.

The mitral valve is represented by a section of connective tissue internal structures of the heart, which performs the functions of dividing the blood flow between the left atrium and ventricle. In other words, the valve resembles a door whose the valves close during the contraction of the ventricle and the expulsion of blood from its cavity, and open during the flow of blood into the ventricle. This mechanism provides for alternate relaxation of the heart chambers, while at the same time ensuring a continuous blood flow within the heart.

With the development of a pathological process on the tissues of the valve, its function is disturbed, and the intracardiac blood flow is disturbed. This process can be represented by two forms, as well as their combination - and valve ring stenosis. In the first case, the cusps do not close hermetically, and thus do not retain blood in the cavity of the left ventricle, and in the second, the area of ​​the valve ring decreases due to fusion of the cusps (the norm is 4-6 cm 2). The latter variant is called mitral stenosis, in which the left atrioventricular (atrioventricular) orifice becomes smaller.

normal heart and mitral valve stenosis

Mitral stenosis occurs mainly in people of the older age group (55-65 years), accounts for about 90% of all cases of acquired defects and develops much more often.

Video: Mitral Stenosis - Medical Animation

Causes of the disease

Mitral stenosis is usually an acquired pathology. Narrowing of the valvular ring of a congenital nature is extremely rarely diagnosed, but in such cases it is almost always combined with other severe congenital heart defects that do not cause difficulties in making a diagnosis.

The main reason for the acquired narrowing of the valve ring is. This is a serious disease resulting from tonsillitis, frequent tonsillitis, chronic pharyngitis, as well as scarlet fever and pustular skin infection. All these diseases are caused by hemolytic streptococcus. The severity of rheumatic fever is that the body produces antibodies against its own tissues of the heart, joints, brain and skin (rheumatic heart disease, arthritis, chorea and erythema annulare develop). With rheumatic heart disease, autoimmune inflammation occurs on the leaflets of the valves, which are replaced by coarse scar tissue and soldered together, leading to fusion of the hole - to rheumatic mitral valve stenosis.

Another common cause of the defect is bacterial, or infectious. Most often, it is caused by the same streptococci, as well as other microorganisms that enter the systemic circulation in people with reduced immunity, HIV-infected people, and in patients who use drugs intravenously.

What symptoms should alert the patient?

Usually, the period of time between the transferred acute rheumatic fever, which occurs 2-4 weeks after streptococcal infection, and the first clinical manifestations of the defect is at least five years.

The first symptoms in the initial stage of the disease, or with minor mitral stenosis, when the area of ​​the mitral orifice is more than 3 cm 2, include:

• increased fatigue,
• Severe general weakness
• Cyanotic (with a blue tint) blush on the cheeks - “mitral blush”,
• Feeling of palpitations and interruptions in the work of the heart during psycho-emotional or physical stress, as well as at rest,
• Shortness of breath when walking long distances.

Further symptoms develop as the stenosis progresses, which can be moderate (valve ring area 2.3-2.9 cm 2), severe (1.7-2.2 cm 2) and critical (1.0-1.6 cm 2), and are largely determined by the stage of heart failure and disorders circulation.

So, in the first stage, the patient notes shortness of breath, palpitations and chest pain, caused only by significant physical exertion, for example, walking long distances or climbing stairs on foot.

In the second stage circulatory disorders, the described signs disturb the patient when performing smaller loads, and venous congestion is also noted in the capillaries and veins of one of the circles of blood circulation - small (vessels of the lungs) or large (vessels of internal organs). This is manifested by attacks of shortness of breath, especially when lying down, dry cough, significant swelling of the legs and feet, pain in the abdominal cavity due to venous plethora in the liver, etc.

In the third stage illness during normal household activities (tying shoelaces, preparing breakfast, moving around the house), the patient notes the occurrence of attacks of shortness of breath. In addition, there is an increase in edema of the extremities, face, accumulation of fluid in the abdominal and chest cavities, as a result of which the abdomen increases in volume, and compression of the lungs by fluid only exacerbates shortness of breath. The patient's skin acquires a bluish tint - cyanosis develops due to a decrease in the level of oxygen in the blood.

In the fourth, most severe, or terminal, stage, all the above complaints occur in a state of complete rest. The heart can no longer perform the function of pumping blood through the body, the internal organs are deficient in nutrients and oxygen, and dystrophy of the internal organs develops. Due to the fact that the blood practically does not move through the vessels, but stagnates in the lungs and in the internal organs, swelling of the whole body occurs - anasarca. The natural outcome of this stage without treatment is death.

In general, the first stages of the process without treatment from the onset of clinical manifestations take a different period of time, mainly 10-20 years, and are characterized by a slow course. However, if blood stasis develops in both circulations, rapid progression is noted. In medicine, isolated cases of life expectancy with an untreated defect of about 40 years are described.

How to diagnose mitral stenosis?

If the patient has noticed the above symptoms in himself, he should consult a general practitioner or cardiologist as soon as possible. The doctor may suspect the diagnosis even during the examination of the patient, for example, listen with a phonendoscope for mitral stenosis murmurs at the projection point of the mitral valve (under the left nipple), or hear congestive wheezing in the lungs.

decreased output from the left ventricle - a sign of mitral insufficiency

However, mitral stenosis can only be reliably confirmed using imaging methods, in particular, using. This method allows you to assess the area of ​​the mitral ring and the degree, to see the thickened, soldered leaflets, to measure the pressure in the heart chambers. One of the main indicators evaluated in mitral stenosis is, showing the blood volume expelled into the aorta and further through the vessels of the whole organism The normal EF is at least 55%, with mitral stenosis it can significantly decrease, reaching critical values ​​- 20-30% with severe stenosis.

In addition to ultrasound of the heart, the patient is shown:

1. Exercise tests - treadmill test, bicycle ergometry,
2. Individuals with myocardial ischemia may undergo coronary angiography to assess the need for intervention on the coronary vessels,
3. Examination by a rheumatologist with a history of rheumatic fever,
4. Examination by a dentist, an ENT doctor, a gynecologist for women and a urologist for men in order to detect and eliminate foci of chronic infections (carious teeth, chronic inflammation in the nasopharynx, etc., which can lead to the development of bac. endocarditis).

In any case, the initial examination of a patient with suspected mitral stenosis begins only after an initial consultation with a general practitioner or cardiologist.

Medical treatment of the disease

Treatment of mitral valve disease is divided into conservative and surgical. These two methods are used in parallel, since the medical support of the patient is especially important before and after the operation.

Drug therapy includes the appointment of the following groups of drugs:

• Beta blockers- drugs that reduce the load on the heart due to a decrease in heart rate and a decrease in vascular resistance, especially when blood stagnates in the vessels. More often, concor, coronal, egilok, etc. are prescribed.
• ACE inhibitors- "protect" blood vessels, heart, brain and kidneys from the negative effects of increased vascular resistance. Apply perindopril, lisinopril, etc.
• ARA II blockers- lower blood pressure, which is important for patients with stenosis who have concomitant hypertension. More commonly used are losartan (lorista, lozap) and valsartan (valz).
• Drugs that have antiplatelet and anticoagulant effects- prevent increased thrombosis in the bloodstream, are used in patients with angina pectoris, a history of heart attack, as well as atrial fibrillation. Aspirin Cardio, acecardol, thromboAss, warfarin, clopidogrel, xarelto and many others are prescribed.
• Diuretics- one of the most important groups in the presence of chronic heart failure, as they prevent fluid retention in the arteries and veins, and reduce the afterload on the heart. The use of indapamide, veroshpiron, diuver, etc. is justified.
• cardiac glycosides- are indicated with a decrease in the contractile function of the left ventricle, as well as in persons with constant atrial fibrillation. Digoxin is mainly prescribed.

In each case, an individual treatment regimen is used, determined by the cardiologist, depending on the manifestations of the defect and echocardioscopy data.

Surgical treatment of mitral stenosis

Depending on the degree of stenosis and the stage of CHF, surgery may or may not be indicated.

With minor stenosis, surgery is not vital, and conservative management of the patient is acceptable. When the area of ​​the valve opening is less than 3 square meters. see (moderate, severe and critical stenosis) it is preferable to perform surgery on the mitral valve.

At the same time, the operation is contraindicated in patients with terminal heart failure, since irreversible processes have set in in the heart and internal organs, which the restored blood flow will no longer be able to correct, but a fatal outcome during open surgery on a completely worn out heart is quite likely.

So, with mitral stenosis, the following types of operations can be performed:

Balloon valvuloplasty

Balloon mitral valvuloplasty is used in the following cases:

1. Any degree of narrowing of the valvular ring in the absence of calcification of the leaflets and without thrombi in the cavity of the left atrium, as well as asymptomatic critical stenosis,
2. Stenosis with concomitant atrial fibrillation,
3. Absence according to ultrasound
4. The absence of combined and combined severe heart defects (pathologies of several valves at the same time),
5. The absence of concomitant, requiring coronary artery bypass grafting.

Technically, this operation is carried out as follows - after the introduction of sedatives intravenously, access is made to the femoral artery, through which a catheter with a small balloon at the end is inserted through a guide (introducer) through a vein into the heart. The balloon, after reaching the level of stenosis, is inflated, destroying adhesions and adhesions between the valve leaflets, after which it is removed. The operation takes no more than two hours and is almost painless.

a variant of open valve surgery with removal of an area of ​​rheumatic fibrosis

Open commissurotomy

The open method is indicated in the presence of the above conditions, excluding the possibility of balloon valvuloplasty. The main indication is mitral stenosis of 2-4 degrees. The operation is performed under general anesthesia on an open heart, and is carried out by dissecting the narrowed valve with a scalpel.

Valve prosthetics

It is indicated in cases where there is a gross lesion of the valves, which is not subject to conventional surgical intervention. Mechanical and biological (porcine heart) transplants are used.

The operation in most cases is carried out according to a quota, which can be obtained within a few weeks after the submission of the necessary documents. In the case of self-payment for the operation by the patient, the cost can vary between 100-300 thousand rubles, if we are talking about mitral valve replacement. Technically, such treatment is available in almost all major cities of Russia.

Lifestyle with mitral stenosis

Lifestyle with minor, asymptomatic mitral stenosis does not require any correction, with the exception of such items as:

• dieting,
• Regular visits to the doctor
• Exclusion of extreme physical activity,
• Regular intake of prescribed drugs.

A more pronounced stenosis before surgery can bring a lot of inconvenience to the patient, since it is necessary to protect the heart and exclude any significant stress that brings discomfort. Therefore, surgical treatment helps to improve the quality of life, but requires a more responsible approach to lifestyle after surgery, in particular, even stricter implementation of medical recommendations, as well as frequent visits to the doctor for the purpose of echocardioscopy (first monthly, then every six months, and then every in year).

Are complications possible?

Before surgery, in the case of severe stenosis and in the presence of heart failure, the risk of serious arrhythmias and thromboembolic complications is quite high.

After surgery, this risk is minimized, but in rare cases, adverse conditions such as infection of the postoperative wound, bleeding from the wound in case of open surgery, re-development of stenosis (restenosis) may occur in rare cases. Prevention is the quality of the intervention, as well as the timely prescription of antibiotics and other necessary drugs.

Forecast

The prognosis is determined by the degree of stenosis and the stage of chronic heart failure. With 2-4 degrees of stenosis in combination with 3-4 stages of CHF, the prognosis is unfavorable. Surgical intervention in this case makes it possible to change the prognosis in a favorable direction and incomparably improve the patient's quality of life.

Video: TV program about mitral stenosis

Video: lecture on mitral valve stenosis

Valvular symptoms that are direct signs mitral stenosis:

1. Clapping I tone.
2. Opening click.
3. diastolic murmur.
4. Diastolic trembling ("cat's purr").
5. ECG signs of mitral stenosis.

Indirect signs mitral valve stenosis, caused by impaired blood circulation in the pulmonary circulation:

1. An increase in the left atrium (detected on the radiograph and echocardiography) and its hypertrophy (detected by an ECG study).
2. Disorders in the lungs caused by congestion in the pulmonary circulation:
   • shortness of breath on exertion;
   • attacks of cardiac asthma;
   • pulmonary edema;
   • bulging of the trunk of the pulmonary artery;
   • expansion of the branches of the pulmonary artery.
3. Changes in the right side of the heart due to pulmonary hypertension:
   • pulsation in the epigastrium due to the right ventricle;
   • an increase in the right ventricle and atrium, detected by X-ray and echocardiographic examination;
   • hypertrophy of the right ventricle (atrium), detected by an ECG study;
   • right ventricular failure (impaired circulation in a large circle).

The presence and severity of direct and indirect signs allow us to assess the severity of mitral valve stenosis.

characteristic auscultatory symptom mitral valve stenosis is a diastolic murmur that occurs at various periods of diastole and is heard in a limited area:

• at the beginning of diastole - protodiastolic murmur of varying duration with a gradual decrease in intensity;
• at the end of diastole - a presystolic short noise of a rough, scraping timbre of an increasing character (ends with a clapping I tone), disappearing when atrial fibrillation appears.

Of great importance in the diagnosis of mitral stenosis is phonocardiography, the value of which increases with the tachysystolic form of atrial fibrillation, when ordinary auscultation does not allow attributing the heard noise to one or another phase of the cardiac cycle:

• a change in the intensity of the first tone is detected, the appearance of an additional tone (click of the opening of the mitral valve), the appearance of noise in diastole;
• with the progression of stenosis, the duration of the interval from the beginning of the second tone to the opening tone of the mitral valve is shortened to 0.04-0.06 (normally 0.08-0.12 s);
• various diastolic murmurs are recorded.

With mild mitral valve stenosis ECG practically unchanged. As the stenosis increases, the following changes are detected:

• there are signs of overload of the left atrium;
• signs of right ventricular hypertrophy appear - an increased amplitude of the QRS complex teeth in the corresponding leads, in combination with an altered final part of the ventricular complex in the same leads;
• heart rhythm disturbances appear: flickering, atrial flutter.

At echocardiographic studies the following changes are observed:

• U-shaped movement of the anterior and posterior leaflets of the mitral valve forward (normally, the posterior leaflet should move backward in diastole);
• decreased rate of early diastolic occlusion of the anterior leaflet of the mitral valve;
• a decrease in the amplitude of the opening of the mitral valve leaflet;
• enlargement of the cavity of the left atrium;
• valve thickening.

Cardiac catheterization plays an auxiliary role in the diagnosis of mitral stenosis. Indications for catheterization:

• the need for percutaneous mitral balloon valvotomy;
• assessment of the severity of mitral regurgitation when clinical data contradict echocardiographic (for patients requiring percutaneous mitral balloon valvotomy);
• assessment of the state of the pulmonary artery, left atrium and diastolic pressure in the cavity of the left ventricle, when clinical symptoms do not correspond to the severity of stenosis according to Doppler echocardiography;
• study of the hemodynamic response of the pulmonary artery and pressure in the left atrium to stress, in the case when the clinical symptoms and the state of hemodynamics at rest do not match.

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Mitral stenosis is a heart defect in which the left atrioventricular orifice narrows, thereby disrupting muscle function. In the initial stages, the defect does not cause inconvenience to the patient, however, later it can lead to serious complications.

Features of the disease

Most often, mitral stenosis is found in women 40-60 years old. In children, the congenital form of the defect is extremely rare: approximately 0.2% of all defects. Symptoms are the same for all ages.

Often, the disease does not cause discomfort to the patient, however, it is possible to become pregnant with it only if the mitral valve opening is larger than 1.6 cm 2 in area. Otherwise, the patient is shown termination of pregnancy.

Now let's talk about what types and degrees of mitral valve stenosis are.

The following video will tell you in great detail about the features of mitral stenosis:

Forms and degrees

Mitral stenosis is distinguished by the anatomical shape of the affected valve, degree and stage. The form can be:

1. loop-shaped (doctors call it a "jacket loop";
2. funnel-shaped ("fish mouth");
3. in the form of a double narrowing;

In doctoral practice, there are 4 degrees of the disease, depending on the area of ​​narrowing of the atrioventricular orifice:

• The first or insignificant, when the area is less than 3 cm 2.
• The second or moderate, when the area ranges from 2.3-2.9 cm 2.
• The third, or pronounced, area varies between 1.7-2.2 cm 2.
• Fourth, critical. The hole narrows to 1-1.6 cm2.

There are several classifications of the defect by stages, however, in Russia, the most popular was according to A. N. Bakulev, who distributes the defect into 5 stages:

• Complete compensation of blood circulation. There are no symptoms, the disease is detected during the study. The mitral opening is 3-4 cm 2 in size.
• Relative circulatory failure. Symptoms are mild, the patient complains of shortness of breath, hypertension, slightly elevated venous pressure. The mitral opening is 2 cm 2, and the left atrium increases in size up to 5 cm.
• Severe insufficiency. Symptoms are pronounced, the size of the heart and liver increases significantly. The mitral orifice is 1-1.5 cm 2 and the left atrium is > 5 cm in size.
• Sharply expressed insufficiency with stagnation in a big circle. It is expressed by a strong increase in the liver and heart, high venous pressure and other signs. The mitral opening narrows, becomes less than 1 cm 2, the left atrium becomes even larger.
• The fifth stage corresponds to the third, terminal, stage of insufficiency according to the classification of V. Kh. Vasilenko. The heart and liver are significantly enlarged, ascites and edema appear. The mitral orifice narrows dangerously, and the left atrium enlarges.

Diagram of mitral stenosis

Causes

The most common cause of mitral stenosis is rheumatic fever. In children, the defect appears due to congenital pathologies. Other causes of the disease include:

• blood clots;
• outgrowths, partially narrowing the mitral opening;
• autoimmune diseases;

Rarely, external factors, such as uncontrolled medication, can influence the appearance of stenosis. Let's now look at the main signs and symptoms of mitral valve stenosis.

Symptoms

Symptoms of mitral stenosis do not manifest themselves in the first stage. As the disease progresses, patients report:

1. shortness of breath, which in the later stages occurs even at rest;
2. cough with streaks of blood;
3. tachycardia;
4. cardiac asthma;
5. pain in the region of the heart;
6. cyanosis of the lips, tip of the nose;
7. mitral blush;
8. heart hump (protrusion on the left side of the sternum);

Signs of pathology depend on the stage and degree of the disease. So, compression of the recurrent nerve, angina pectoris, hepatomegaly, peripheral edema, dropsy of the cavities can be observed. Often patients suffer from bronchopneumonia and lobar pneumonia.

Now consider the methods for diagnosing mitral stenosis.

The following video will tell you more about the symptoms of mitral valve stenosis:

Diagnostics

Primary diagnosis consists in collecting an anamnesis of complaints and palpation, which detects presystolic trembling. This and auscultation help to detect mitral stenosis in more than half of patients.

Auscultation usually reveals a weakening of the I tone at the apex and a systolic murmur behind the I tone, which is decreasing or constant. Localization of listening to this noise extends into the armpits and rarely into the subscapular space, sometimes it can be carried out towards the sternum. The loudness of the noise can be different, for example, if it is severe, it is soft.

After making a preliminary diagnosis, the doctor prescribes:

• Phonocardiography, which allows you to trace how the detected noise relates to the phase of the heart cycle.
• An ECG that reveals hypertrophy of the heart, disturbances in its rhythm, blockade of the His bundle in the area of ​​the right leg.
• EchoGC, detecting the area of ​​the mitral orifice, an increase in the size of the left atrium. Transesophageal echocardiography helps to exclude vegetations and calcification of the valve, to identify blood clots.
• An x-ray is necessary to detect bulging of the pulmonary artery, atria and ventricles, dilated vein shadows and other signs of the disease.
• Probing of the cavities of the heart, which is rarely used, helps to detect an increase in pressure in the right heart compartments.

If the patient is subsequently referred for valve replacement, he will need to undergo left ventriculography, atriography, and coronary angiography. Additional consultations with specialists, such as a general practitioner or rheumatologist, are also possible.

Mitral valve stenosis involves treatment, the methods of which we will discuss later.

Treatment

The main treatment of mitral stenosis is surgical, since other measures only help to stabilize the patient's condition.

The operation does not require for the first and fifth stages. In the first case, it is not necessary, because the disease does not interfere with the patient, and in the second case, it can be life-threatening.

Therapeutic

This technique is based on monitoring the patient's condition. Since the disease can develop, the patient should undergo a complete examination and consultation with a cardiac surgeon every 6 months. Also, patients are shown minimal stress on the heart, including avoiding stress, a diet low in cholesterol.

Medical

Drug therapy is aimed at preventing the causes of stenosis. The patient is prescribed:

• Antibiotics for the prevention of infective endocarditis.
• Diuretics and cardiac glycosides to relieve heart failure.
• Beta blocker to eliminate arrhythmias.

If the patient has experienced thromboembolism, he is prescribed antiplatelet agents and heparin subcutaneously.

Operation

If the heart is severely damaged, then patients are prescribed its prosthetics using biological or artificial prostheses or open mitral commissurotomy. The last operation is that the commissures and subvalvular adhesions are dissected, at this time the patient is connected to artificial circulation.

For young patients, the sparing performance of this operation, which is called open mitral commissurotomy, is especially important. The mitral opening during the operation is expanded with a finger or instruments by separating the adhesions.

Sometimes patients are prescribed percutaneous balloon dilatation. The operation is performed under X-ray or ultrasound. A balloon is inserted into the opening of the mitral valve, which inflates, thereby separating the leaflets and eliminating the stenosis.

Disease prevention

Preventive measures are reduced to the treatment and prevention of recurrence of rheumatism, focal rehabilitation of streptococcus. Patients should be observed by a cardiologist and rheumatologist every 6-12 months to exclude the progression of mitral stenosis.

It will be useful to observe the principles of a healthy lifestyle. Moderate and proper nutrition will help improve the body's immune abilities, the condition of the heart muscle.

Mitral stenosis and mitral insufficiency

According to statistics, it appears less frequently than mitral stenosis. The ratio of these pathologies in adults is approximately 1:10. According to research by Yonash, conducted in 1960, the ratio reached 1:20. Children suffer from mitral stenosis more often than adults.

Studies of mitral regurgitation in patients who underwent commissurotomy showed that the defect occurs in approximately 35% of cases. Let's look at the possible complications of mitral stenosis.

Complications

If mitral stenosis is not treated or diagnosed late, the disease can lead to:

• . In this disease, the heart cannot pump blood normally.
• Expansion of the heart muscle. The condition develops due to the fact that with mitral stenosis, the left atrium is overflowing with blood. Over time, this leads to overflow and right offices.
• Atrial fibrillation. Due to the disease, the heart contracts chaotically.
• thrombus formation. Fibrillation leads to the formation of blood clots in the right atrium.
• Pulmonary edema, when plasma accumulates in the alveoli.

Since mitral stenosis affects hemodynamics, blood does not flow to the organs in a normal volume, which can affect their work.

The following video will tell you more about hemodynamics in mitral stenosis:

Forecast

Mitral stenosis tends to progress, so the five-year survival rate is 50%. If the patient has undergone surgery, then the percentage of five-year survival increases to 90-95%. The probability of developing postoperative stenosis is 30%, so patients should be constantly monitored by a cardiac surgeon.

Heart disease is a permanent change in the structure of an organ that disrupts its function. In most cases, they are caused by changes in one or more of the heart valves and corresponding orifices. Pathology of the mitral valve is noted more often than others.

The mitral valve is located between the left atrium and the ventricle. It prevents the backflow of blood from the ventricle to the atrium. When a defect occurs, blood flows back into the atrium during a heart contraction, due to which it stretches and deforms. As a result, arrhythmia, heart failure and other abnormalities often develop.

mitral valve insufficiency

Mitral insufficiency is the most common type of valvular heart disease. It is diagnosed in half of patients who have mitral valve disease or aortic valve insufficiency. This disease is not independent, and manifests itself along with other heart defects.

Symptoms

Mitral insufficiency has specific signs:

• at first dry, then with the addition of sputum cough, sometimes with streaks of blood. This symptom progresses with an increase in the severity of stagnation of blood in the lungs;
• dyspnea;
• rapid heart rate, a feeling of sinking heart, coups in the left side of the chest. Such manifestations are caused by trauma to the heart or myocarditis;
• decreased performance, lethargy.

Forms

Depending on the rate of development, acute and chronic insufficiency are distinguished.

Acute mitral valve insufficiency manifests itself in a number of ways:

• rupture of chords in the valve leaflets. Occurs as a result of chest trauma, infective endocarditis;
• damage to papillary muscles in acute myocardial infarction;
• a sharp expansion of the fibrous ring;
• rupture of the mitral valve leaflets during commissurotomy.

The chronic form occurs as a result of the following factors:

• inflammatory diseases;
• degenerative abnormalities: myxomatous degeneration, Marfan's syndrome, etc.;
• infectious diseases, for example, inflammation of the inner lining of the heart;
• structural pathologies caused by rupture of tendon chords;
• congenital structural features of the valve.

According to the time of occurrence, congenital and acquired mitral insufficiency are distinguished.

1. Congenital pathology appears as a result of adverse factors affecting the fetus during pregnancy.
2. Acquired insufficiency appears in the process of action on the body of adverse factors.

According to the degree of severity, the following degrees are distinguished:

• 1 degree - insignificant;
• 2 degree - moderate;
• 3 degree - pronounced;
• Grade 4 is severe.

With a slight degree, the reverse movement of blood from the left ventricle to the left atrium (the process of regurgitation) is observed in the mitral valve cusps. The second degree is characterized by regurgitation, which occurs 1-1.5 cm from the valve. With a pronounced degree, the reverse blood flow reaches the middle of the atrium, as a result of which it expands and changes its size. A severe form of insufficiency leads to the complete filling of the left atrium with blood flowing in the opposite direction.

Causes

There are several options for the development of congenital mitral valve insufficiency:

• myxomatous degeneration;
• pathology of the structure of the mitral valve;
• the specificity of the structure of chords in the form of shortening or lengthening.

Acquired mitral heart disease occurs for the following reasons:

• rheumatism;
• infective endocarditis;
• surgery for mitral stenosis;
• closed heart injury with rupture of the valves.

Acquired functional mitral insufficiency occurs as a result of:

• damage to the papillary muscles in myocardial infarction of the left ventricle;
• rupture of chords;
• expansion of the fibrous ring.

Diagnostics

Mitral valve disease is diagnosed in the following ways:

• analysis of the patient's complaints - how long ago did shortness of breath, palpitations, cough with blood;
• analysis of the anamnesis of life;
• physical examination. With mitral insufficiency, cyanosis of the skin, bright red staining of the cheeks, and a pulsating protrusion to the left of the sternum are fixed. When tapping, there is a shift of the heart to the right, when listening - a murmur in systole in the region of the apex of the heart;
• general analysis of blood and urine to identify the inflammatory process;
• a biochemical blood test to determine the quantitative content of cholesterol, sugar, protein, uric acid and creatinine;
• an immunological blood test detects the presence of antibodies to microorganisms and the heart muscle;
• with the help of an ECG, the rhythm of the heart beat and the presence of its pathology are determined. The size of the heart sections is also estimated, with mitral valve insufficiency, the left atrium and left ventricle are enlarged;
• phonocardiogram demonstrates the presence of systolic murmur in the projection of the bicuspid valve;
• Echocardiography is a complex method for studying mitral valve defects.

Treatment

It is important to treat the disease that caused the development of deficiency. With complications of the pathology, drug treatment is indicated, for example, treatment of rhythm disturbances or heart failure.

Moderate mitral valve insufficiency does not require specific treatment. With a pronounced and severe degree, only surgical treatment, prosthetics or valve plastic is indicated.

Mitral valve prolapse

Due to the incorrect structure of the heart apparatus, mitral valve prolapse develops in people. Often this pathology occurs in children, especially in adolescence. This is due to the spasmodic development of the body during this period. There are frequent cases of transmission of the disease by heredity. Prolapse is a sagging mitral valve. The reason for the uncontrolled flow of blood from the chamber to the chamber of the heart is the loose fit of the valve leaflets to the walls of the vessels.

Causes

The reasons for the development of mitral valve prolapse is the formation of bending of the valves, caused by a change in the connective tissue. This phenomenon is caused by Marfan, Ehlers-Danlos syndromes, elastic pseudoxanthoma and other pathologies.

Prolapse can be:

• congenital, or primary. It develops as a result of congenital pathology of the connective tissue or toxic effects on the fetus during pregnancy;
• acquired, or secondary. It develops against the background of rheumatism, coronary heart disease, chest injuries and other concomitant diseases.

Symptoms

With a congenital type of mitral prolapse, symptoms provoked by hemodynamic deviations are rarely observed. Such mitral heart defects are recorded in thin, tall people with long limbs, an increased content of collagen and elastin in the skin, and hypermobility of the joints. Often, a concomitant disease is vegetovascular dystonia, the signs of which are often attributed to the manifestation of heart disease.

Patients note chest pain that occurs with nervous shocks or emotional overstrain. Has an aching or tingling character. The duration of pain varies from a few seconds to several days. With the appearance of shortness of breath, dizziness, increased pain and the appearance of a pre-syncope state, it is necessary to contact a cardiologist.

Patients have additional symptoms:

• abdominal pain;
• headache;
• causeless increase in temperature to 37.9 ° C;
• frequent urination;
• feeling short of breath;
• fatigue and low endurance to heavy loads.

Fainting with congenital mitral valve prolapse is extremely rare and is caused by severe stress. To eliminate them, it is necessary to provide an influx of fresh air, calm the patient and stabilize temperature conditions.

Often, patients experience:

• strabismus;
• nearsightedness or farsightedness;
• postural disorder, etc.

These diseases are caused by pathology of the connective tissue, which indicates the likelihood of a congenital defect of the mitral valve.

Based on the intensity of regurgitation, the main stages of the disease are distinguished:

• in the first stage, the valve sags less than 5 mm;
• at the second stage, a gap of up to 9 mm is formed;
• more complex third and fourth stages are characterized by a leaf deviation from the normal position by more than 10 mm.

An amazing feature of prolapse is that with a significant deviation of the valves, regurgitation can be much less than in the initial stages.

Diagnostics

When listening to the heart, the cardiologist notes a characteristic murmur. If necessary, the doctor prescribes an ECG and a Holter ECG, which show changes in the work of the heart. Holter ECG records heart rate data for 24 hours.

Stenosis

Mitral valve stenosis in 80% of cases develops due to rheumatism. In other cases, the reasons are:

• infective endocarditis;
• syphilis;
• atherosclerosis;
• genetic predisposition;
• heart injury;
• atrial myxoma;
• systemic lupus erythematosus, etc.

The mitral valve is funnel-shaped and consists of leaflets, annulus fibrosus, and papillary muscles. When the valve narrows, the load on the left atrium increases, as a result, the pressure in it rises and secondary pulmonary hypertension develops. As a result, right ventricular failure occurs, which provokes thromboembolism and atrial fibrillation.

The following stages of development of stenosis are noted:

• Stage I is characterized by narrowing of the atrioventricular orifice to 4 square meters. cm;
• at stage II, hypertension appears, venous pressure increases, but there are no pronounced symptoms of mitral valve pathology. The atrioventricular orifice was reduced to 2 square meters. cm;
• at stage III, the patient has signs of heart failure, the size of the heart increases, the indicators of venous pressure increase, the size of the liver increases. The atrioventricular opening is reduced to 1.5 square meters. cm;
• Stage IV is characterized by aggravation of signs of heart failure, stagnation of blood circulation is noted, the liver thickens, the atrioventricular opening narrows to 1 square. cm;
• at stage V, the terminal stage of heart failure is noted, the atrioventricular orifice is practically closed.

Symptoms

For a long time, stenosis proceeds without pronounced signs. From the moment of the first serious attack on the heart to the appearance of the first specific symptoms, sometimes up to 20 years pass. From the moment of the onset of dyspnea at rest to the death of the patient, 5 years pass.

If the patient has mild stenosis, there are no complaints about the state of health. Only during a hardware examination, signs are recorded:

• increased venous pressure;
• narrowing of the lumen between the left ventricle and the atrium.

A sharp increase in venous pressure is caused by excessive exercise, sexual intercourse, fever, and is manifested by cough and shortness of breath. As a result of the progression of stenosis, the patient reduces endurance to physical activity, limit activity. Often fixed:

• attacks of cardiac asthma;
• tachycardia;
• arrhythmia;
• development of pulmonary edema.

The progression of hypoxic encephalopathy causes the appearance of fainting and dizziness caused by physical activity. The development of constant atrial fibrillation is a critical moment that accompanies the expectoration of blood and increased shortness of breath. Pulmonary hypertension leads to the formation and progression of right ventricular failure.

The patient has:

• swelling;
• severe weakness;
• heaviness in the right hypochondrium;
• pain in the region of the heart;
• ascites;
• right-sided hydrothorax.

During the inspection are determined:

• cyanosis of the lips;
• mitral butterfly (bluish-pink blush on the cheeks).

When percussion and listening to heart sounds are determined:

• displacement of the borders of the organ to the left;
• intensifying clapping tone and additional III tone;
• amplification and bifurcation of the II tone;
• systolic murmur, increasing at the peak of inspiration.

Patients with stenosis are often diagnosed with:

• bronchitis;
• bronchopneumonia;
• thromboembolism of the extremities, kidneys or spleen.

Mitral valve stenosis is complicated by recurrent rheumatism and pulmonary embolism, which lead to death.

Diagnostics and treatment of defects of the mitral valve

Diagnosis of pathologies of the mitral valve and the heart is carried out using the following methods:

• echocardiography;
• dopplerography;
• radiography;
• cardiac catheterization;
• auscultation.

Mitral defects involve medical and surgical treatment. The drug method is used to correct the general condition of the patient in preparation for surgery or in the stage of defect compensation. Medication therapy includes taking the following drugs:

• diuretics;
• anticoagulants;
• beta blockers;
• antibiotics;
• cardioprotectors;
• cardiac glycosides;
• ACE inhibitors;
• anti-traumatic agents, etc.

If the patient cannot be operated on, drug therapy is used.

For surgical treatment of subcompensated and decompensated acquired mitral defects, the following types of interventions are performed:

• plastic;
• valve prosthetics;
• valve-preserving;
• replacement of valves in combination with shunting and preservation of subvalvular structures;
• restoration of the aortic root;
• sinus rhythm reconstruction;
• atrioplasty of the left atrium.

After surgical treatment, patients are prescribed a course of rehabilitation, which includes:

• breathing exercises;
• taking medications to maintain immunity and prevent the recurrence of defects;
• regular control tests to evaluate the effectiveness of treatment.

Forecast

The effectiveness of the treatment of mitral heart disease depends on the following factors:

• patient's age;
• the degree of development of pulmonary hypertension;
• concomitant diseases;
• degree of development of atrial fibrillation.

The surgical method for mitral stenosis restores the normal state of the valve in 95% of patients, but most patients are recommended to repeat mitral recommissurotomy.

Prevention

To prevent the formation of valvular defects, the patient is recommended to promptly treat pathologies that cause damage to the heart valves, lead a healthy lifestyle and do the following:

• as they appear, treat infectious and inflammatory processes;
• maintain immunity;
• give up caffeine and nicotine;
• monitor the maintenance of normal body weight;
• to live an active lifestyle.