aortic insufficiency - a pathological wrong move connective tissue aortic valve, which resulted in the observed development expressed reverse blood flow under a high pressure gradient in the cavity left ventricle from the lumen of aorticvessel during diastole.
syndrome aortic insufficiency, as an isolated acquired valvular cardiac profile is extremely rare.Much more often in different age groups of patients have a combination of damaged valvular as stenosis of the aorta and failure, and men suffer from this form of defect much more often.
aortic insufficiency in pediatric patients occurs less than 3% of an insulated version, but unfortunately are installed only at the stage of formation expressed cardiohemodynamic violations.
Causes of aortic insufficiency
aortic insufficiency, as an isolated cardiac defect is classified polyetiology pathologies, as the process of its development and formation may cause provocative influence a wide range of factors.
Congenital aortic insufficiency develops when aortoannulyarnoy ectasia, Marfan syndrome, cystic fibrosis, hereditary osteoporosis, the disease Erdheim.In this case, instead of three connective tissue aortic valve is formed by one, two or four folds that inevitably provokes changes in cardiac hemodynamics of the heart.When existing abnormal number of leaflets marked or they prolapse into the left ventricular cavity, or their incomplete closure.
Organic aortic regurgitation secondary or acquired genesis can be formed against various diseases of infectious, bacterial, immunodeficient nature, among which 80% of cases of rheumatic heart disease.Rheumatic changes aortic valve presented deformation and thickening of the flaps, which are incapable of further adequately perform the function.Note that rheumatism mostly affects the mitral valve, so when changes are detected aortic valve should think about the combined lesions of valvular.
In addition, various infections of the heart in the form of syphilis, bacterial endocarditis can also cause the development of aortic insufficiency.The presence of an infectious inflammation provokes not only a change in the shape and thickness of the valves, but may cause a violation of their integrity as perforation and erosion.
relatively moderate aortic regurgitation observed in pathological changes were the leaflets and the wall of the aorta, which is observed in hypertensive heart disease, aneurysmal aortic enlargement with signs of separation.The marked expansion of the fibrous ring of the aortic valve in this situation can provoke a full separation (divergence) of connective tissue aortic valve, which is a very bad sign for the patient.
Symptoms of aortic insufficiency
In a situation where cardiohemodynamic violation of a person with aortic insufficiency are compensated state, the patient can completely ignore the changes in the state of their own health and not seek medical care.In some cases, the asymptomatic aortic insufficiency lasts a long time.The sharp increase in clinical symptoms observed exclusively in the aortic aneurysm subjected to delamination as well as in infective endocarditis.
debut clinical manifestations in aortic insufficiency manifests a sense of throbbing pain in the head and neck, feeling increased frequency and intensity of the heart.Pulse in aortic insufficiency not always speeded up, but most patients notice the appearance of this symptom.
In a situation where a person has indicated the presence of a significant defect aortic valve marks an increase of hemodynamic disturbances, which manifests the appearance of symptoms indicating a violation of cerebral circulation."Brain" signs of aortic insufficiency manifested as dizziness, throbbing headaches, tinnitus, disorders of visual function and transient episode of loss of consciousness type of syncope, which has a clear link with the sharp change in the position of the body in space.
minimal aortic regurgitation is usually not accompanied by the appearance of cardiovascular events, but with marked hemodynamic abnormalities in patients observed cardiac symptoms.Manifestations of heart failure in this case is the appearance of anginal pain, disturbance of heart rhythm, respiratory disorders.In the initial stages of aortic insufficiency of the above symptoms are of short duration and disturb the patient only after excessive physical or psychological and emotional activity.When expressed cardiohemodynamic violations signs of heart failure occur constantly and significantly worsens the prognosis of life in aortic insufficiency.
acute for aortic insufficiency is characterized lightning increase of symptoms of left ventricular failure and pronounced respiratory disorders.Manifestations of the alveolar lung edema often combined with a sharp drop in blood pressure, so this category of patients in need of immediate application of the full range of emergency resuscitation.
degrees of aortic insufficiency
development of the clinical picture of aortic insufficiency is slow, regardless of the etiology and pathogenesis.Each of etiopathogenetic development stages accompanied by the appearance of certain cardiohemodynamic violations that inevitably affects the health of the patient.Classification of aortic insufficiency in severity used by cardiologists and cardiac surgeons in daily medical practice, because for each of these stages of the disease show the different methods of correction of the defect.The basis of cardiovascular classification is not only clinical criteria, but these instrumental examination of the patient, so the passage of the full range of the survey is the main key to successful treatment of aortic insufficiency.
Given the global cardiac classification of aortic insufficiency can be divided into four severity.
The earliest stage of development blemish different long latency over and compensated hemodynamic disturbances.The main tool of indicators to suspect aortic regurgitation 1 degree of development, is the registration of regurgitant minimum blood volume (less than 15%) in the aortic valve of the type "Blue Stream" in Doppler mapping of the extent of not more than 5 mm near the aortic valve.Establishment of aortic regurgitation 1 degree is not subject to surgical correction of the defect.
2 degree of aortic insufficiency is accompanied by the appearance of symptoms of non-specific nature, occurring only after increased physical or psychological and emotional activity.When electrocardiographic recording of the heart in patients showing signs indicating the presence of hypertrophic changes in left ventricular myocardium.Volume regurtiruyuschego blood flow in Doppler mapping is less than 30%, and the parameters of the "blue blood flow" is 10 mm.
3 degree of aortic insufficiency is characterized by a significant decrease in performance, as well as the emergence of the specific anginal pain, changes in numbers of blood pressure.During electrocardiographic studies concurrently with signs of left ventricular hypertrophy recorded signs of ischemia.Echocardiographic indices is the registration of so-called "Blue Stream" on the leaflets of the aortic valve in excess of 10 mm.
4 or extreme degree of aortic insufficiency is characterized appearance expressed cardiohemodynamic violations in the form of the strongest regurgitant blood flow of more than 50%.Aortic insufficiency stage 4 is accompanied by marked dilatation of abdominal heart structures and the development of relative mitral insufficiency.
Treatment of aortic insufficiency
Cardiologists, especially surgeons around the world adhere to the principles of feasibility and continuity in the application of a method for the treatment of aortic insufficiency.Patients with an initial degree of aortic insufficiency are not subject to the application of any method of treatment, in addition to the basic criteria of the modification work and rest (a minimum limitation of physical and psycho-emotional activity).Drug therapy for aortic insufficiency involves the use of drugs, the pharmacological effect of which is directed to the leveling manifestations of cardiovascular disease, such as: drugs diuretic series (Furosemide at a daily dosage of 40 mg), ACE inhibitors (Enap minimal daily dose of 5 mg), cardiacglycosides (digoxin in a daily dose of 0.25 mg).
Despite the positive effect of medical treatment the most effective way to eliminate aortic insufficiency is the surgical correction of vice.Operational benefit in one way or another modification in aortic insufficiency perfectly illustrated in the development of symptoms of left ventricular failure, severe regurgitation in the aortic valve and the expansion of the size of the left ventricle.In acute aortic insufficiency in any situation required is the use of surgical correction.
If aortic regurgitation develops against the background of defeat themselves connective tissue aortic valve surgery involves excision of the affected biological material and replace it with a mechanical or biological prosthesis.When aneurysmal expansion of the aortic sinus applied plastic with the maximum possible preservation of the structure of the valve.Mortality rates in the postoperative period is less than 4%.
Note that in the absence of remedial measures develop complications of aortic insufficiency inflammation, thromboembolic and ischemic profile.
Aortic insufficiency - a doctor will help ?In the presence or suspected development of aortic insufficiency should immediately seek the advice of such physicians as cardiology and cardiac surgery.