mitral insufficiency - regurgitation is the development of arterial blood in the cavities of the left heart during ventricular systolic contraction that occurs on a background of disturbed clamping wing structures of the mitral valve.
The share of the isolated defect in the form of mitral valve among all possible cardiac malformations account for at least 2%.Much more often the patient is combined lesion of the mitral valve in the form of a combination of stenosis and insufficiency.
mitral valve insufficiency causes
mitral valve of the heart, as opposed to a stenosis of the same location, is polietiologichesky pathology, that is, on the development of its symptoms is influenced by a number of factors, although each of them individually can initiate the development of theblemish.
organic mitral valve insufficiency, which arises as a result of the primary lesion of the valve device, can be observed in the following diseases cardiac and noncardiac nature: rheumatic
fundamental difference of organic mitral valve insufficiency of the functional changes of the mitral valve is its development on the background of the existing coarse myocardial damage, accompanied by development of severe dilation of the left ventricular cavity.Dilated left ventricle changes over time provoke tension valve ring and papillary muscles laterally offset, against which there is dysfunction of the mitral valve in the complete absence of organic damage.
Hypertrophic cardiomyopathy constrictive type is also accompanied by the development of signs of mitral regurgitation, and pathogenetic mechanism of development lies in the reduction of hyperdynamic left ventricle, which occurs during retraction in front of the wings increased outflow tract of the left ventricle.
mitral insufficiency signs
mitral insufficiency is characterized indolent course with a gradual increase in clinical symptoms.In cardiology practice is allocated a separate category of patients whose clinical manifestations may be absent, and changing valve apparatus identified during the instrumental methods of research.
initial complaint, which often impose patients with mitral valve insufficiency, are increasing shortness of breath, which is the result of venous stasis in the pulmonary parenchyma, decreased performance and fatigue due to a decrease in cardiac output.Depending on the extent of damage to the valves of the valve unit, a breathing disorder of cardiac origin may be minor or severe, until the development of signs of pulmonary edema.
mitral insufficiency is a whole range of specific changes, an experienced cardiologist diagnosed in the period of the primary objective of the study.The skin of patients with mitral valve insufficiency become cyanotic shade projected distal extremities and face.On palpation of the pulse usually can not reveal any changes, but in some cases there are signs of a positive venous pulse.The marked expansion of the boundaries of cardiac dullness, and the offset and gain apical impulse is observed only in severe dilatation of the left ventricular cavity.On examination, the patient with symptoms of pulmonary hypertension is defined by abnormal surge in the fourth intercostal space on the projection of the contour of the left of the sternum.
most characteristic feature of mitral regurgitation is the presence of noise pansystolic projected apex of the heart with the holding in the left armpit.Specific symptoms characteristic only for mitral regurgitation is to increase the noise in the translation of the body in a horizontal position on the left side.The degree of manifestation of noise depends more on the myocardial contractility of the left ventricle, rather than the severity of regurgitation.If you are not a strong expression of noise attenuation can be discerned first pitch due to violation of the complete closure of the mitral valve leaflets.In severe regurgitation there is a poor prognostic sign - the emergence of a third tone.Listening to the emphasis in the projection of the second tone of the pulmonary artery favors the development of symptoms of pulmonary hypertension.
mitral insufficiency degree
Splitting failure of the mitral valve is used to define the degree of central cardiac hemodynamics, and determine whether the use of surgery.
first (1) the degree of mitral regurgitation is characterized as compensatory stage, ie regurgitation of blood flow is so minimal that it is not accompanied by cardiohemodynamic disorders.The only clinical symptoms in the patient in the compensatory phase of the disease may be the appearance of noise in the projection systolic heart apex.In this situation the patient is shown holding echocardiography to determine the presence of regurgitation.Mitral insufficiency in this step does not require the application of surgical treatments.
second (2) the degree of mitral regurgitation, or subcompensation stage, accompanied by an increase in the return of blood flow during systolic ventricular contraction, there are signs of compensatory hypertrophy of the left ventricular wall to compensate for violations of hemodynamics.At this stage, most of the patients blemish marks an increase of dyspnea during excessive physical activity, and auscultation auscultated moderately pronounced systolic murmur in the projection of the apex of the heart.X-rays to determine the expansion of the boundaries of the left heart, and their excessive pulsation.This stage is reflected in the ECG registration in the form of formation levocardiogram and signs of overload of the left heart.Echocardiographic sign is the presence of moderate regurgitation in the projection of mitral valve.Stage subcompensation is no justification for the use of surgical methods of correction.
third (3) the degree of mitral regurgitation is characterized by the appearance of severe left ventricular decompensation caused significant regurgitation of blood in the left ventricular cavity.Clinical symptoms suggestive of development of decompensated heart failure is a progressive shortness of breath with minimal physical activity and visualization of the anterior chest wall pulsations projected apex of the heart.Listening rough systolic murmur in the projection of the apex of the heart is not difficult, and additional instrumental examination methods allow the patient to determine the presence of left ventricular hypertrophy and expression of reverse blood flow through the mitral valve blatant.The only effective treatment of mitral insufficiency in this stage is surgery.
fourth (4) the degree of mitral regurgitation accompanied by the addition of signs of right heart failure and is called "dystrophic".Distinctive visual symptoms are considered severe throbbing neck veins and the displacement of the apical impulse, as well as its strengthening.Mitral valve insufficiency in these patients is accompanied not only hemodynamic disturbances and heart rhythm failure.Radiography allows you to visualize a pronounced widening of the mediastinum shadow due to increase in all parts of the heart, as well as signs of stagnation in the pulmonary circulation.At this stage of the disease appear extracardiac symptoms of functional changes in the kidney and liver.Surgical correction methods are widely used and in most cases have a favorable outcome.
fifth (5) the degree of mitral regurgitation is a terminal characterized by expression of the patient's total clinical symptom characteristic of the third stage of cardiovascular disease.The severity of the patient's condition does not allow surgery and mitral regurgitation prognosis at this stage is extremely unfavorable.In the terminal stage defect frequently observed complications, each of which can be fatal disorders: paroxysmal atrial fibrillation, infective endocarditis and systemic thromboembolism vessels of various calibers.
mitral insufficiency treatment
on the severity of regurgitation of the mitral valve in the projection of a decisive influence affects the value of systolic blood pressure in the lumen of the aorta, so pathogenetically justified is the appointment of vasodilators for a long time.The drugs of choice in this situation is an ACE inhibitor at a dosage capable of holding a systolic pressure of 120 mm Hg level mark(Berlipril an initial daily dose of 2.5 mg followed by titration of the drug to therapeutic doses and chronic administration of the drug).Recent randomized studies prove the need for vasodilators even if asymptomatic during mitral valve insufficiency with minimal performance regurgitation.
Already during the second or third degree mitral regurgitation, when there are changes in dilatation of the cavities of the left heart, it is advisable to lifelong use of anticoagulants as preventing the development of thromboembolic complications (Aspekard a daily dose of 100 mg orally).
In a situation where the patient has electrocardiographic signs of arrhythmia recommended the use of blockers (metoprolol in the average daily dose of 100 mg orally).
absolutely shows the use of surgical correction of mitral valve insufficiency in the following situations:
- regurgitation level is about 40% of cardiac output;
- the absence of a positive result from the use of massive antibiotic therapy during the aggressive nature of infectious endocarditis complicating the underlying disease;
- expressed sclerotic changes valve apparatus having irreversible;
- pronounced increase in left ventricular dilatation with signs of systolic dysfunction;
- single or multiple episodes of thromboembolism vessels.
Currently cardio branch of medicine allows you to use the latest reconstructive operational benefits that allow to preserve the structure of the valve unit.In a situation where there are pronounced sclerotic changes of the leaflets and it is not possible to perform a surgical decalcification, applied a technique of prosthesis using both synthetic and xenopericardial materials.In order to eliminate the rigidity of structures valve valvuloplasty technique is used, in most cases, completely eliminate the symptoms of regurgitation.