aortic valve - a pathological movement patterns of the aortic valve, the result of which is the development of severe regurgitation of blood flow in the left ventricular cavity from the lumen of the aorta during diastole. aortic valve insufficiency, acquired as an isolated cardiac defect develops quite rare and is not more than 14% in the overall incidence of all vices.More often patients develop combined valvular damage as a failure and aortic stenosis, and the share of the male half of humanity accounts for over 75% of cases of disease.
aortic valve insufficiency in children as an isolated organic heart disease occurs in no more than 3% of cases and is verified only at the stage of pronounced disorders of cardiac hemodynamics.
Causes of aortic valve regurgitation
Until recently, the only etiopathogenetic mechanism of aortic insufficiency of varying severity was syphilitic or rheumatic heart disease, and for each of these specific pathologies characterized by the differen
Due to the successful use of preventive treatment of nosology, currently aortic valve regurgitation of rheumatic and syphilitic origin is extremely rare, and in the forefront in the etiology of this vice are the birth defects of the connective tissue with a primary lesion of the ascending aorta.Marfan syndrome, idiopathic necrosis of the mediators of the ascending aorta and Takayasu syndrome develops so-called chronic variants of aortic valve regurgitation.
acute severe regurgitation in the aortic valve is rare and develops against the background of infective endocarditis, acute aortic dissection, rupture of an aortic aneurysm or aortic valve subjected myxomatous change.
Congenital aortic valve in the isolated form occurs almost exclusively diagnosed in conjunction with other cardiac malformations.
Symptoms of aortic valve regurgitation
moderate aortic valve insufficiency is characterized slowly progressive course and a long asymptomatic period during which the patient has no complaints completely change health status, while the heart valve is already changing.The most common complaint of patients suffering from long-term failure of the aortic valve is the unpleasant sensations in the heart, which has a clear link to its reduction.A characteristic feature is to enhance the feeling of heart in finding the body in a horizontal position on the left side, and after severe physical activity.
The period of extensive clinical symptom to the fore symptoms of heart failure in the form of increasing respiratory distress, swelling of the limbs and severe weakness.
specific clinical criteria aortic valve regurgitation is the appearance of syphilitic nature of the patient's pain by the type of "anginal attacks" during the night, due to an increase in the voltage of left ventricular myocardium in a physiological bradycardia.
Some patients experience sudden dizziness, up to a short-term loss of consciousness orthostatic character (their appearance is due to a sharp change in body position in space).This symptom is a result of acute ischemic damage to the developing brain structures as a result of the fall of the intraluminal pressure gradient in the aorta during diastole.
flow of aortic valve regurgitation of rheumatic origin has some special features, which consists in the formation of long-term hemodynamic disturbances (not less than seven years after the acute rheumatic fever).
due to lack of clinical manifestations of a given cardiac vice major importance in the correct diagnosis verification data are objective examination of the patient and the results of the survey instrument.There are absolute visual criteria to stage deployed hemodynamic correctly establish the diagnosis, and these include: enhanced surge in projection jugular notch and the anterior abdominal wall, which corresponds to the projection of the aortic arch and its abdominal department, expressed a pulsation in the neck at the site of the carotid arteriesa sign of Mueller, comprising pronounced ripple tonsils and uvula, Landolfi sign consisting in systolic contraction and diastolic dilation of the pupils.
When pulse palpation is marked tachycardia, but the pulse is not only fast, but also high and short.Severe aortic valve regurgitation is accompanied by changes in pulse pressure, is to increase systolic and diastolic decrease in its index.
In a situation where a patient holds expressed progressive regurgitation, when the palpation of the apex beat is marked not only the displacement of the left half of the chest, but also the emergence of so-called "heart shock."However, the most important in the implementation of primary diagnosis of aortic valve regurgitation is the cardiac defect, is the discovery of auscultation changes in the appearance of a specific heart murmurs.
For protodiastolic noise when this vice is listened in the projection of the third or fourth intercostal space on the left parasternal line and is held on top of the heart.With a small degree of regurgitation should be performed auscultation of the heart with the patient sitting at a height of maximum exhalation.Also in isolated aortic valve regurgitation observed weakening of both the first and second heart sound, and the development of signs of left ventricular failure auscultation auscultated additional third tone.A specific criterion auscultatory aortic valve regurgitation is the appearance of a loud popping systolic tone (tone Traube) over the femoral artery.
degrees of aortic valve regurgitation
development of aortic valve as any other cardiac defect, occurs gradually, regardless of the etiology of the disease.Each of pathogenic stages characterized by various changes cardiohemodynamic that has a reflection on the state of health of the patient.Separation aortic defect severity used by cardiologists and heart surgeons are more in daily practice, for each of the degrees shows the use of an amount of therapeutic measures.The classification put the clinical criteria as well as the instrumental methods of research, and therefore, every patient with suspected or established earlier diagnosis of "aortic valve" is necessary to pass a full range of clinical and instrumental examination.
According to the World Heart classification aortic valve can be divided into four levels.
The earliest, 1 degree of aortic valve regurgitation is characterized by asymptomatic and full compensation of hemodynamic disturbances.The only criterion that allows a correct diagnosis at this stage of the disease, is the detection of a small amount of blood (less than 15%) regurgitant on the leaflet that the Doppler study of the heart manifests itself in the form of "Blue Stream" for no more than 5 mm from the aortic valve leaflets.Detection of aortic valve regurgitation 1 degree is not a reason for surgical correction of the defect.
2 degree nedostatochnostiaortalnogo valve, or the period of the "hidden heart failure" is characterized by the emergence of non-specific nature of the complaints, which appear only after excessive physical activity.When you register ECG in these patients showing signs suggestive of change left ventricular hypertrophic character.The volume of blood in the reverse current Doppler investigation does not exceed 30%, and the length of "blue blood flow" is 10 mm.
grade 3 aortic valve regurgitation, or period developed clinical symptoms, characterized by a pronounced decline in performance, the appearance of a typical anginal pain, changes in blood pressure.When electrocardiography changes in addition to signs of left ventricular hypertrophy found Criteria ischemic myocardial injury.Echocardiographic criteria is the detection of "Blue Stream" aortic valve length of more than 10 mm, which corresponds to the volume of blood by 50%.
fourth or terminal degree of aortic valve regurgitation is accompanied by severe hemodynamic disturbances in the form of a powerful stream of regurgitation volume exceeding 50%.At this stage, a marked dilatation of the heart cavity structures and the development of relative mitral insufficiency.
Treatment of aortic valve regurgitation
Specialists Cardiology and cardiac surgery profile around the world take the position appropriate to apply the medical or surgical treatment.For patients with an initial degree of aortic valve not shown the use of any type of treatment, other than compliance with rules of operation (slight limitation of physical activity).
volume of drug therapy is limited by the use of drugs, the effect of which is aimed at eliminating the manifestations of heart failure, such as diuretics (furosemide 40 mg 1 time a day), ACE inhibitors (Enap in the minimum dose of 5 mg 1 time per day), heartglycosides (digoxin 0.25 mg 1 time per day).
And yet the only effective treatment for aortic valve regurgitation, like most cardiac defects is surgical correction of the defect.Absolute indications for the use of a surgical aid in case of insufficiency of the aortic valve is the development of signs of left ventricular failure, severe regurgitation in the aortic valve and the expansion of the size of the left ventricular cavity.Acute aortic valve regurgitation in any situation is an emergency and requires immediate surgical elimination.
In situations where the cause of this condition is defeated themselves valvular leaflets, operational manual is excision of the damaged biological material and replacing it with a biological or mechanical prosthesis.When an aneurysm of the aortic sinus is made of plastic with preservation of the valve.The mortality rate in the late and early postoperative period does not exceed the 4%.
aortic valve - a doctor will help ?In the presence or suspected development of aortic valve regurgitation should immediately seek the advice of such physicians as cardiology and cardiac surgery.