Regurgitation grade 3 treatment. How to identify and treat mitral regurgitation? degree (2024)

In cardiological practice, a heart defect such as mitral valve insufficiency is often encountered. The movement of blood in the cavity of the heart depends on the functioning of the valves. The bicuspid valve is located in the left parts of the organ. It is located in the area of вЂ‹вЂ‹the atrioventricular opening. When it closes incompletely, blood rushes back into the atrium, which leads to disruption of the organ.

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Valvular dysfunction

Mitral regurgitation is an acquired heart defect in which the valve leaflets do not close completely, which leads to the backflow (regurgitation) of blood into the atrium. This condition leads to the appearance of various clinical symptoms (shortness of breath, edema). The isolated form of this defect is diagnosed very rarely.

It accounts for no more than 5% of all cases of this pathology. Most often, mitral regurgitation is combined with a narrowing of the left orifice between the atrium and the ventricle, aortic valve defects, atrial septal defect and the septum between the ventricles. During preventive heart examinations, bicuspid valve dysfunction is detected in 5% of the population. In most cases the degree of deviation is insignificant. This defect is detected using ultrasound.

Disease severity

Mitral insufficiency can be of several types: ischemic, non-ischemic, acute and chronic, organic and functional. The ischemic form is caused by a lack of oxygen in the heart muscle. Organic pathology develops as a result of damage to the valve itself or tendon cords. In the functional form of this defect, disruption of blood flow is associated with an increase in the cavity of the left ventricle.

There are 4 degrees of this pathology: mild, moderate, severe and severe. This defect includes 3 stages. In the compensation stage, the backflow of blood into the atrium does not exceed 20-25% of the total blood volume during heart contraction. This condition does not pose a danger, since compensatory mechanisms are activated (increased work of the left atrium and left ventricle).

In the subcompensation stage, congestion is observed in the pulmonary circulation (lungs). The left parts of the heart are heavily overloaded. Blood regurgitation is 30-50%. Stage 3 inevitably leads to severe heart failure. From 50 to 90% of the blood returns back to the atrium. With this pathology, the valve begins to sag.

The degree of sagging varies (from 5 to 9 mm). When assessing the condition of the mitral valve, the size of the opening between the atrium and the ventricle is also taken into account. With a mild degree it is less than 0.2 cmВІ, with a moderate degree it is 0.2-0.4 cmВІ, and with a severe degree there is a hole larger than 0.4 cmВІ. In the latter case, the left atrium is constantly filled with blood.

Etiological factors of the disease

The following reasons for the development of this acquired heart defect in children and adults are identified:

rheumatism;
endocarditis of infectious nature;
acute form of myocardial infarction;
deposition of calcium salts in the area of вЂ‹вЂ‹the valve leaflets;
bulging of the valves forward due to weakness of the connective tissue;
autoimmune diseases (lupus, scleroderma);
coronary heart disease due to atherosclerosis or thrombosis of the coronary arteries;
dilated cardiomyopathy;
myocarditis;
cardiosclerosis.

The ischemic form of the defect often develops against the background of myocardial sclerosis after a heart attack. Sometimes this pathology becomes a manifestation of Marfan and Ehlers-Danlos syndrome. The expansion of the fibrous ring and the ventricular cavity causes the development of relative insufficiency of the bicuspid heart valve. The bicuspid valve is a structure of the heart made of connective tissue. It is located in the fibrous ring.

In a healthy person, during contraction of the left stomach, blood rushes into the aorta. It moves in only one direction (from the left atrium to the left ventricle and aorta). If the valve is not completely closed, blood regurgitation occurs (reverse reflux). The condition of the valve leaflets largely depends on the health of the chordae tendineae. These are the structures that allow flexibility and movement of the valve. When inflammation or injury occurs, the chords are damaged, which leads to disruption of the tone of the valves. They don't close completely. A small hole is formed through which blood flows freely.

Clinical manifestations in the early stages

The signs of this pathology depend on the degree of regurgitation. In the first two stages, the following symptoms are possible:

rapid heartbeat;
heart rhythm disturbance;
fast fatiguability;
weakness;
malaise;
dyspnea;
chest pain;
cough;
slight swelling of the lower extremities.

With mitral valve insufficiency of the 1st degree, complaints may be absent. The body compensates for these violations. This stage can last several years. Most often, such patients complain of chilly legs and weakness. In the second stage (subcompensation), the first signs of heart failure appear (shortness of breath, tachycardia).

Shortness of breath occurs with physical exertion. Its appearance can be caused by long walking, heavy lifting, or climbing stairs. She doesn't bother me when she's alone. Shortness of breath is a feeling of lack of air. The heart of such patients begins to beat faster (80 or more beats per minute). The heart rhythm is often disturbed, such as atrial fibrillation.

With it, the atria are excited and contract randomly at a frequency of 300-600 beats per minute. Long-term arrhythmia can cause heart attack, ischemic stroke and vascular thrombosis. With mitral valve insufficiency of the 2nd degree, edema may appear on the feet and legs. Both limbs are affected symmetrically. Cardiac edema worsens in the evening. They are bluish in color, cold to the touch and grow gradually.

Late stage manifestations

Symptoms of stage 3 mitral valve insufficiency are most pronounced. Due to significant regurgitation, venous blood stagnates in the pulmonary circle, which leads to an attack of cardiac asthma. Most often, attacks occur at night. They are characterized by lack of air, shortness of breath, and dry cough. Symptoms are most pronounced when the person is lying down. Such people breathe through their mouths and have difficulty speaking.

At stage 3 of mitral insufficiency, complaints become constant. The symptoms are disturbing even at rest. Such people often develop pulmonary edema. Sometimes hemoptysis is observed. Edema syndrome is pronounced. Swelling appears not only on the limbs, but also on the face and other parts of the body.

Impaired blood flow leads to stagnation in the liver. This manifests itself as pain in the hypochondrium on the right. Depletion of the heart muscle leads to multiple organ failure. Against the background of mitral ventricular failure, the right side of the heart often suffers. Right ventricular failure develops. The following symptoms are observed:

increase in abdominal volume (ascites);
acrocyanosis;
bulging veins in the neck area.

The most serious complication of mitral disease is atrial fibrillation.

How are patients examined?

Treatment of patients begins after a final diagnosis is made. Diagnostics includes:

collection of anamnesis of life and illness;
identification of main complaints;
physical examination;
electrocardiography;
Ultrasound of the heart;
heart murmur analysis;
immunological blood test;
X-ray of the chest organs;
Dopplerography;
general blood and urine analysis.

If necessary, coronary angiography (examination of the coronary arteries using a dye) and spiral computed tomography are performed. In order to determine the pressure in the left side of the heart, catheterization is performed. Physical examination is very informative. With mitral insufficiency, the following changes are detected:

the presence of a heart hump;
increased apical impulse;
increase in the boundaries of cardiac dullness;
weakening or absence of 1 heart sound;
systolic murmur at the apex;
splitting or accent of 2 tones in the area of вЂ‹вЂ‹the pulmonary artery.

Cardiac ultrasound can determine the severity of mitral regurgitation. This is the main method for diagnosing this defect. During an ultrasound of the heart, the condition of the valves, the size of the atrioventricular orifice, the presence of pathological inclusions in the valve area, the size of the heart and its individual chambers, wall thickness and other parameters are assessed.

Conservative treatment tactics

Treatment of patients with this defect can be conservative or surgical. It is necessary to identify the main cause of this pathology. If bicuspid valve insufficiency has developed against the background of rheumatism, then treatment involves the use of glucocorticoids, NSAIDs and immunosuppressants. Additionally, antibiotics may be prescribed. Sanitation of all foci of chronic infection is required.

In the case of coronary heart disease against the background of atherosclerosis, lifestyle changes are required (giving up alcohol and tobacco products, following a diet, limiting exercise, eliminating stress), and using statins (Simvastatin, Lovastatin, Atorvastatin). If necessary, beta blockers and antiplatelet agents are prescribed.

Drug treatment for bicuspid valve insufficiency includes the use of the following medications:

reducing vascular resistance (ACE inhibitors);
antiarrhythmic drugs (Cordarone, Novocainamide);
beta blockers (Bisoprolol);
diuretics (Veroshpiron, Indapamide);
anticoagulants (Heparin, Warfarin);
antiplatelet agents (Thrombo ACC).

Diuretics reduce the volume of blood circulating in the vessels. Nitrates are necessary to reduce afterload on the heart. In case of developed heart failure, the use of glycosides is indicated. In case of mild severity of the defect and absence of symptoms, drug therapy is not required.

Therapeutic actions

For moderate to severe mitral regurgitation, surgical intervention is required.

In the terminal stage, surgery is not performed. The most common procedures are plastic surgery or prosthetics. This treatment is aimed at preserving the heart valves. Plastic surgery is indicated in the following situations:

with prolapse of the bicuspid valve;
when the structures of the valve apparatus rupture;
when the valve ring expands;
with relative insufficiency of the bicuspid valve.

Surgical treatment is also carried out if a woman plans to have children. Prosthetics are organized when plastic surgery is ineffective or when there are gross changes. After installation of prostheses, you need to take indirect anticoagulants. Possible complications after surgery include the development of atrioventricular block, thromboembolism, and secondary infective endocarditis.

If complications (pulmonary edema) develop in the later stages, then additional drug therapy is carried out. In case of swelling, oxygen supply is indicated. Diuretics and nitrates are used. For high blood pressure, antihypertensive drugs are prescribed. The prognosis for life and health is determined by the degree of regurgitation, the personвЂ™s age and the presence of concomitant pathology.

If all doctorвЂ™s recommendations are followed, the five-year survival rate reaches 80%. 6 out of 10 people live 10 years or more. The worst prognosis is observed with the ischemic form of mitral regurgitation. With a defect of mild to moderate severity, sick women can carry a child and give birth. Thus, disruption of the bicuspid heart valve is a dangerous condition that causes heart failure and early death in patients.

The term вЂњregurgitationвЂќ is quite often used by doctors of various specialties - cardiologists, therapists, functional diagnosticians. Many patients have heard it more than once, but have little idea what it means and what it threatens. Should we be afraid of having regurgitation and how to treat it, what consequences to expect and how to identify it? Let's try to find out these and many other questions.

Regurgitation is nothing more than reverse flow of blood from one chamber of the heart to another. In other words, during contraction of the heart muscle, a certain volume of blood, for various reasons, returns to the cavity of the heart from which it came. Regurgitation is not an independent disease and therefore is not considered a diagnosis, but it characterizes other pathological conditions and changes (for example).

Since blood continuously moves from one part of the heart to another, coming from the vessels of the lungs and leaving for the systemic circulation, the term вЂњregurgitationвЂќ applies to all four valves on which reverse flow may occur. Depending on the volume of blood that returns, it is customary to distinguish the degrees of regurgitation that determine the clinical manifestations of this phenomenon.

A detailed description of regurgitation, identification of its degrees and detection in a large number of people became possible with the use of ultrasound examination of the heart (echocardiography), although the concept itself has been known for quite a long time. Listening to the heart provides subjective information, and therefore does not allow one to judge the severity of the return of blood, while the presence of regurgitation is not in doubt except in severe cases. The use of ultrasound with Doppler makes it possible to see in real time the contractions of the heart, how the valve flaps move and where the blood stream rushes.

Briefly about anatomy...

In order to better understand the essence of regurgitation, it is necessary to recall some aspects of the structure of the heart, which most of us conveniently forgot, having once studied in biology lessons at school.

The heart is a hollow muscular organ with four chambers (two atria and two ventricles). Between the chambers of the heart and the vascular bed there are valves that function as вЂњgatesвЂќ, allowing blood to pass in only one direction. This mechanism ensures adequate blood flow from one circle to another due to the rhythmic contraction of the heart muscle, which pushes blood inside the heart and into the vessels.

The mitral valve is located between the left atrium and ventricle and consists of two doors. Since the left half of the heart is the most functionally burdened, works under heavy load and under high pressure, it is often here that various malfunctions and pathological changes occur, and the mitral valve is often involved in this process.

The tricuspid, or tricuspid, valve lies on the path from the right atrium to the right ventricle. It is already clear from its name that anatomically it consists of three interlocking valves. Most often, its damage is secondary in nature to an existing pathology of the left side of the heart.

The valves of the pulmonary artery and aorta each have three valves and are located at the junction of these vessels with the cavities of the heart. The aortic valve is located on the path of blood flow from the left ventricle to the aorta, and the pulmonary artery - from the right ventricle to the pulmonary trunk.

In the normal state of the valve apparatus and myocardium, at the moment of contraction of one or another cavity, the valve leaflets close tightly, preventing the reverse flow of blood. With various heart lesions, this mechanism may be disrupted.

Sometimes in the literature and in doctorsвЂ™ reports you can find references to the so-called physiological regurgation, which means a slight change in blood flow at the valve leaflets. In fact, in this case, a вЂњswirlвЂќ of blood occurs at the valve opening, and the leaflets and myocardium are completely healthy. This change does not affect blood circulation in general and does not cause clinical manifestations.

Physiological can be considered regurgitation of 0-1 degree on the tricuspid valve, at the mitral valves, which is often diagnosed in thin, tall people, and according to some data is present in 70% of healthy people. This feature of blood flow in the heart does not in any way affect your well-being and can be detected by chance during an examination for other diseases.

As a rule, pathological reverse blood flow through the valves occurs when their valves do not close tightly at the moment of myocardial contraction. The reasons may be not only damage to the leaflets themselves, but also to the papillary muscles, chordae tendineae involved in the mechanism of valve movement, stretching of the valve ring, and pathology of the myocardium itself.

Mitral regurgitation

Mitral regurgitation is clearly observed with or. At the moment of contraction of the left ventricular muscle, a certain volume of blood returns to the left atrium through an insufficiently closed mitral valve (MV). At the same moment, the left atrium fills with blood flowing from the lungs through the pulmonary veins. This flooding of the atrium with excess blood leads to overdistension and increased pressure (volume overload). Excess blood during contraction of the atria penetrates into the left ventricle, which is forced to push more blood into the aorta with greater force, as a result of which it thickens and then expands ().

For some time, disturbances in intracardiac hemodynamics may remain invisible to the patient, since the heart compensates for blood flow as best it can by expanding its cavities.

With mitral regurgitation of the 1st degree, there are no clinical signs for many years, and with a significant volume of blood returning to the atrium, it expands, the pulmonary veins become overfilled with excess blood and signs appear.

Among the causes of mitral regurgitation, which is the second most common acquired heart defect after changes in the aortic valve, we can highlight:

Prolapse;
, on the valves of the MK;
Some connective tissue diseases, autoimmune processes, metabolic disorders (Marfan syndrome, rheumatoid arthritis, amyloidosis);
(especially with damage to the papillary muscles and chordae tendineae).

With mitral regurgitation of the 1st degree, the only sign may be the presence of a murmur in the area of вЂ‹вЂ‹the apex of the heart, detected by auscultation, while the patient has no complaints, and there are no manifestations of circulatory disorders. Echocardiography (ultrasound) can detect slight divergence of the leaflets with minimal disruption of blood flow.

Grade 2 mitral valve regurgitation accompanies a more severe degree of regurgitation, and the stream of blood returning back to the atrium reaches its middle. If the amount of blood return exceeds a quarter of the total amount located in the cavity of the left ventricle, then signs of stagnation in the small circle and characteristic symptoms are detected.

The third degree of regurgitation is said to occur when, in the case of significant defects of the mitral valve, the blood flowing back reaches the posterior wall of the left atrium.

When the myocardium cannot cope with the excess volume of contents in the cavities, pulmonary hypertension develops, leading, in turn, to overload of the right half of the heart, resulting in circulatory failure in the systemic circle.

With grade 4 regurgitation, characteristic symptoms of severe disturbances in blood flow inside the heart and increased pressure in the pulmonary circulation are shortness of breath, arrhythmias, and the possible occurrence of cardiac asthma and even pulmonary edema. In advanced cases, signs of damage to the pulmonary bloodstream include swelling, cyanosis of the skin, weakness, fatigue, a tendency to (atrial fibrillation), and pain in the heart. In many ways, the manifestations of severe mitral regurgitation are determined by the disease that led to damage to the valve or myocardium.

Separately, it is worth mentioning about mitral valve prolapse (MVP), quite often accompanied by varying degrees of regurgitation. In recent years, prolapse has begun to appear in diagnoses, although previously such a concept was quite rare. This state of affairs is largely due to the advent of imaging methods - ultrasound examination of the heart, which makes it possible to trace the movement of the valves of the MV during cardiac contractions. With the use of Doppler, it became possible to determine the exact degree of blood return to the left atrium.

MVP is typical for tall, thin people; it is often discovered accidentally in adolescents during examination before conscription into the army or undergoing other medical examinations. Most often, this phenomenon is not accompanied by any disturbances and does not in any way affect the lifestyle and well-being, so you should not be alarmed right away.

Mitral valve prolapse with regurgitation is not always detected; its degree in most cases is limited to the first or even zero, but at the same time, this feature of the functioning of the heart can be accompanied by.

If low-grade MVP is detected, you can limit yourself to observation by a cardiologist, and treatment is not required at all.

Aortic regurgitation

Reverse blood flow on the aortic valve occurs when it is insufficient or the initial part of the aorta is damaged, when, in the presence of an inflammatory process, its lumen and the diameter of the valve ring expand. The most common reasons for such changes are:

Rheumatic lesions;
Infectious with inflammation of the valves, perforation;
Congenital malformations;
Inflammatory processes of the ascending aorta (syphilis, rheumatoid arthritis, ankylosing spondylitis, etc.).

Such common and well-known diseases as atherosclerosis can also lead to changes in the valve leaflets, aorta, and left ventricle of the heart.

Aortic regurgitation is accompanied by the return of blood to the left ventricle, which becomes overfilled with excess volume, while the amount of blood flowing into the aorta and further into the systemic circulation may decrease. The heart, trying to compensate for the lack of blood flow and pushing excess blood into the aorta, increases in volume. For a long time, especially with stage 1 regurgitation, such an adaptive mechanism allows maintaining normal hemodynamics, and symptoms of disorders do not occur for many years.

As the mass of the left ventricle increases, its need for oxygen and nutrients, which the coronary arteries are unable to provide, also increases. In addition, the amount of arterial blood pushed into the aorta becomes less and less, and, therefore, it will not flow enough into the vessels of the heart. All this creates the preconditions for hypoxia and ischemia, resulting in (overgrowth of connective tissue).

As aortic regurgitation progresses, the load on the left half of the heart reaches its maximum degree, the myocardial wall cannot hypertrophy indefinitely and it stretches. Subsequently, events develop in the same way as with damage to the mitral valve (pulmonary hypertension, in the small and large circles, heart failure).

Patients may complain of palpitations, shortness of breath, weakness, and pallor. A characteristic feature of this defect is the appearance of angina attacks associated with inadequacy of coronary circulation.

Tricuspid regurgitation

Isolated lesions of the tricuspid valve (TC) are quite rare. As a rule, its insufficiency with regurgitation is a consequence of pronounced changes in the left half of the heart (relative TC insufficiency), when high pressure in the pulmonary circulation prevents adequate cardiac output into the pulmonary artery, which carries blood for oxygenation into the lungs.

Tricuspid regurgitation leads to a violation of complete emptying of the right side of the heart, adequate venous return through the vena cava and, accordingly, a systemic circulation appears.

For tricuspid valve insufficiency with regurgitation, the occurrence of atrial fibrillation, cyanosis of the skin, edematous syndrome, swelling of the neck veins, enlarged liver and other signs of chronic circulatory failure are quite typical.

Pulmonary valve regurgitation

Damage to the pulmonary valve leaflets can be congenital, manifesting itself in childhood, or acquired as a result of atherosclerosis, syphilitic lesions, or changes in the leaflets due to septic endocarditis. Often, damage to the pulmonary valve with insufficiency and regurgitation occurs with existing pulmonary hypertension, lung diseases, and damage to other heart valves ().

Minimal regurgitation on the pulmonary valve does not lead to significant hemodynamic disorders, while significant return of blood to the right ventricle and then to the atrium, causing hypertrophy and subsequent dilatation(expansion) of the cavities of the right half of the heart. Such changes are manifested by severe heart failure in the systemic circle and venous stagnation.

Pulmonary regurgitation is manifested by all kinds of arrhythmias, shortness of breath, severe edema, accumulation of fluid in the abdominal cavity, changes in the liver up to cirrhosis and other signs. With congenital valve pathology, symptoms of circulatory disorders occur already in early childhood and are often irreversible and severe.

Features of regurgitation in children

In childhood, the proper development and functioning of the heart and circulatory system is very important, but disorders, unfortunately, are not uncommon. Most often, valve defects with insufficiency and blood return in children are caused by congenital developmental anomalies (hypoplasia of the pulmonary valve, defects of the septa between the atria and ventricles, etc.).

Severe regurgitation with an abnormal structure of the heart manifests itself almost immediately after the birth of a child with symptoms of respiratory distress, cyanosis, and right ventricular failure. Often, significant violations end fatally, so every expectant mother needs to not only take care of her health before the intended pregnancy, but also promptly visit an ultrasound diagnostic specialist during pregnancy.

Possibilities of modern diagnostics

Medicine does not stand still, and the diagnosis of diseases is becoming more reliable and of high quality. The use of ultrasound has made significant progress in detecting a number of diseases. The addition of ultrasound examination of the heart (EchoCG) with Dopplerography makes it possible to assess the nature of blood flow through the vessels and cavities of the heart, the movement of valve leaflets at the time of myocardial contractions, establish the degree of regurgitation, etc. Perhaps this is the most reliable and informative method for diagnosing cardiac pathology in real time time and at the same time being accessible and inexpensive.

In addition to ultrasound, indirect signs of regurgitation can be detected by careful auscultation of the heart and assessment of symptoms.

It is extremely important to identify disorders of the heart valve apparatus with regurgitation not only in adults, but also during fetal development. The practice of ultrasound examination of pregnant women at different stages makes it possible to detect the presence of defects that are beyond doubt even during the initial examination, as well as to diagnose regurgitation, which is an indirect sign of possible chromosomal abnormalities or developing valve defects. Dynamic observation of women at risk makes it possible to timely establish the presence of serious pathology in the fetus and resolve the issue of the advisability of continuing pregnancy.

Treatment

The treatment tactics for regurgitation are determined by the cause that caused it, the degree of severity, the presence of heart failure and concomitant pathology.

Both surgical correction of structural abnormalities of the valves (various types) and medical conservative therapy aimed at normalizing blood flow in the organs, combating arrhythmia and circulatory failure are possible. Most patients with severe regurgitation and damage to both circulation circles require constant monitoring by a cardiologist, the prescription of diuretics, beta-blockers, antihypertensive and antiarrhythmic drugs, which will be selected by a specialist.

In case of low-grade mitral prolapse or prevalvular regurgitation of another localization, dynamic observation by a doctor and timely examination in case of worsening of the condition are sufficient.

The prognosis of valvular regurgitation depends on many factors: its degree, cause, age of the patient, the presence of diseases of other organs, etc. With a caring attitude towards your health and regular visits to the doctor, minor regurgitation does not threaten complications, and with pronounced changes, their correction, including including surgical, allows you to prolong the life of patients.

MVR (mitral valve insufficiency) is the most common cardiac anomaly. Of all patients, 70% suffer from an isolated form of cerebrovascular accident. Typically, rheumatic endocarditis is the main underlying cause of the disease. Often, a year after the first attack, the heart condition leads to chronic failure, the cure of which is quite difficult.

The highest risk group includes people with valvulitis. This disease damages the valve leaflets, as a result of which they undergo processes of wrinkling, destruction, and gradually become shorter than their original length. If valvulitis is at an advanced stage, calcification develops.

Septic endocarditis leads to the destruction of many cardiac structures, so NMC has the most severe manifestations. The valve flaps do not fit together tightly enough. When they are not completely closed, too much blood comes out through the valve, which provokes its reboot and the formation of stagnant processes, an increase in pressure. All signs lead to increasing insufficiency of uric acid.

As you know, the main job of the heart muscle is to continuously transport blood throughout the human body and saturate it with oxygen.

In the heart itself, blood moves in a certain order from one section to another, after which it continues its movement through the veins in the systemic circulation.

With regurgitation, a reverse movement of blood occurs in various volumes, and the severity of symptoms depends on the indicators of the latter.

Regurgitation is a pathological process indicating improper functioning of the heart muscle due to a serious illness. This condition has 5 stages of development. Each of them needs to be considered:

Regurgitation is the movement of liquids or gases in the opposite direction, that is, in the direction opposite to the natural one. Observed in hollow organs during muscle contractions.

The phenomenon occurs due to partial loss of functionality of the sphincter or disruption of the structure of the partitions.

In this article we will talk about grade 1 regurgitation, what it is and the reasons for its occurrence. Let's touch on 2 and other degrees of pathology.

Regurgitation means the movement of fluid is opposite to normal. For the cardiovascular system, this phenomenon is associated with the movement of blood and is characteristic of both heart valves and blood vessels. The situation of blood regurgitation in the heart valves depends on which valve is affected and occurs either in the systole or diastole phase.

Valvular heart defects include a group of cardiac dysfunctions caused by morphological or functional damage to the valve apparatus. The changes can be isolated and affect one valve or become generalized and affect several valves.

Valve pathology can manifest itself as stenosis, insufficiency, or, in some cases, a combination of these disorders.

This is explained by the fact that the main significant manifestation of this defect will be the return flow of blood into the cavity of the left ventricle during cardiac diastole, caused by incomplete closure or complete non-closure of the semilunar valves.

Regurgitation is more common in men than in women. The incidence of pathology increases with age. However, AR caused by acquired rheumatic diseases is more common in young patients.

Grade 1 aortic valve regurgitation implies the presence of a minimal return wave, which is not accompanied by the formation of significant circulatory disorders and does not require specific treatment.

Such a return wave is detected during color Doppler sonography and is designated as a return wave that does not extend beyond the outflow tract of the left ventricle (LV).

Trivial (minimal) mitral regurgitation (MR) can occur in three percent of healthy people and is a variant of the individual norm. Such reverse flow is not accompanied by the formation of significant hemodynamic disorders and does not lead to the development of volume overload of the left ventricular cavity.

Such PG, like minimal aortic and mitral, does not require treatment. Patients with a slight back wave are advised to undergo regular preventive examinations and avoid severe physical overload.

The presence of such changes has little effect on the rate of progression of acquired heart defects in rheumatism, endocarditis, etc.

There are many diseases associated with the cardiovascular system, all of them are life-threatening, since it is this system that delivers nutrients and oxygen to all parts of the body. One of the pathological processes associated with blood flow is regurgitation of heart valves. Many people have heard this definition, but they have little understanding of what it is and how much it affects life.

Regurgitation of the heart valves determines the process of blood flow in the opposite direction. This happens for various reasons. Depending on the volume of the flow passing, degrees of regurgitation are distinguished, for example, blood can flow back from one part of the heart to another, or maybe affect the entire circulatory system.

Detection of such pathology has become easier with the use of ultrasound (ultrasound) of the heart. The method shows how the valves close and close and where the blood flows.

Causes and mechanism of development

The human heart is a four-chamber structure, the cavities of which are separated by valves. This prevents the mixing of venous and oxygenated arterial blood, which ensures smooth functioning of the heart.

The mitral valve leaflets (MV) are 2 folds of connective tissue located between the left ventricle and the atrium. Violation of their functioning can be caused by:

Infectious endocarditis.
Rheumatism.
Congenital heart defects.

The action of the causative factor leads to damage (sagging, sclerosis) of the mitral valve leaflets. The blood entering the left ventricle from the pulmonary veins and ejected into the aorta during systole partially enters the left atrium, since the valve remains half-open. This leads to increased load on the left ventricle and left atrium, pulmonary hypertension develops, and the volume of oxygenated blood entering the aorta decreases.

Cardiologists identify minor physiological regurgitation, which is possible under normal conditions. For example, 70% of tall adults have incomplete closure of the tricuspid valve, which the person is not aware of. Ultrasound reveals slight swirling flows when the valves are completely closed. This does not affect general blood circulation.

Pathology occurs during inflammatory processes:

rheumatism,
infective endocarditis.

The formation of scars after an acute heart attack, against the background of cardiosclerosis, in the area approaching the valve leaflets and threads, leads to breakdown of the necessary tension mechanism and changes the shape of the leaflets. Therefore, they do not completely close.

In a pathological process, an equally significant role is played by the diameter of the outlet, which must be blocked. Significant enlargement due to left ventricular dilatation or hypertrophy prevents the tight junction of the aortic valve leaflets.

Infectious endocarditis.
Rheumatism.
Mitral valve prolapse.
Congenital heart defects.
History of acute myocardial infarction.
Injuries and wounds of the chest.
Diseases leading to enlargement of the left side of the heart - angina pectoris, arterial hypertension (so-called relative mitral regurgitation).
Systemic diseases (amyloidosis, rheumatoid arthritis, Marfan syndrome, etc.).

Causes

The causes of damage to the aortic valves, the diameter of the hole between the left ventricle and the initial part of the aorta, are:

rheumatic inflammation localized along the line of valve closure - tissue infiltration at the initial stage leads to wrinkling of the valves, creating a hole in the center for the passage of blood during systole into the cavity of the left ventricle;
bacterial sepsis with damage to the endocardium and aortic arch;
warty and ulcerative endocarditis in severe forms of infection (typhoid fever, influenza, measles, scarlet fever), pneumonia, cancer intoxication (myxoma) - the valves are completely destroyed;
congenital defects (formation of two leaflets instead of three) involving the aorta, large ventricular septal defect;
specific autoimmune processes in the ascending aorta in chronic syphilis, ankylosing spondylitis, rheumatoid polyarthritis;
hypertension, atherosclerosis - the process of compaction of the valves with the deposition of calcium salts, expansion of the ring due to dilatation of the aorta;
consequences of myocardial infarction;
cardiomyopathy;
chest injuries with rupture of the muscles that contract the valves.

The reasons include complications of treatment of heart diseases using catheter radiofrequency ablation, as well as cases of destruction of the biological valve prosthesis.

The portion of the aortic arch closest to the heart is called the aortic root. It is its structure that influences the вЂњhealth of the valvesвЂќ and the width of the gate ring from the left ventricle. Root lesions include:

age-related or degenerative changes causing dilatation;
cystic necrosis of the middle layer of the aorta in Marfan syndrome;
dissection of the aneurysm wall;
inflammation (aortitis) with syphilis, psoriatic arthritis, ankylosing spondylitis, ulcerative colitis;
giant cell arteritis;
malignant hypertension.

Among the reasons, a negative effect of drugs used to reduce appetite in obesity was found.

This pathology occurs to a small extent in absolutely healthy people. But pronounced, ranging from moderate to severe, is already a rare phenomenon and is provoked by the following reasons:

congenital and acquired defects of the main вЂњmotorвЂќ of the body;
mitral valve prolapse;
previous endocarditis of an infectious nature;
previous myocardial infarction;
injuries.

In this case, several degrees of valvular pathology are distinguished. First-degree mitral regurgitation, in which the backflow appears as a vortex on the valve. In medicine, it is considered practically the norm and does not require correction with medications, but only observation.

In second-degree pathology, the flow penetrates the atrium to a distance not exceeding half its length. With the third degree, this distance increases by more than half, and with the fourth, the flow reaches the back wall, penetrates behind the ear or into the veins of the lung.

In addition, mitral valve regurgitation can be acute or chronic. Acute disease is caused by dysfunction of the papillary muscles or their rupture, acute rheumatic fever, etc. Chronic disease develops for the same reasons. Less commonly, it is caused by atrial myxoma, calcification of the mitral annulus, characteristic of older women, etc.

NMC affects people with one or more of the following pathologies:

Congenital predisposition.
Connective tissue dysplasia syndrome.
Mitral valve prolapse, characterized by regurgitation of 2 and 3 degrees.
Destruction and breakage of the chords, rupture of the valves of the mitral valve due to injuries in the chest area.
Rupture of the valves and chords with the development of infectious endocarditis.
Destruction of the apparatus that unites the valves in endocarditis resulting from connective tissue diseases.
Infarction of part of the mitral valve with subsequent scar formation in the subvalvular region.
Changes in the shape of the valves and tissues under the valves in rheumatism.
Enlarged mitral annulus in dilated cardiomyopathy.
Insufficiency of valve function in the development of hypertrophic cardiomyopathy.
MK insufficiency due to surgery.

Mitral regurgitation is often accompanied by another defect - mitral valve stenosis.

Sometimes regurgitation is observed in absolutely healthy people (degree 0вЂ“1), but it is insignificant and does not interfere with life. According to WHO, the incidence of this pathology is 50вЂ“70%.

The causes of more severe mitral regurgitation are varied:

Congenital heart diseases and changes in the valve apparatus.
Acquired heart muscle defects.
History of myocardial infarction.
Chest and heart injuries.
Infectious diseases of the heart (endocardium).
Valve prolapse.
Rheumatoid diseases.
Violation of the integrity and function of the muscles that move the valve leaflets.
In newborns, if the valvular area is filled with protein deposits.

In addition to diseases, chest injuries that damage the heart can lead to the development of regurgitation.

The chronic form is caused by:

Pathology of the aortic valve:
- rheumatism;
- bacterial endocarditis;
- autoimmune diseases: rheumatoid arthritis, lupus erythematosus;
- atherosclerosis;
- severe chest injuries;
- diseases of the gastrointestinal tract: Whipple's disease, Crohn's disease;
- valve damage that occurs as a side effect of certain medications;
- wear of the bioprosthetic valve.
Pathology of the ascending aorta and its root:
- enlargement of the aortic root in older people;
- aortitis caused by syphilis;
- hypertension;
- psoriasis;
- osteogenesis imperfecta;
- Reiter's syndrome;
- BehГ§et's disease;
- Marfan syndrome;
- cystic medial necrosis of the aorta.

Acute aortic valve insufficiency is also provoked by damage to the valve, root and ascending aorta. The causes of pathology include:

severe chest injuries;
infective endocarditis;
prosthetic valve dysfunction;
aortic aneurysm dissection;
paraprosthetic fistula.

congenital developmental anomalies or genetically determined pathologies of connective tissue;
inflammation of the endocardium of non-infectious (rheumatism, systemic lupus erythematosus) or infectious (bacterial, fungal endocarditis) nature;
structural changes: dysfunction of the papillary muscles, tears or ruptures of the chord, expansion of the mitral ring, cardiomyopathy arising from left ventricular hypertrophy.

From this article you will learn what tricuspid regurgitation is, its causes, symptoms and choice of treatment method (depending on the stage and form of the disease).

When there is incomplete closure of the tricuspid valve. In this condition, the patient experiences reverse blood flow from the right ventricle into the atrium.

The human circulatory system provides one-way blood flow. Blood moves from the ventricle to the atrium in one direction thanks to valves that close tightly with each contraction of the heart. If they are incompletely closed, then some of the blood returns to the ventricle (regurgitation).

The disease is treated by a cardiologist. The choice of treatment method depends on the severity of the pathology. Thus, grade 1 does not require specific treatment; doctors recommend simply monitoring the patientвЂ™s condition. Patients with stage 2 pathology undergo conservative treatment. And at degrees 3 and 4, the functioning of the cardiovascular system can only be restored through surgery.

Primary, the causes of which are the following diseases: rheumatism, endocarditis (acute inflammation of the inner wall of the heart), myocardial infarction, the formation of fibrous plaques in the heart tissue and genetic predisposition. Secondary. Such valve damage is observed due to its stretching during cardiomyopathy and pulmonary hypertension, which increase the functional load on the right ventricle.

KA insufficiency is divided into rheumatic and non-rheumatic (this also includes degenerative forms of RG. In young patients, RG on the aortic valve is usually associated with:

acquired rheumatic heart defects and combined with aortic stenosis, mitral valve disease (mitral regurgitation);

In addition to rheumatic heart damage, arterial hypertension with frequent hypertensive crises plays an important role in the formation of the return wave. A significant increase in blood pressure contributes to the expansion of the aortic root, contributing to the development of coronary artery insufficiency.

The main causes of RG are divided into dysfunction of the coronary artery and pathologies of its root.

Valve dysfunctions include:

congenital defects of the KA (bicuspid or quadricuspid), accompanied by incomplete closure of the semilunar valves or prolapse (bending of the valves). In children, the most common cause of congenital severe regurgitation is considered to be tetralogy of Fallot, hyperplasia of the pulmonary artery valve, and significant septal defects;

Acquired defects that are accompanied by RG include:

hemodynamic disorders after infective endocarditis and valvuvitis (inflammatory damage to the leaflets and endocardium);

Pathologies of the aortic root leading to RG include:

aneurysms;
root expansion due to arterial hypertension;
damage to the cardiovascular system in syphilitic aortitis;
Ehlers-Danlos syndrome (hereditary connective tissue disorder caused by defective collagen synthesis);
dilation of the coronary artery ring in patients with Marfan syndrome;
Reiter's syndrome, which develops with gonococcal or chlamydial infection;
blunt chest injuries.

Types, forms, stages

With NMC, the total stroke volume of the blood of the left ventricle is assessed. Depending on its quantity, the disease is divided into 4 degrees of severity (the percentage indicates the part of the blood that is redistributed incorrectly):

I (the softest) - up to 20%.
II (moderate) - 20-40%.
III (medium form) - 40-60%.
IV (heaviest) - over 60%.

When determining the characteristics of the movement of the mitral leaflets, 3 types of pathology classification are distinguished:

1 - standard level of mobility of the leaflets (in this case, painful manifestations consist of dilatation of the fibrous ring, perforation of the leaflets).
2 - destruction of the valves (the chords take the greatest damage, as they are stretched or ruptured, and a violation of the integrity of the papillary muscles also occurs.
3 - decreased mobility of the valves (forced connection of commissures, reduction in the length of the chords, as well as their fusion).

There are several degrees of mitral regurgitation. They differ in the volume of blood returned. There are only 4 stages:

First. The volume of reverse blood flow is less than 25%. Mitral regurgitation of the 1st degree at the beginning of its development is not characterized in any way, but on the electrocardiogram it is already possible to detect minor disruptions in the activity of the valves.
Second. With pathology of the second degree, a more significant hemodynamic failure is observed. Blood returns in a volume of over 25%, but not more than 50%. As a result, pulmonary hypertension appears. Regurgitation at this stage can cause disturbances in the functioning of the myocardium. An ECG reveals a malfunction of the heart.
Third. When the disease enters the third stage, the volume of returned blood exceeds 50%. At this stage, other diseases are often associated, for example, left ventricular hypertrophy. The electrocardiogram clearly shows cardiac dysfunction.
Fourth. Regurgitation of this degree refers to a severe form of pathology. Because of it, a person may completely lose his ability to work or become disabled. At this stage, only surgical intervention can prolong the patient's life.

Aortic regurgitation is classified based on the amount of blood flow from the aorta to the heart. There are 4 degrees of this pathology:

I degree: the jet does not extend beyond the outflow tract of the left ventricle.
II degree: the jet extends to the anterior mitral leaflet.
III degree: reaches the level of the papillary muscles.
IV degree: may reach the wall of the left ventricle.

Aortic regurgitation is a sign of valvular insufficiency, which can be acute or chronic. The acute form of the disease provokes a rapid disruption of hemodynamics, and if a person is not provided with timely medical care, the likelihood of developing cardiogenic shock increases.

Chronic aortic insufficiency is characterized by the absence of pronounced symptoms. Left ventricular dysfunction gradually develops, provoked by stagnation of venous blood in the pulmonary circle. The coronary arteries are also affected and diastolic blood pressure decreases. Chronic aortic regurgitation leads to a gradual decrease in left ventricular contractility.

Mitral regurgitation is most often observed in patients with heart disease, severe valve prolapse. Another reason is MC deficiency. This manifests itself as follows: the MK, or rather its doors, do not close completely. At the same time, the atrium continues to fill with blood, which flows through the veins from the lungs.

The consequence of overfilling is excessive stretching and increased pressure on the ventricle. It expands and thickens. This process is called dilatation.

At first, the functional impairment will not be noticeable to the patient. The cardiac mechanism compensates for blood flow. The cardiac cavities hypertrophy.

If a diagnosis of grade 1 regurgitation is made, which concerns damage to the mitral valve, then its clinical manifestations and consequences will not appear for many years. If the pathology is not eliminated, the likely outcome will be pulmonary hypertension.

The causes of this type of regurgitation are as follows:

MK prolapse;
Rheumatic disorders;
Deposition of calcium salts on the valve leaflets;
Atherosclerotic lesions;
Cardiac ischemia;
Autoimmune processes.

2nd degree of pathology is expressed by greater MC insufficiency. The flow can reach the middle of the atrium. Stagnation of the ICC and a number of other symptoms are possible.

Stage 3 damage means that the flow of blood in reverse flow penetrates to the posterior wall of the left atrium. Pulmonary hypertension may occur, but only if the myocardium cannot function normally. It leads to excess load on the right half. BCC deficiency is observed.

If grade 4 regurgitation is diagnosed, then the symptoms will be as follows:

Changes in blood flow;
Increased pressure according to the ICC;
Shortness of breath;
Flickering type arrhythmia;
Cardiac type asthma;
Swelling of the lungs.

Patients often experience heart pain. There is weakness and noticeable bluishness of the skin. Symptoms of mitral regurgitation are caused by the disease that caused the pathology.

At grade 1 or 2, no treatment is required. It is enough to be periodically observed by a cardiologist.

Valvular pathology of the aorta can manifest itself due to aortic valve insufficiency. Another option is changes in the functionality of the initial aortic section, which occurs in the presence of one of the possible inflammatory processes.

Rheumatic lesions;
Perforation of the aortic valves;
Congenital defects;
Inflammation of the valves as a result of infection.

Other causes may be arterial hypertension or atherosclerosis. With regurgitation, blood flow flows back into the left ventricle. The consequence is excess blood volume. At the same time, the blood that flows through the BCC decreases.

The mechanism will attempt to compensate for this lack of volume, and excess blood will inevitably flow into the aorta. With stage 1 damage, normal hemodynamics will be maintained for quite a long time. Symptoms do not appear for years.

If the pathology begins to progress, then there will be a load on the left half of the heart.

It occurs to the maximum extent, which leads to stretching of the myocardial wall, which simply cannot hypertrophy constantly and without consequences.

Heart failure, pulmonary hypertension, blood stagnation in the BCC and ICC occurs

Tricuspid valve pathology is a rare occurrence when considering an isolated lesion. Typically, subvalvular regurgitation of the tricuspid valve is a consequence of early changes in the structure of the left side. The characteristics of the pathology tell us that the lungs begin to enrich the blood with oxygen less.

Due to disruption of the normal flow through the vena cava, stagnation occurs in the venous part of the BCC.

When the tricuspid valve is damaged, the following symptoms appear:

Atrial fibrillation;
Blueness on the skin;
Edema;
Swelling of the veins in the neck;
Increased liver volume.

acute and chronic;
rheumatic and non-rheumatic;
associated with pathologies of the coronary artery, root or ascending aorta.

The development of acute coronary artery insufficiency in a short period of time leads to the formation of significant circulatory disorders due to the fact that the left ventricle does not have time to adapt to the increase in end-diastolic volume.

Excessive diastolic pressure in the LV cavity contributes to:

increased pressure in the pulmonary veins;
connection of the diastolic mitral RG;
pulmonary congestion.

In chronic AP, part of the effective volume is discharged back into the cavity of the left ventricle and its severe volume overload occurs. As a consequence of this process, compensatory development of eccentric LV hypertrophy occurs.

Subsequently, the compensatory capabilities of the myocardium are exhausted, the LV walls become thinner and the following develops:

dilatation of the LV cavity;
a sharp decrease in ejection fraction and CO (cardiac output).

In accordance with the localization of heart valve disorders, they are divided into classifications:

Mitral regurgitation occurs when blood flow from the left ventricle of the heart flows back into the atrium. This leads to its stretching and increased work and wear. At first, this is not noticed by a person in any way, since the heart compensates for the pathology by changing its shape. Its causes include diseases of the heart and blood vessels, joints and muscles, dysfunction of valves, deposits of cholesterol and calcium on the inner walls of blood vessels and myocardium, some connective tissue pathologies, autoimmune processes, improper functioning of metabolic processes, decreased blood supply to certain areas of the body;
Aortic regurgitation is formed when the valves are not completely closed or there are pathologies associated with the structure of the largest unpaired vessel, when, as it expands, the valve ring also enlarges and the valve simply cannot close completely. Here, a reverse flow of blood occurs into the ventricle, which begins to fill excessively, stretching, it takes in more blood, and much less of it enters the vessel. At the same time, the heart begins to pump blood faster and stronger. As a result, oxygen starvation, stagnation of blood in large vessels;
Tricuspid regurgitation is less common. Occurs when the pressure in the small circle is too high. Leads to devastation of the right side of the heart, after which stagnation occurs in the veins of the systemic circle. Externally, this may manifest itself in blueness of the skin, an increase in the size of the liver, swelling of the veins in the neck, atrial fibrillation;
Pulmonary artery regurgitation can occur with atherosclerosis, syphilis, endocarditis, or be congenital. This pathology often occurs in diseases of the pulmonary system. It is an incomplete closure of the valve in the artery of the pulmonary circulation.

Forms of mitral insufficiency

Mitral regurgitation grades 1 and 2

Mitral regurgitation of the 1st degree (minimal) is the most initial degree of divergence of the valves. Their deflection into the left atrium occurs by no more than 3вЂ“6 mm. This degree is usually not clinically manifested. When listening to the heart (auscultation), the doctor may hear a characteristic murmur at the apex or a вЂњclickвЂќ of the mitral valve, characteristic of prolapse. Confirmation of regurgitation is possible only with echocardiographic examination of the heart (ultrasound).

Mitral regurgitation of the 2nd degree is the return of blood in a volume of 1/4 or more of the total amount of blood in the left ventricle. Valve prolapse can range from 6 to 9 mm. At this degree, the load on the left ventricle becomes greater as the volume of blood that needs to be pumped increases.

In addition, the pressure in the pulmonary veins and throughout the pulmonary circulation increases. All this is manifested by complaints in the form of shortness of breath, weakness and fatigue, heart rhythm disturbances, and sometimes pain in the heart area. The patient may experience presyncope and fainting conditions. If left untreated, heart failure may develop.

Mitral regurgitation of the 3rd degree is the return of blood from the ventricle to the atrium in a volume of more than 1/2 of the volume of the ventricle. In this case, prolapse can amount to more than 9 mm of valve deflection. This is a severe degree that overloads not only the left parts of the heart, but also the right. Pulmonary failure develops with severe shortness of breath, cyanosis of the skin, cough and wheezing during breathing. Heart failure manifests itself in the form of edema, portal hypertension (increased pressure in the liver vessels), and heart rhythm disturbances.

Grade 4 mitral regurgitation is an extremely serious condition, which is accompanied by heart failure and occurs when the blood of the left ventricle returns in a volume of more than 2/3.

cardioportal.ru

Minimal disruption of blood flow, which is completely asymptomatic. The presence of a backflow of blood up to 2 cm long. Regurgitation is more than 2 cm. The disease is accompanied by acute heart failure.

The term вЂњregurgitationвЂќ is quite often used by doctors of various specialties - cardiologists, therapists, functional diagnosticians.

Many patients have heard it more than once, but have little idea what it means and what it threatens. Should we be afraid of having regurgitation and how to treat it, what consequences to expect and how to identify it? Let's try to find out these and many other questions.

Regurgitation is nothing more than the reverse flow of blood from one chamber of the heart to another. In other words, during contraction of the heart muscle, a certain volume of blood, for various reasons, returns to the cavity of the heart from which it came. Regurgitation is not an independent disease and therefore is not considered a diagnosis, but it characterizes other pathological conditions and changes (heart defects, for example).

A detailed description of regurgitation, identification of its degrees and detection in a large number of people became possible with the use of ultrasound examination of the heart (echocardiography), although the concept itself has been known for quite a long time. Listening to the heart provides subjective information, and therefore does not allow one to judge the severity of the return of blood, while the presence of regurgitation is not in doubt except in severe cases.

The prevalence of pathology is recorded exclusively among professional functional diagnostic specialists. The degree cannot be judged in relation to the total population. Only the extent of spread is taken into account by the number of patients who underwent Doppler examination.

Signs of reverse blood flow through the heart, namely through the aorta, have so far been found in just under 9% of women and 13% of male patients. Among all variants of pathology, the most common is aortic. It occurs in one out of ten subjects.

We are talking about a chronic pathology. The effects are most noticeable in older men. The consequences of regurgitation can affect the large (BCC) and pulmonary circulation (PCC).

There are four degrees of reverse blood transfusion:

With grade 1 valve regurgitation, there are no symptoms for several years. A large amount of returning blood enlarges the heart, which can cause, if proper treatment is not followed upon detection, a persistent increase in blood pressure. When examining the patient, a heart murmur is detected, ultrasound shows a slight discrepancy in the valve and a slight disturbance in blood flow.
Stage 2 regurgitation of heart valves is characterized by greater severity of the returning flow. There is stagnation in the small circle.
Stage 3 valve regurgitation is characterized by a large backflow, the flow of which reaches the posterior wall of the atrium. Here an increase in blood pressure develops in the pulmonary artery, due to which there is an overload on the right side of the heart muscle. As a result of this disorder, insufficiency occurs in the systemic circulation.

In the last stage, shortness of breath, heart rhythm disturbances, asthma, and pulmonary edema appear. If you do not consult a doctor for help, swelling, blueness of the skin (skin acrocyanosis), weakness, fatigue, and pain in the chest area appear.

The severity of the stages is determined by the power of the blood stream that returns to the ventricle or atrium:

does not extend beyond the anterior leaflet of the valve connecting the left ventricle to the atrium;
reaches or crosses the gate;
the magnitude of the flow approaches half the length of the ventricle;
the stream touches its top.

There is also prolapse of the bicuspid heart valve, due to which there is a backflow of body fluid of varying degrees. Previously, this diagnosis was not made often. This is due to newer ways of detecting the disease. The use of the Doppler method helped to determine the exact amount of the returning jet.

Heart valve prolapse is found in thin, tall people, and teenagers. In most cases, the disease does not cause any ailments in the patient and is detected in young people by chance, undergoing various medical examinations, for example, when entering college, or before being drafted into the army.

If the degree is first or even zero, then there is no need for treatment. The main thing is not to miss the transition to the formation of complications; for this you need to be examined by a doctor.

What happens in the heart during the development of regurgitation

Doctors identify the following most common causes of the development of this disease:

Typically, tetralogy of Fallot is diagnosed in early childhood due to severe symptoms in a child who is immediately operated on. The disease in question often causes thickening of the walls of the right heart ventricle. This, in turn, can lead to the development of heart failure. In another case, an existing pathology can provoke the occurrence of this disease.

In medicine there is the concept of physiological regurgitation. This condition is called physiological only if the changes resulting from pathology are insignificant. That is, the blood flow at the valve slows down, but the heart muscle does not undergo any negative changes and remains healthy. Typically, grade 1 regurgitation is considered a physiological phenomenon.

Blood enters the atria from the vessels (venous to the right, arterial to the left). Filled with blood, the atria contract, pushing their contents into the ventricles, and the valves open (tricuspid on the right, mitral on the left). After all the fluid has flowed into the ventricles, the valves close tightly, preventing reverse blood flow. After the valves close, a powerful contraction of the ventricles occurs, and blood rushes through the arteries.

The left side of the heart works with a higher load, because it supplies blood to all organs and tissues of the body. This happens normally.

To accommodate the blood flowing from the ventricle and entering through the veins, the atrium chamber gradually increases. Moreover, due to the fact that the atrial cavity is partially filled at the moment of relaxation, blood flow in the pulmonary veins worsens, leading to stagnation in the pulmonary circulation. The flow of increased blood flow from the atrium into the ventricular cavity gradually leads to its increase.

The degree of health risk associated with this pathology depends on the size of the regurgitation and how it develops.

In acute valvular insufficiency, symptoms increase quickly.

A person develops:

stagnation of blood, first in the pulmonary and then in the systemic circulation; pulmonary edema, often bilateral; failure of both ventricles; cardiogenic shock.

Such patients require urgent hospitalization and resuscitation measures. If assistance is not provided in a timely manner, death can occur.

In this case, the pathology develops gradually, at the initial stage it can be asymptomatic or accompanied by minor pain and shortness of breath with little physical exertion.

With further development of the disease:

cardiac decompensation occurs; stagnation of pulmonary blood flow develops; disturbances occur in the functioning of first the right atrium, and then the ventricle.

If the disease was not diagnosed in a timely manner and the person did not begin treatment, then the heart subsequently increases in size and is no longer able to provide adequate blood supply to organs and tissues. Insufficiency of the systemic circulation develops.

Features of regurgitation in children

In childhood, the proper development and functioning of the heart and circulatory system is very important, but disorders, unfortunately, are not uncommon. Most often, valve defects with insufficiency and return of blood in children are caused by congenital developmental anomalies (tetralogy of Fallot, hypoplasia of the pulmonary valve, defects of the septa between the atria and ventricles, etc.).

Regurgitation in children is usually congenital. Disturbances in the functioning of the heart are quite common.

Congenital heart valve defects, which result in regurgitation, are caused by the following anomalies:

Pulmonary valve hypoplasia;
Partition defects;
Tetralogy of Fallot.

If the structure of the heart is abnormal, the symptoms of regurgitation are visible soon after birth. The most common symptoms are respiratory distress, bluish skin, and right ventricular failure. Significant violations often lead to death.

Experts recommend that future parents, especially mothers, carefully monitor their own health before trying to conceive. During pregnancy, it is necessary to be observed by your doctor. Regular ultrasound examinations are mandatory.

Heart valve regurgitation in children mainly occurs due to congenital causes. Such cases occur quite often. A pronounced manifestation of the disease is noted almost immediately after birth.

Signs on the face: blue skin color, difficulty breathing, heart failure in the right side of the heart. Such disorders can lead to the death of the newborn, so during pregnancy it is necessary to visit a specialist for routine examinations.

Mitral valve insufficiency symptoms and signs

Mitral valve insufficiency (insufficiency of the left atrioventricular orifice) is non-closure (or incomplete closure) of the mitral valve leaflets, leading to pathological reflux of blood (regurgitation) into the left atrium from the left ventricle during its systole. In this article, we will look at the symptoms of mitral valve regurgitation and the main signs of mitral valve regurgitation in humans.

Prevalence

Isolated rheumatic mitral valve insufficiency is observed in 10% of cases of all acquired defects. Occurs more often in men. Often combined with mitral stenosis or aortic valve defects.

Pathogenesis of mitral valve insufficiency

In this case, rupture of the tendon threads may occur. In this regard, the aphorism вЂњmitral regurgitation gives rise to mitral regurgitationвЂќ is correct. Dilatation of the left atrium leads to tension on the posterior mitral valve leaflet and increased mitral valve non-closure, which further aggravates mitral valve regurgitation.

Constant overload of the left ventricle with excess blood volume leads to hypertrophy of its walls. An excess amount of blood in the left atrium subsequently causes a retrograde increase in pressure in the pulmonary circulation and the development of pulmonary hypertension (unlike mitral stenosis, it develops much later and is much less pronounced). In an advanced stage of mitral valve insufficiency, chronic heart failure develops (right ventricular type).

Signs of mitral valve insufficiency

Clinical manifestations of mitral valve insufficiency depend on the degree of regurgitation, the speed and cause of its development, as well as on the functional state of the left ventricle and left atrium.

Symptoms of mitral valve insufficiency

With mild mitral valve insufficiency, there may be no complaints. With moderate insufficiency and a slight increase in pressure in the pulmonary circulation, rapid fatigue during physical activity (low cardiac output does not provide skeletal muscles with sufficient oxygen) and shortness of breath, which quickly disappear with rest, are a concern.

Severe mitral valve insufficiency and more severe pulmonary hypertension are characterized by the occurrence of shortness of breath with minor physical exertion, attacks of nocturnal paroxysmal shortness of breath, pulmonary congestion, and hemoptysis. Acute mitral valve insufficiency (during myocardial infarction) is manifested by pulmonary edema or cardiogenic shock.

Examination for mitral valve insufficiency

With mild mitral valve insufficiency, there are no external manifestations of the defect. In the advanced stage of mitral disease, there are characteristic manifestations of chronic heart failure.

Percussion for mitral valve insufficiency

Characteristic is the expansion of the boundaries of relative cardiac dullness to the left with severe mitral valve insufficiency.

Palpation for mitral valve insufficiency

The apical impulse is shifted to the left and downward due to dilatation of the left ventricle. With severe mitral valve insufficiency, systolic vibration is detected at the apex of the heart.

Auscultation of the heart with mitral valve insufficiency

Heart sounds

The first tone is usually weakened (difficult to assess with pronounced systolic murmur). The II tone is not changed if there is no severe pulmonary hypertension. With a significant shortening of the ejection time of the left ventricle, a paradoxical splitting of the second sound occurs. Additionally, a pathological third sound is heard in diastole, which occurs with sudden tension of the papillary muscles, tendon threads and valves. It (together with a weakened first sound) is considered an important auscultatory sign of severe mitral valve insufficiency.

When pulmonary hypertension occurs, listen to the accent of the second tone above the pulmonary trunk in the second intercostal space to the left of the sternum.

Systolic murmur due to mitral valve insufficiency

The main symptom of mitral valve insufficiency is systolic murmur. It is holosystolic (throughout the entire systole) and captures the first and second heart sounds. The murmur is most pronounced at the apex of the heart; it can radiate to the left into the axillary region when the anterior leaflet is affected and upward along the sternum when the posterior leaflet is affected. The noise increases with increasing afterload (isometric arm tension).

ECG for mitral valve insufficiency

In sinus rhythm, signs of hypertrophy and dilatation of the left atrium are detected. Signs of left ventricular hypertrophy are recorded in advanced stages of mitral valve insufficiency. When the defect is complicated by atrial fibrillation, its signs appear on the ECG.

Echocardiography for mitral valve insufficiency

Echocardiography allows you to identify the cause of mitral valve insufficiency (according to its morphology), assess the degree of regurgitation and the function of the left ventricle and atrium.

Rheumatic mitral valve insufficiency is characterized by thickening of its leaflets (especially at the edges) and tendon threads. The posterior leaflet may be less mobile than the anterior one due to subvalvular adhesions.

Infectious endocarditis. Mitral valve insufficiency in infective endocarditis is characterized by the presence of vegetation, perforation of the leaflets, and separation of tendon threads. These changes can be more accurately detected by transesophageal echocardiographic examination.

IHD. Mitral valve insufficiency in ischemic heart disease is characterized by dilatation of the left ventricular cavity, local disturbances in the movement of the walls of the left ventricle (dyskinesis), normal (non-thickened) mitral valve leaflets and the central location of the regurgitation jet in most cases.

I degree, minor, - the length of the regurgitation jet is up to 4 mm from the base of the mitral valve leaflets into the left atrium.

II degree, moderate, - 4-6 mm.

III degree, average, - 6-9 mm.

IV degree, pronounced - more than 9 mm.

It should be remembered that the volume of regurgitation depends on the size of the hole remaining between the mitral valve leaflets when they close, the magnitude of the pressure gradient between the ventricle and the atrium, and the duration of regurgitation. The degree of mitral regurgitation is not fixed and can vary in the same patient depending on the conditions and the JTC used.

X-ray examination of mitral valve insufficiency

With severe mitral valve insufficiency, dilatation of the left atrium and its appendage (third arch) and enlargement of the left ventricle (fourth arch) are detected. Cardiomegaly is found in advanced stages of the disease.

Signs of pulmonary hypertension on an x-ray may be absent if the defect is mild. With severe mitral regurgitation, characteristic signs of pulmonary hypertension appear.

Catheterization of cardiac cavities for mitral valve insufficiency

I degree - less than 15% of the stroke volume of the left ventricle.

II degree - 15-30%.

III degree - 30-50%.

IV degree - more than 50% of the stroke volume.

The severity and severity of MCT depends on the degree of its development in the body:

Stage 1 of the disease has no specific symptoms.
Stage 2 does not allow patients to carry out physical activity in an accelerated manner, since shortness of breath, tachycardia, pain in the chest, loss of heart rhythm, and discomfort immediately appear. Auscultation with mitral insufficiency determines increased tone intensity and the presence of background noise.
Stage 3 is characterized by left ventricular failure and hemodynamic pathologies. Patients suffer from constant shortness of breath, orthopnea, increased heart rate, chest discomfort, and their skin is paler than in a healthy state.

The presence of mitral valve regurgitation can be suspected during examination and auscultation, as well as in the presence of complaints corresponding to a certain degree. The patient is prescribed laboratory tests of blood and urine. With their help, you can identify inflammation, changes in protein and blood sugar levels, as well as characteristic indicators of concomitant diseases. Instrumental diagnostic methods will help confirm the diagnosis:

Electrocardiography may show signs of left heart enlargement, ischemia, and arrhythmia.
X-ray examination of the chest organs. The image shows the expanded borders of the heart, signs of pulmonary edema and other pathology.
Daily ECG monitoring. A study is carried out using a device that monitors heart function throughout the day. It helps to determine rhythm patterns at different times of the day and note short-term rhythm disturbances.
Heart ultrasound (echocardiography) is the most accessible and reliable method for diagnosing heart pathology. This type of study helps determine the enlargement of the heart and the presence of changes in the valve apparatus. Using ultrasound, you can visually observe the presence of reverse blood flow in the cavities of the heart and determine the degree of regurgitation.
Transesophageal ultrasound helps to examine the mitral valve in more detail. This type of diagnosis is also indicated before valve repair.
Before surgical treatment, cardiac catheterization is performed.
It is very important to determine the pathology of the valve apparatus in the fetus. For this purpose, an ultrasound examination is performed during pregnancy.

What is cardioneurosis, symptoms and treatment

In case of acutely developed mitral valve insufficiency (for example, resulting from rupture of the papillary muscles during myocardial infarction), minutes count and immediate medical attention is required.

Chronic mitral regurgitation does not manifest itself for a long time, although the disease only progresses over time.

There are four degrees of the disease:

MK insufficiency of the 1st degree. No complaints. Auscultation reveals a quiet, soft systolic murmur at the apex of the heart, which is better heard when the patient lies on his left side. On R-graphy and ECG, the changes are nonspecific. On echocardiography, grade 1 mitral regurgitation is manifested by slight divergence of the leaflets and minimal reverse blood flow.
MK insufficiency of the 2nd degree. The first complaints appear: weakness, fatigue, shortness of breath during physical activity (due to the load on the pulmonary circulation). The systolic murmur at the apex persists, and the first sound weakens. The R-graph and ECG still show no signs of the disease. Ultrasound of the heart with a doler detects the reverse movement of blood to a distance of 1.5 cm and below.
Insufficiency of MK 3 degrees. Complaints intensify: shortness of breath with slight exertion, accompanied by a cough with difficult to separate viscous sputum, a feeling of palpitations, вЂњsomersaultsвЂќ of the heart in the chest. On examination, there is a pallor of the face with cyanosis of the lips and tip of the nose. On the ECG and R-graphy, the first signs of left ventricular hypertrophy appear: levogram, expansion of the heart shadow. Echocardiography indicates a backflow of blood occupying half of the atrium.
Insufficiency of uric acid 4 degrees. Terminal stage of the disease: clear signs of heart failure, pulmonary hypertension, painful cough streaked with blood. A typical appearance of the patient: a pale face with a bright bluish blush caused by a lack of oxygen in the peripheral tissues. A вЂњheart humpвЂќ appears - a pulsating projection of the heart on the left side of the chest. ECG and X-ray indicate an increase in the left volumes of the heart: a sharp deviation of the EOS to the left, smoothing of the waist of the heart and a displacement of the border (the outline of the organ takes the shape of a shoe). Ultrasound records the complete filling of the atrium with blood during cardiac ejection.

Most patients with this pathology do not feel any discomfort or unpleasant sensations, but gradually, as the volume of the left atrium increases, pulmonary pressure increases, as well as remodeling of the left ventricle. The patient begins to suffer from shortness of breath and fatigue, increased heart rate, that is, signs of heart failure appear.

Mitral regurgitation of the 1st degree does not have such signs, but in moderate and severe forms, palpation reveals an enlargement of the left atrium. The left ventricle is hypertrophied. In addition, noise is audible when listening.

The latter increase when squatting and shaking hands. That is, we are talking about a complication of mitral regurgitation associated with the above-described symptoms of heart failure and atrial fibrillation.

Prevalence

Heart sounds

II degree - 15-30%.

The clinical manifestations of this pathology will correspond to the severity of its development.

0вЂ“1 degree of regurgitation is recognized as a physiological feature. It often occurs in tall and thin people. Pathology of the 1st degree is asymptomatic for a long time, since the heart manages to compensate for this condition by expanding the cavities of the heart and thickening its walls. The only clinical sign of regurgitation is the presence of a murmur that can be heard by auscultation at the apex. At this time, the person does not feel any problems in the heart and, accordingly, does not complain.

Pathology 2 degrees. In this case, more blood is pumped in, the volume of which reaches the middle of the atrium. If the return of blood is more than 25% of the total volume, then stagnation occurs in the pulmonary circulation. This condition is manifested by characteristic symptoms:

pain in the chest, in the area of вЂ‹вЂ‹вЂ‹вЂ‹the projection of the heart;
feeling of chest tightness and lack of air;
rapid breathing;
interruptions in heart function;
lethargy, constant fatigue, possible loss of consciousness.

If the reverse flow of blood reaches the posterior wall of the atrium, then grade 3 regurgitation develops. In this case, the myocardium can no longer cope with such a load and pulmonary hypertension occurs. This, in turn, contributes to overload of the right side of the heart. Insufficiency of the systemic circulation develops. The patient has an increase in liver size and swelling. Hypertension develops.

With the development of grade 4 pathology, a pronounced disturbance of intracardiac circulation and worsening pulmonary hypertension are observed. The patient may develop pulmonary edema, arrhythmias, and cardiac asthma. The symptoms correspond to the underlying disease, which caused mitral valve incompetence.

If the patient develops minimal grade 1 mitral regurgitation, then no clinical signs will be observed. A person can live for several years and not suspect that the functioning of his heart is impaired.

As the disease progresses, the patient experiences symptoms such as shortness of breath, rapid heartbeat, fatigue, and coughing up blood. If left untreated, a person experiences swelling of the legs, disruption of the sinus rhythm of the heart, hypoxia, and heart failure.

In most cases, stage 1 of the disease does not have clearly defined symptoms. Some patients may experience signs of heart failure.

If the sick person does not have this ailment, such symptoms may occur due to impaired functioning of the right cardiac ventricle. Regurgitation of the 1st degree as an independent pathology does not cause significant disturbances in the human circulatory system.

This is due to the expansion of the chambers and thickening of the walls of the heart muscle.

Despite the hidden heart defect at the first stage, some patients experience the following symptoms:

severe shortness of breath;
blue discoloration of the skin;
mild hypertension;
swelling;
weakness;
dizziness.

In cases where this pulmonary artery defect is congenital, the disease manifests itself in the first few months of the childвЂ™s life. Most sick children have severe symptoms due to the severe form of the disease.

It is for this reason that both adults and children should annually undergo appropriate procedures and tests that will help identify the disease at an early stage.

Chronic aortic insufficiency manifests itself when a person's left ventricular function is impaired. Symptoms:

shortness of breath (at first observed only during physical activity, but at rest indicates the progression of the disease);
bradycardia, most often at night;
angina pectoris (less commonly).

The acute form of the disease is characterized by the following manifestations:

severe shortness of breath;
fainting;
chest pain;
loss of strength.

Acute aortic regurgitation, which occurs with valvular insufficiency, has symptoms similar to aortic dissection. Therefore, if a person experiences the symptoms listed above, he needs emergency medical help.

There are also symptoms indicating aortic valve insufficiency:

rhythmic change (pulsation) in the color of the tongue, palate, tonsils and nail plates;
constriction of the pupils, alternating with their dilation;
pronounced pulse in the temporal, carotid and brachial arteries;
pale skin.

If a person experiences similar symptoms, he should consult a cardiologist. Aortic insufficiency, like any other disease of the heart and blood vessels, must be diagnosed in a timely manner.

Mitral regurgitation of the 1st degree often does not manifest itself at all, and the person remains practically healthy. Thus, this pathology is found in 1.8% of healthy children aged 3вЂ“18 years, which does not interfere with their future life at all.

Main symptoms of the pathology:

fast fatiguability;
heartbeat;
shortness of breath, first with exertion, then at rest;
if the conduction of impulses from the pacemaker is disrupted, atrial fibrillation;
manifestations of chronic heart failure: edema, heaviness in the right hypochondrium and enlarged liver, ascites, hemoptysis.

Listening to the tones (sounds) of the heart, the doctor discovers that the 1st tone (which normally occurs when the valve flaps between the ventricle and the atrium closes) is weakened or completely absent, the 2nd tone (normally appearing due to the simultaneous closure of the valves of the aorta and pulmonary trunk) is split into aortic and pulmonary components (that is, these valves close asynchronously), and between them the so-called systolic murmur is heard.

The final diagnosis is made by Doppler echocardiography. The approximate volume of regurgitation, the size of the heart chambers and the safety of their functions, and the pressure in the pulmonary artery are determined. With echocardiography, you can also see prolapse (sagging) of the mitral valve, but its degree does not affect the volume of regurgitation in any way, so it is not important for further prognosis.

The presence of visible pulsation of the neck veins. Swelling of blood vessels in the left side of the sternum and right hypochondrium. Progressive swelling of the soft tissues of the legs. Loss of performance and fatigue. Frequent feeling of вЂњchillinessвЂќ. Feeling of rapid heartbeat. Frequent urination. Shortness of breath, which first bothers the patient during physical activity, and then is diagnosed at rest. Periodic attacks of abdominal pain. A yellow tint to the skin, which is combined with painful sensations in the right hypochondrium.

The severity of the above symptoms depends on the individual characteristics of the body and the degree of damage. For example, a patient diagnosed with tricuspid regurgitation at the initial stage has no pathological symptoms. A pronounced clinical picture is usually observed in phases 3вЂ“4 of the disease, when radical intervention is required.

pronounced pulsation on large aortic trunks;
вЂњcarotid danceвЂќ (visible pulsation in the carotid arteries);
pulsating pupils;
fainting conditions;
pallor and cyanotic tint of the skin;
liver enlargement;
displacement of the cardiac borders to the left;
the appearance of diastolic murmur in the 2nd intercostal space on the left;
chest pain.

Diagnostics

Indirect signs of aortic regurgitation are noted in:

chest x-ray - the left contour of the cardiac shadow is expanded to the side and down, the expansion of the aortic arch is similar to an aneurysm, clear signs of enlargement of the left atrium, calcifications may be detected in the aortic arch;
electrocardiogram - overload of the left chambers of the heart is revealed.

In the diagnosis of regurgitation, echocardiography serves as the main objective method; it allows one to determine the cause, the degree of regurgitation, the sufficiency of compensatory reserves, and circulatory disorders even in the asymptomatic stage of the disease with minimal disturbances. It is recommended for patients in the initial stage annually, and twice a year when clinical symptoms appear.

The calculations take into account the surface area of вЂ‹вЂ‹the patient's body, due to the lack of pronounced expansion of the ventricular chamber in short people.

The most commonly used mode is color Doppler scanning. The sensors are installed in such a way as to measure the area of вЂ‹вЂ‹blood flow at the aortic valves, in the initial part of the aorta, and compare it with the width of the passage. In severe cases, it exceeds 60% of the ring diameter.

In the practice of cardiologists, a division of the return jet into 4 degrees is used in relation to its length to the size and internal formations of the left ventricle:

1 - does not extend beyond half the length of the anterior leaflet at the mitral valve;
2 - reaches or crosses the gate;
3 - the magnitude of the flow approaches half the length of the ventricle;
4 - the jet touches the top.

If information from Doppler sonography is not enough, the following is carried out:

magnetic resonance imaging;
radionuclide angiography;
cardiac catheterization.

The degree of this pathology is determined by Doppler echocardiography. In addition, the doctor may additionally recommend undergoing Holter monitoring, taking an x-ray, donating blood for analysis and undergoing a stress test, for example, undergoing a procedure such as bicycle ergometry. Only after this does the doctor decide on reasonable therapy.

In case of acute mitral regurgitation, emergency mitral valve repair or replacement is performed. Surgeons cannot determine the ideal time for the operation, but if it is done before the development of ventricular decompensation, including in children, the chances of preventing deterioration in the functioning of the left ventricle increase.

It must be said that pathology of the first and second degrees is not a contraindication to pregnancy and childbirth, but in more severe cases it is necessary to first assess all the risks and only then make a decision.

The prognosis is largely determined by the functions of the left ventricle, the degree and duration of this pathology, its severity and causes. As soon as the disease manifests itself first with minimal and then with pronounced symptoms, then every year approximately 10% of patients are admitted to the hospital with clinical manifestations of mitral regurgitation. About 10% of patients with chronic pathology require surgical intervention.

Common methods for detecting NMC:

If there is the slightest suspicion of cardiac dysfunction, you should contact a cardiologist. You can also first visit a therapist, who, if necessary, will refer you to the right specialist. During the examination, the doctor studies the symptoms, medical history, and conducts auscultation.

If there is regurgitation, then when listening, the doctor reveals that the first tone is very weak or does not appear at all, and the second tone is divided into two sounds and is accompanied by a systolic murmur. The presence of noise suggests a violation of blood flow in the heart.

In severe cases of pathology, listening shows the appearance of an additional third tone. It appears due to the fact that the ventricle quickly fills with a large volume of blood.

To make an accurate diagnosis, the doctor prescribes echocardiography (ultrasound of the heart). This method allows you to assess the condition of the organ, its activity, determine the pressure in the pulmonary artery, and detect cardiac pathologies and defects. As an addition, the doctor may prescribe phonography and magnetic resonance imaging.

Modern technology can do everything possible to ensure that pulmonary regurgitation is diagnosed as quickly as possible. This can be done using an ultrasound examination, which will reveal any changes in the functioning of the heart.

Doppler sonography is designed to determine the nature of blood movement in the heart chambers of a particular person. After receiving the results, the attending physician compares them with the norms. Echocardiography is the best way to determine the disease. They show the work of the heart muscle in real time.

An ECG is another assistant in making a diagnosis. It is able to identify some signs of the disease that are not symptomatic. An ultrasound will determine this pathology in an unborn child. In most cases, it is caused by chromosomal abnormalities.

Treatment can only be prescribed by a doctor who has compared the patientвЂ™s symptoms and well-being with the degree of pathology. Also, the prescription of a specific list of medications and procedures should take into account the chronic diseases a person has and the presence of heart failure.

Surgery gives the best results. With the help of surgery, the patient has a defective valve replaced with a healthy one. Stage 1 disease most often does not involve complex therapeutic treatment regimens, and the latter is only due to the use of medications.

With the help of medications, the patient will be able to normalize blood flow, eliminate arrhythmia and improve tissue circulation. Typically, such diseases are dealt with by a cardiologist. It is he who will be able to prescribe the appropriate treatment, taking into account all the characteristics of the patient.

Self-therapy for pulmonary regurgitation is unacceptable. The lack of qualified assistance or incorrectly selected medications will only worsen the patientвЂ™s situation and well-being and can lead to complications. Before starting treatment, the cardiologist conducts a number of tests, compares their results and contraindications that the person has. Only after this the patient is prescribed a list of medications suitable for him.

Modern research methods help not only to make an accurate diagnosis, but also to determine the extent of the disease. If aortic regurgitation and aortic insufficiency are suspected, the patient should undergo the following tests:

Electrocardiogram: informative only in severe cases of the disease.
Phonocardiogram: a diastolic murmur is heard coming after the second sound.
X-ray of the heart: reveals an increase in the size of the organ due to enlargement of the left ventricle and expansion of the ascending aorta.
Echocardiography: the most informative diagnostic method.
Aortography: the degree of regurgitation is determined.
Catheterization: assessment of the regurgitation wave and pulmonary capillary pressure (during the study of the right sections), assessment of the amplitude of pulse pressure (left sections).

X-ray. An X-ray will show enlargement of the left chambers of the heart. With advanced pathologies, enlargement of all parts of the organ is possible. ECG. This method is not very informative. Only in the case when the posterior papillary muscle of the myocardium is affected, negative T waves are recorded on the electrocardiogram in leads II and III, and moderate tachycardia is noted.

Echocardiography. The study makes it possible to determine the size of the valve gap at the moment of closure of the valves, the amount of backflow and the cause of the disorder (prolapse, rupture of the valve muscles or destructive changes). Through esophageal echocardiography. It is used infrequently, mainly in severe cases.

Cardiac patients undergo the following diagnostic measures:

Visually examine the patient and listen to heart sounds using a phonendoscope. Ultrasound examination, which allows you to determine the condition of the heart tissue and valve. Electrocardiography. The method determines early signs of enlargement of the right stomach and atrium. X-ray of the chest organs. Such a study determines disturbances in the operation of the valve system. Cardiac catheterization is an innovative, minimally invasive procedure used to diagnose and treat cardiac diseases.

Click on photo to enlarge

Medicine does not stand still, and the diagnosis of diseases is becoming more reliable and of high quality. The use of ultrasound has made significant progress in detecting a number of diseases. The addition of ultrasound examination of the heart (EchoCG) with Dopplerography makes it possible to assess the nature of blood flow through the vessels and cavities of the heart, the movement of the valve leaflets at the time of myocardial contractions, to determine the degree of regurgitation, etc.

Review of tricuspid regurgitation: causes, degrees, treatment

The choice of treatment method depends on the stage of the disease and the causative factor that caused it. If possible, medical correction of the condition is carried out: bicillin prophylaxis for rheumatism, taking antihypertensive, antiarrhythmic drugs, nitrates, beta blockers. Mitral regurgitation of the 1st degree does not require special treatment methods, you just need to be regularly monitored by a cardiologist.

In case of decompensation, surgical treatment is indicated. In cases where restoration of the mitral valve is impossible, they resort to transplantation. Prostheses can be either biological (mostly made from animal aorta) or mechanical. Mitral regurgitation of 2-3 degrees and minor changes in the papillary muscles make it possible to perform plastic surgery that restores the integrity of the valve leaflets.

Treatment of aortic regurgitation depends entirely on the underlying disease and the completeness of elimination of the causes.

Drug therapy uses drugs that can lower systolic blood pressure and reduce reflux volume.

A group of vasodilators is used (Nifedipine, Hydralazine, ACE inhibitors). They are not indicated for patients with asymptomatic or mild or moderate forms of regurgitation.

The only form of surgical intervention is aortic valve replacement. The operation is indicated for:

severe form of regurgitation with impaired left ventricular function;
if the course is asymptomatic, with preserved ventricular function, but pronounced expansion (dilatation).

Mild mitral valve regurgitation does not require treatment. The doctor chooses tactics to monitor the development of the disorder. The patient will need to be regularly examined by a cardiologist to monitor any changes in the functioning of the heart.

If the second or third degree of pathology is detected, drug treatment is prescribed. The goal of this method is to eliminate clinical manifestations and eliminate the causes that caused the development of regurgitation.

Antibacterial agents. A group of penicillins is used, with the help of which the development of an infectious process is prevented or eliminated.
Anticoagulants. Thanks to them, the blood thins and the formation of blood clots is prevented.
Diuretics. Designed to remove excess fluid from the body, reduce the load on the heart and cope with edema.
Beta blockers. They are used to normalize heart rate.

The operation is prescribed only for severe mitral regurgitation. The purpose of the intervention is to eliminate defects in the valve leaflets or replace the valve with a prosthesis. It is best to perform surgery before ventricular decompensation occurs.

The effectiveness of the surgical technique is quite high. A personвЂ™s heart activity is normalized, so hemodynamics are restored and clinical manifestations cease to disturb the patient.

To eliminate symptoms and improve a personвЂ™s general condition, many people use traditional medicine. Preference is given to herbal infusions and decoctions that produce a calming effect.

The most effective is the following recipe: make a mixture of equal amounts of valerian, motherwort, hawthorn, mint, then pour boiling water over a small spoon of the mixture, let it brew and drink it like regular tea.

Another popular recipe for a folk remedy: a mixture of equal proportions of motherwort, hawthorn, heather and thorns mixed in one proportion. Pour one large spoonful of herbs into a glass of hot water, wait until it cools down, and drink throughout the day, dividing into several doses.

Particular attention should be paid to nutrition during and after treatment of mitral and tricuspid regurgitation. Patients will have to give up junk food and alcoholic drinks. To improve heart function, the diet should include grapes, nuts, dried apricots, and rosehip decoction.

If a person has an acute form of aortic insufficiency, then urgent replacement of the aortic valve is indicated. This is an open cardiac surgery that involves removing the diseased valve and implanting its artificial, fully functioning analogue. After the operation the following is indicated:

vasodilators;
inotropic drugs.

Treatment for chronic aortic regurgitation depends on the symptoms the patient experiences. If the manifestations of the disease interfere with a full life, a person is advised to replace the aortic valve.

If the symptoms of the disease are minor, a person should reduce the intensity of physical activity and regularly visit a cardiologist. To optimize left ventricular function, your doctor may prescribe vasodilators. For ventricular failure, diuretics (Veroshpiron, Verospilactone) and angiotensin-converting enzyme inhibitors (Lisinopril) can also be prescribed. With such a diagnosis, it is not recommended to take beta-blockers in large doses.

For patients with this disease and those who have undergone surgery to implant an artificial valve, it is extremely important to prevent infective endocarditis. Its essence lies in taking antibiotics, especially for the following medical procedures:

treatment and removal of teeth;
removal of tonsils and adenoids;
urinary tract or prostate surgery;
operations on the gastrointestinal tract.

Prevention of infective endocarditis is provided by the following drugs:

Ampicillin.
Clindamycin.
Amoxicillin.

Antibiotics are taken strictly according to the regimen prescribed by the doctor.

An increase in the intensity of symptoms of aortic insufficiency is an indication for termination of pregnancy.

In the absence of clinical manifestations of the disease, it is recommended to limit intense physical activity. In case of decompensation of the disease and symptoms of CHF, it is necessary to limit sodium intake from food.

If surgical treatment is impossible (for example, in case of severe concomitant diseases), mitral regurgitation is treated with medication. The use of nitrates and diuretics is justified, although controlled studies of the effectiveness of these drugs in mitral regurgitation have not been conducted. The use of ACE inhibitors, according to a small number of studies, is effective in patients with mitral regurgitation and CHF.

For atrial fibrillation, the use of digoxin and anticoagulants is indicated. In general, patients with mitral regurgitation are less likely to develop embolic complications than patients with mitral stenosis, but they are more likely to develop infective endocarditis.

The main method of treatment for mitral regurgitation is surgical (mitral valve surgery or replacement). Surgical treatment is indicated when symptoms of CHF appear or when LV systolic function is impaired.

Main indications for surgery for mitral regurgitation

Reconstructive surgery (mitral valve repair) is preferred over replacement in most patients with severe mitral regurgitation: patients should be referred to cardiac surgery centers with experience in mitral valve reconstruction (Class I, Level of Evidence C).

For non-ischemic mitral regurgitation, the operation of choice is reconstructive surgery (mitral valve repair), regardless of age and the need for coronary bypass surgery. In other words, an elderly patient with rheumatic mitral regurgitation and concomitant coronary artery disease with preserved LV function is indicated for plastic surgery rather than mitral valve replacement.

Mitral regurgitation is treated promptly: either by performing valve repair or replacing it with a prosthesis - the technique is determined by a cardiac surgeon.

The patient is prepared for surgery either after he or she develops symptoms or if examination reveals that left ventricular function is impaired, atrial fibrillation has occurred, or pulmonary artery pressure has increased.

Ideally, the goal of conservative therapy is to improve the patientвЂ™s condition so that it becomes possible to operate.

If the pathology has developed acutely, emergency surgery is performed.

If mitral regurgitation is detected during a preventive examination, its volume is small, and the patient himself does not complain about anything - the cardiologist puts him under observation, re-examining him once a year. The person is warned that if his health changes, he needs to visit a doctor outside of the schedule.

Possible complications and postoperative consequences

If symptoms of cervical urinary tract are severe, surgical intervention is indicated for the patient. The operation is performed urgently for the following reasons:

In the second and later stages, despite the fact that the volume of blood ejected is 40% of its total amount.
In the absence of effect from antibacterial therapy and worsening of infectious endocarditis.
Increased deformation, sclerosis of the valves and tissues located in the subvalvular space.
In the presence of signs of progressive left ventricular dysfunction together with general heart failure occurring at 3-4 degrees.
Heart failure in the early stages can also be a reason for surgery, however, to form an indication, thromboembolism of large vessels located in the systemic circulation must be detected.

The following operations are practiced:

Valve-sparing reconstructive surgeries are necessary to correct cerebrovascular accidents in childhood.
Commissuroplasty and decalcification of the leaflets are indicated for severe MV insufficiency.
Chordoplasty is intended to normalize the mobility of the valves.
Translocation of cords is indicated when they fall off.
Fixation of parts of the papillary muscle is carried out using Teflon gaskets. This is necessary when separating the head of the muscle from the remaining components.
Prosthetics of the chords is necessary when they are completely destroyed.
Valvuloplasty avoids leaflet rigidity.
Anuloplasty is intended to relieve the patient of regurgitation.
Valve replacement is carried out when it is severely deformed or when fibrosclerosis develops irreparably and interferes with normal functioning. Mechanical and biological prostheses are used.

When cardiac regurgitation develops, a person may experience some complications. It could be:

Arrhythmia, the characteristic of which is a disruption of the rhythm of the heart.
Atrioventricular block, in which there is a deterioration in the movement of the impulse from one chamber of the heart to another.
Infectious endocarditis.
Heart failure.
Pulmonary hypertension.

If a patient has undergone heart surgery to eliminate the cause of regurgitation, he may experience the following negative consequences:

Ischemic stroke, which occurs due to blockage of blood vessels in the brain and is characterized by the death of its tissue.
Endocarditis, in which an inflammatory process occurs in the inner lining of the heart.
Atrioventricular block.
Thrombosis of the installed prosthesis.
Destruction or calcification of a biological prosthesis.

To prevent these complications and postoperative consequences from occurring, the patient should strictly follow all the recommendations of the attending physician, both during the treatment period and after it.

Consequences of aortic regurgitation

The return of blood to the left ventricle inevitably leads to its expansion and increase in volume. Possible expansion of the mitral annulus and further enlargement of the left atrium.

At the point of contact of the blood flow, вЂњpocketsвЂќ are formed on the endocardium. The greater the degree of regurgitation, the faster the left ventricular overload develops.

Studies have shown the meaning of heart rate:

bradycardia increases the volume of return flow and promotes decompensation;
tachycardia reduces regurgitation and causes greater adaptation.

With the gradual progression of NMC, the following disorders appear:

The development of thromboembolism due to constant stagnation of a large part of the blood.
Valve thrombosis.
Stroke. Previously occurring valve thrombosis is of great importance in the risk factors for stroke.
Atrial fibrillation.
Symptoms of chronic heart failure.
Mitral regurgitation (partial failure of the mitral valve to perform functions).

What to expect and preventative measures

With the development of cerebrovascular accident, the prognosis determines the severity of the disease, that is, the level of regurgitation, the occurrence of complications and irreversible changes in cardiac structures. Survival rate 10 years after diagnosis is higher than for similar severe pathologies.

If valve insufficiency manifests itself in moderate or moderate form, women are able to bear and give birth to children. When the disease becomes chronic, all patients should undergo an annual ultrasound and visit a cardiologist. If worsening occurs, you should visit the hospital more often.

Prevention of NMC consists of preventing or promptly treating the diseases that cause this pathology. All diseases or manifestations of mitral valve insufficiency due to an abnormal or reduced valve must be quickly diagnosed and promptly treated.

NMC is a dangerous pathology that leads to severe destructive processes in the heart tissue, and therefore requires proper treatment. Patients, if they follow the doctorвЂ™s recommendations, can return to normal life and cure the disorder some time after starting treatment.

Forecast

The prognosis for the patientвЂ™s life depends on the underlying disease, the degree of regurgitation, and the form. An early mortality rate is typical for the acute development of pathology. In the chronic form, 75% of patients live more than 5 years, and half live 10 years or longer.

In the absence of timely surgical intervention, the development of heart failure is noted in the next 2 years.

Treatment of moderate clinical symptoms is accompanied by positive results in 90% of patients. This reinforces the importance of evaluating and monitoring patients with aortic regurgitation.

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The prognosis for mitral valvular regurgitation depends on the extent to which it occurs, whether there are concomitant pathologies, how old the patient is, and whether he follows the recommendations of the treating doctor. With a mild form of the disorder, people live for many more years without losing their ability to work.

With severe pathology, the prognosis is less favorable. As regurgitation progresses, other cardiac dysfunctions occur, which are quite difficult to treat. Therefore, most people with a severe form live about 5 years; in rare cases, a person can live 10 years.

Mitral valve regurgitation is a pathological process in which inadequate closure of the valve leaflets or dysfunction of the subvalvular apparatus occurs, which leads to circulatory disorders. Timely detection and elimination of the disease helps to avoid possible complications and prolong a personвЂ™s life.

This is especially important during pregnancy. After all, many heart defects arise during the intrauterine development of a newborn. Therefore, at the slightest suspicion of a malfunction of the fetal heart, you should immediately undergo examination by a cardiologist.

If a person has aortic regurgitation of II (III) severity without any signs, and there is no left ventricular dysfunction, then the prognosis will be favorable. For patients with grade I aortic valve insufficiency, the probability of 10-year survival can reach 95%, with grade II (III) - 50%.

For people with mild aortic regurgitation, follow-up with a cardiologist and an annual echocardiogram are recommended. A similar recommendation is also relevant for patients with severe aortic insufficiency occurring against the background of full functioning of the left ventricle. If aortic root enlargement is diagnosed, it is recommended to monitor the extent of the pathology at least once a year.

Mitral insufficiency is characterized by a fairly long period of compensation. With the formation of LV systolic dysfunction, symptoms of CHF appear. The prognosis for rheumatic mitral regurgitation is more favorable than for ischemic regurgitation.

Chronic mitral regurgitation develops slowly and remains compensated for a long time. The prognosis sharply worsens with the development of chronic heart failure. Without surgery, the six-year survival rate for men is 37.4%, for women вЂ“ 44.9%. In general, the prognosis is more favorable for mitral regurgitation of rheumatic origin compared to ischemic regurgitation.

If mitral insufficiency appears acutely, the prognosis is extremely unfavorable.

Prognosis depends on what disease resulted from the onset and development of regurgitation. Other factors are the patientвЂ™s age, diseases of organs of other systems, and the degree of pathology. Early mortality is typical for the group of patients with acute regurgitation.

If the pathology is chronic, then three quarters of patients live within five years after diagnosis, and half live more than ten.
If surgery is not performed on time, heart failure develops within two years.
If a moderate clinical picture is observed, then a positive effect of therapy is observed in the vast majority of patients.

Mitral, tricuspid, aortic and pulmonary valve regurgitation are far from a death sentence.

It is very important to identify the problem in a timely manner, prescribe appropriate therapy, as well as regular monitoring by a cardiologist.

For patients with minor AP and asymptomatic progression, the prognosis is favorable.

With a compensated course and compliance with the prescribed treatment, the disease can proceed for a long time without progression. The average survival rate is twenty to thirty years, so the prognosis can be considered relatively favorable.

LV dysfunction, without surgical treatment, average survival does not exceed four years;
heart failure - about two years.

In patients with acute AP, death from severe arrhythmias, heart failure, or cardiogenic shock is possible.

The prognosis for first-degree heart valve regurgitation is favorable. With constant monitoring by the attending physician, complications are identified immediately and, if necessary, treatment is prescribed.

With the second degree the situation is different. Once diagnosed, only sixty percent remain on their feet, and then only for fifteen years. Death occurs due to heart attack, heart failure, embolism, pulmonary pneumonia.

Preventive measures are aimed at reducing the risk of reverse blood flow in the heart.

Thus, heart valve regurgitation is a serious disease. Which can be either acquired or congenital. It is localized between different parts of the heart (in its right or left part). It has various degrees of development, the first of which is the simplest, has no symptoms, so the disease is difficult to calculate.

If pathology is detected, treatment is carried out using surgical methods or medication. The main thing is not to be late, so a systematic examination of the body by a specialist is recommended.

The heart has several valves: mitral, tricuspid, aortic, pulmonary. They are designed to prevent blood from flowing back. For this they have special doors. One of the important valves is the mitral valve, in the presence of a defect in which the blood begins to return to the original section, which is called regurgitation.

What kind of violation is this?

Mitral regurgitation is a pathological process in which blood from the left ventricle returns to the left atrium. In the international classification of diseases ICD-10, it has code I05.1.

Regurgitation can occur in two forms:

Spicy. Appears unexpectedly and is characterized by ruptures of chordae, papillary muscles, and valve leaflets. Heart damage and endocarditis can lead to the development of this form of pathology. With acute regurgitation, the risk of death of the patient is high.
Chronic. Development occurs slowly under the influence of endocarditis, congenital defects, disruption of the papillary or mitral-papillary muscles, and other diseases.

A healthy person may also experience mild mitral regurgitation. In this case, it is called physiological. It is diagnosed in most people, does not bother the person and does not require medical intervention.

Classification

There are several degrees of mitral regurgitation. They differ in the volume of blood returned. There are only 4 stages:

First. The volume of reverse blood flow is less than 25%. Mitral regurgitation of the 1st degree at the beginning of its development is not characterized in any way, but on the electrocardiogram it is already possible to detect minor disruptions in the activity of the valves.
Second. With pathology of the second degree, a more significant hemodynamic failure is observed. Blood returns in a volume of over 25%, but not more than 50%. As a result, pulmonary hypertension appears. Regurgitation at this stage can cause disturbances in the functioning of the myocardium. An ECG reveals a malfunction of the heart.
Third. When the disease enters the third stage, the volume of returned blood exceeds 50%. At this stage, other diseases often appear, for example. The electrocardiogram clearly shows cardiac dysfunction.
Fourth. Regurgitation of this degree refers to a severe form of pathology. Because of it, a person may completely lose his ability to work or become disabled. At this stage, only surgical intervention can prolong the patient's life.

Causes

There are many reasons for the development of mitral valve regurgitation. But there are a number of pathologies that are most often found in patients. These include the following diseases:

with 1st degree regurgitation (PMR),
endocarditis,
heart defect,
myocardial infarction,
rheumatism.

In addition to diseases, chest injuries that damage the heart can lead to the development of regurgitation.

Symptoms

Possible complications and postoperative consequences

When cardiac regurgitation develops, a person may experience some complications. It could be:

Arrhythmia, the characteristic of which is a disruption of the rhythm of the heart.
Atrioventricular block, in which there is a deterioration in the movement of the impulse from one chamber of the heart to another.
Infectious endocarditis.
Heart failure.

If a patient has undergone heart surgery to eliminate the cause of regurgitation, he may experience the following negative consequences:

Ischemic stroke, which occurs due to blockage of blood vessels in the brain and is characterized by the death of its tissue.
Endocarditis, in which an inflammatory process occurs in the inner lining of the heart.
Atrioventricular block.
Thrombosis of the installed prosthesis.
Destruction or biological prosthesis.

Diagnostics

In severe cases of pathology, listening shows the appearance of an additional third tone. It appears due to the fact that the ventricle quickly fills with a large volume of blood.

Treatment of pathology

Antibacterial agents. A group of penicillins is used, with the help of which the development of an infectious process is prevented or eliminated.
Anticoagulants. Thanks to them, the blood thins and the formation of blood clots is prevented.
Diuretics. Designed to remove excess fluid from the body, reduce the load on the heart and cope with edema.
Beta blockers. They are used to normalize heart rate.

The effectiveness of the surgical technique is quite high. A personвЂ™s heart activity is normalized, so hemodynamics are restored and clinical manifestations cease to disturb the patient.

To eliminate symptoms and improve a personвЂ™s general condition, many people use traditional medicine. Preference is given to herbal infusions and decoctions that produce a calming effect.

Particular attention should be paid to nutrition during and after mitral treatment. Patients will have to give up junk food and alcoholic drinks. To improve heart function, the diet should include grapes, nuts, dried apricots, and rosehip decoction.

Forecast

This is especially important during pregnancy. After all, many heart defects arise during the intrauterine development of a newborn. Therefore, at the slightest suspicion of a malfunction of the fetal heart, you should immediately undergo examination by a cardiologist.

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, each heartbeat intensifies, and the person experiences palpitations, especially when lying on his 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.

However, these symptoms of mitral regurgitation cannot be the basis for making such a diagnosis. All these signs are present in other heart defects.

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;
chest x-ray;
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 for diagnosing 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. A healthy lifestyle is necessary, smoking and drinking alcohol should 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.

With surgical treatment of mitral valve insufficiency, its restoration occurs. 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 forms of mitral regurgitation, a person can maintain working capacity for a long time if he is observed by a cardiologist and follows his advice. The disease at these stages is not a contraindication for having a child.

Mitral valve insufficiency symptoms and signs

Mitral valve insufficiency (insufficiency of the left atrioventricular orifice) is non-closure (or incomplete closure) of the mitral valve leaflets, leading to pathological reflux of blood (regurgitation) into the left atrium from the left ventricle during its systole. In this article, we will look at the symptoms of mitral valve regurgitation and the main signs of mitral valve regurgitation in humans.

Prevalence

Isolated rheumatic mitral valve insufficiency is observed in 10% of cases of all acquired defects. Occurs more often in men. Often combined with mitral stenosis or aortic valve defects.

Pathogenesis of mitral valve insufficiency

Failure of the mitral valve leaflets to close during left ventricular systole leads to the appearance of pathological blood flow from the left ventricle to the left atrium. The blood thrown into the left atrium creates a volume overload during systole and a volume overload of the left ventricle during diastole. Excessive blood volume in the left ventricle leads to its dilatation and widening of the mitral annulus. In this case, rupture of the tendon threads may occur. In this regard, the aphorism вЂњmitral regurgitation gives rise to mitral regurgitationвЂќ is correct. Dilatation of the left atrium leads to tension on the posterior mitral valve leaflet and increased mitral valve non-closure, which further aggravates mitral valve regurgitation.

standing overload of the left ventricle with excess blood volume leads to hypertrophy of its walls. An excess amount of blood in the left atrium subsequently causes a retrograde increase in pressure in the pulmonary circulation and the development of pulmonary hypertension (unlike mitral stenosis, it develops much later and is much less pronounced). In an advanced stage of mitral valve insufficiency, chronic heart failure develops (right ventricular type).

Signs of mitral valve insufficiency

Symptoms of mitral valve insufficiency

With mild mitral valve insufficiency, there may be no complaints. With moderate insufficiency and a slight increase in pressure in the pulmonary circulation, rapid fatigue during physical activity (low cardiac output does not provide skeletal muscles with sufficient oxygen) and shortness of breath, which quickly disappear with rest, are a concern. Severe mitral valve insufficiency and more severe pulmonary hypertension are characterized by the occurrence of shortness of breath with minor physical exertion, attacks of nocturnal paroxysmal shortness of breath, pulmonary congestion, and hemoptysis. Acute mitral valve insufficiency (during myocardial infarction) is manifested by pulmonary edema or cardiogenic shock.

Examination for mitral valve insufficiency

With mild mitral valve insufficiency, there are no external manifestations of the defect. In the advanced stage of mitral disease, there are characteristic manifestations of chronic heart failure.

Percussion for mitral valve insufficiency

Characteristic is the expansion of the boundaries of relative cardiac dullness to the left with severe mitral valve insufficiency.

Palpation for mitral valve insufficiency

The apical impulse is shifted to the left and downward due to dilatation of the left ventricle. With severe mitral valve insufficiency, systolic vibration is detected at the apex of the heart.

Auscultation of the heart with mitral valve insufficiency

Heart sounds

The first tone is usually weakened (difficult to assess with pronounced systolic murmur). The II tone is not changed if there is no severe pulmonary hypertension. With a significant shortening of the ejection time of the left ventricle, a paradoxical splitting of the second sound occurs. Additionally, a pathological third sound is heard in diastole, which occurs with sudden tension of the papillary muscles, tendon threads and valves. It (together with a weakened first sound) is considered an important auscultatory sign of severe mitral valve insufficiency.

When pulmonary hypertension occurs, listen to the accent of the second tone above the pulmonary trunk in the second intercostal space to the left of the sternum.

Systolic murmur due to mitral valve insufficiency

The main symptom of mitral valve insufficiency is systolic murmur. It is holosystolic (throughout the entire systole) and captures the first and second heart sounds. The murmur is most pronounced at the apex of the heart; it can radiate to the left into the axillary region when the anterior leaflet is affected and upward along the sternum when the posterior leaflet is affected. The noise increases with increasing afterload (isometric arm tension).

ECG for mitral valve insufficiency

Echocardiography for mitral valve insufficiency

Echocardiography allows you to identify the cause of mitral valve insufficiency (according to its morphology), assess the degree of regurgitation and the function of the left ventricle and atrium.

Infective endocarditis. Mitral valve insufficiency in infective endocarditis is characterized by the presence of vegetation, perforation of the leaflets, and separation of tendon threads. These changes can be more accurately detected by transesophageal echocardiographic examination.

IHD. Mitral valve insufficiency in ischemic heart disease is characterized by dilatation of the left ventricular cavity, local disturbances in the movement of the walls of the left ventricle (dyskinesis), normal (non-thickened) mitral valve leaflets and the central location of the regurgitation jet in most cases.

One-dimensional and two-dimensional echocardiography reveals indirect signs of mitral valve insufficiency: dilatation of the left atrium and ventricle, increased mobility of the walls of the left ventricle (hyperkinesis). Doppler examination reveals direct signs of mitral valve insufficiency: reflux of a blood stream from the left ventricle into the left atrium during systole. Based on the severity of the regurgitation jet in the left atrium, four degrees of mitral valve insufficiency are distinguished:

I degree, minor - the length of the regurgitation jet is up to 4 mm from the base of the mitral valve leaflets into the left atrium.

II degree, moderate - 4-6 mm.

III degree, average, - 6-9 mm.

IV degree, pronounced - more than 9 mm.

It should be remembered that the volume of regurgitation depends on the size of the hole remaining between the mitral valve leaflets when they close, the magnitude of the pressure gradient between the ventricle and the atrium, and the duration of regurgitation. The degree of mitral regurgitation is not fixed and can vary in the same patient depending on the conditions and the JTC used.

X-ray examination of mitral valve insufficiency

Signs of pulmonary hypertension on an x-ray may be absent if the defect is mild. With severe mitral regurgitation, characteristic signs of pulmonary hypertension appear.

Catheterization of cardiac cavities for mitral valve insufficiency

Cardiac catheterization is an accurate method for assessing the degree of mitral regurgitation, making it possible to determine the volume of regurgitant blood in the left atrium (expressed as a percentage of the stroke volume of the left ventricle). There are four degrees of mitral regurgitation according to catheterization data:

I degree - less than 15% of the stroke volume of the left ventricle.

II degree - 15-30%.

III degree - 30-50%.

IV degree - more than 50% of the stroke volume.

Mitral valve insufficiency

Mitral valve insufficiencyвЂ“ this is the development of regurgitation of arterial blood in the cavities of the left parts of the heart during the period of systolic contraction of the ventricular myocardium, which occurs against the background of impaired closure of the leaflet structures of the mitral valve.

The share of isolated defect in the form of mitral valve insufficiency among all possible cardiac defects accounts for at least 2%. Much more often, the patient experiences a combined lesion of the mitral valve in the form of a combination of stenosis and insufficiency.

Mitral valve insufficiency causes

Mitral valve insufficiency, in contrast to stenosis of the same localization, is a polyetiological pathology, that is, the development of its symptoms is influenced by a number of factors, although each of them individually can initiate the development of this defect.

Organic mitral valve insufficiency, which occurs as a result of primary damage to the valve apparatus, can be observed in the following diseases of a cardiac and extracardiac nature: rheumatic fever, endocardial infection, myxomatous degeneration of the leaflets and severe calcification in the projection of the valves, ischemic damage to the myocardium in atherosclerotic disease, connective tissue pathologies hereditary nature (Marfan disease), systemic autoimmune damage to connective tissue (scleroderma, dermatomyositis), traumatic damage to the heart.

The fundamental difference between organic mitral valve insufficiency and functional changes in the mitral valve is its development against the background of existing severe myocardial damage, accompanied by the development of pronounced dilatation of the left ventricular cavity. Dilated changes in the left ventricle over time provoke stretching of the valve ring and displacement of the papillary muscles laterally, against the background of which dysfunction of the mitral valve leaflets occurs in the complete absence of their organic damage.

Hypertrophic cardiomyopathy of the constrictive type is also accompanied by the development of signs of mitral valve insufficiency, and the pathogenetic mechanism of its development is the hyperdynamic contraction of the left ventricle, during which the anterior part of the leaflets is retracted into the outflow tract of the enlarged left ventricle.

Mitral valve insufficiency signs

Mitral valve insufficiency is characterized by a sluggish course with a gradual increase in clinical symptoms. In cardiological practice, a separate category of patients is identified who may have no clinical manifestations, and changes in the valve apparatus are detected during instrumental research techniques.

The initial complaints most often presented by patients suffering from mitral valve insufficiency are: increasing shortness of breath, which is a consequence of venous stagnation in the pulmonary parenchyma, decreased performance and fatigue caused by a decrease in cardiac output. Depending on the degree of damage to the valve flaps, respiratory disorders of cardiac origin can be minor or severe, up to the development of signs of pulmonary edema.

Mitral valve insufficiency has a whole range of specific changes, diagnosed by an experienced cardiologist already during the initial objective examination. The skin of patients with mitral valve insufficiency acquires a bluish tint in the projection of the distal limbs and face. When palpating the pulse, as a rule, it is not possible to detect any changes, but in some cases there are signs of a positive venous pulse. A pronounced expansion of the boundaries of cardiac dullness, as well as displacement and intensification of the apical impulse is observed only in severe dilatation of the left ventricular cavity. When examining a patient with signs of pulmonary hypertension, pathological pulsation is determined in the projection of the fourth intercostal space along the left contour of the sternum.

The most characteristic sign of mitral valve insufficiency is the presence of a pansystolic murmur in the projection of the apex of the heart with conduction to the axillary region on the left. A specific symptom characteristic exclusively of mitral valve insufficiency is increased noise when moving the body to a horizontal position on the left side. The degree of murmur manifestation depends more on the contractility of the left ventricular myocardium than on the severity of regurgitation. If the murmur is not very pronounced, a weakening of the first tone can be distinguished, due to a violation of the complete closure of the mitral valve leaflets. With severe regurgitation, a prognostically unfavorable sign occurs - the appearance of a third sound. Listening to the accent of the second tone in the projection of the pulmonary artery indicates the development of signs of pulmonary hypertension.

Mitral valve insufficiency degree

Separation of mitral valve insufficiency is used to determine the degree of disturbance of central cardiohemodynamics, as well as to determine the advisability of surgical intervention.

The first (1) degree of mitral valve insufficiency is characterized as a compensatory stage, that is, regurgitation of blood flow is so minimal that it is not accompanied by cardiohemodynamic disorders. The only clinical symptom present in a patient in the compensatory stage of the disease may be the appearance of a systolic murmur in the projection of the apex of the heart. In this situation, the patient is advised to undergo an echocardiographic study to determine the presence of regurgitation. Mitral insufficiency at this stage does not require the use of surgical treatment methods.

The second (2) degree of mitral valve insufficiency, or the stage of subcompensation, is accompanied by an increase in the volume of reverse blood flow during the period of systolic contraction of the ventricle, signs of compensatory hypertrophy of the left ventricular wall appear in order to compensate for hemodynamic disturbances. At this stage of the defect, most patients note an increase in shortness of breath with excessive physical activity, and a moderate systolic murmur is heard on auscultation in the projection of the apex of the heart. Fluoroscopy allows you to determine the expansion of the boundaries of the left chambers of the heart, as well as their excessive pulsation. This stage is reflected in the ECG registration in the form of the formation of a levogram and the appearance of signs of overload of the left chambers of the heart. An echocardiographic sign is the presence of moderate regurgitation in the projection of the mitral valve leaflets. The stage of subcompensation is not a justification for the use of surgical correction techniques.

The third (3) degree of mitral valve insufficiency is characterized by the appearance of severe left ventricular decompensation, caused by significant regurgitation of blood into the cavity of the left ventricle. Clinical symptoms indicating the development of decompensated heart failure. is progressive shortness of breath with minimal physical activity, and visualization of pulsation of the anterior chest wall in the projection of the apex of the heart. Listening to a rough systolic murmur in the projection of the apex of the heart is not difficult, and additional instrumental techniques for examining the patient make it possible to determine the presence of left ventricular myocardial hypertrophy and pronounced reverse blood flow through the uncovered mitral valve leaflets. The only effective treatment for mitral regurgitation at this stage is surgery.

The fourth (4) degree of mitral valve insufficiency is accompanied by signs of right ventricular failure and is called вЂњdystrophicвЂќ. Distinctive visual symptoms are pronounced pulsation of the jugular veins and displacement of the apical impulse, as well as its intensification. Mitral valve insufficiency in this category of patients is accompanied not only by hemodynamic disturbances, but also by a disruption of the rhythm of cardiac activity. X-ray allows one to visualize a pronounced expansion of the mediastinal shadow due to an increase in all parts of the heart, as well as the appearance of signs of stagnation in the pulmonary circulation system. At this stage of the disease, extracardiac symptoms of functional changes in the kidneys and liver appear. Surgical correction methods are widely used and in most cases have a favorable outcome.

The fifth (5) degree of mitral valve insufficiency is terminal and is characterized by the patientвЂ™s manifestation of the entire clinical symptom complex characteristic of the third stage of cardiovascular failure. The severity of the patient's condition does not allow surgical intervention, and the prognosis for mitral valve insufficiency at this stage is extremely unfavorable. In the terminal stage of the defect, complications are often observed, each of which can cause a fatal outcome of the disease: paroxysmal atrial fibrillation, infective endocarditis. as well as systemic thromboembolism of vessels of various sizes.

Mitral valve insufficiency treatment

The degree of severity of regurgitation in the projection of the mitral valve is decisively influenced by the magnitude of systolic pressure in the aortic lumen, therefore the prescription of vasodilators for a long time is pathogenetically justified. The drugs of choice in this situation are ACE inhibitors in a dosage that allows you to keep systolic pressure levels at 120 mmHg. (Berlipril in an initial daily dosage of 2.5 mg, followed by titration of the drug to a therapeutic dose and continuous use of the drug). Recent randomized studies prove the need for the use of vasodilators even in asymptomatic mitral valve insufficiency with minimal regurgitation.

Already in the second or third degree of mitral valve insufficiency, when dilated changes in the cavities of the left chambers of the heart occur, lifelong use of anticoagulants is advisable to prevent the development of thromboembolic complications (Aspecard in a daily dose of 100 mg orally).

In a situation where the patient has electrocardiographic signs of arrhythmia, the use of adrenergic blockers is recommended (Metoprolol in an average daily dose of 100 mg orally).

The use of surgical methods for correcting mitral valve insufficiency is absolutely indicated in the following situations:

- the level of regurgitation is about 40% of cardiac output;

вЂ” lack of a positive result from the use of massive antibiotic therapy in the aggressive course of endocarditis of an infectious nature, complicating the course of the underlying disease;

- pronounced sclerotic changes in the valve apparatus, which are irreversible;

- pronounced dilated enlargement of the left ventricle with signs of systolic dysfunction;

- single or multiple episodes of vascular thromboembolism.

Currently, the cardiac surgery branch of medicine makes it possible to use the latest reconstructive surgical techniques, which make it possible to preserve the structure of the valve apparatus as much as possible. In a situation where there are pronounced sclerotic changes in the valve leaflets and it is not possible to perform surgical decalcification, a prosthetic technique using both synthetic and xenopericardial materials is used. In order to eliminate the rigidity of the valve structures, the valvuloplasty technique is used, which in most cases allows to completely eliminate the signs of regurgitation.

heal-cardio.ru

Causes and mechanism of development

The human heart is a four-chamber structure, the cavities of which are separated by valves. This prevents the mixing of venous and oxygenated arterial blood, which ensures smooth functioning of the heart.

The mitral valve leaflets (MV) are 2 folds of connective tissue located between the left ventricle and the atrium. Violation of their functioning can be caused by:

Infectious endocarditis.
Rheumatism.
Mitral valve prolapse.
Congenital heart defects.
History of acute myocardial infarction.
Injuries and wounds of the chest.
Diseases leading to enlargement of the left side of the heart - angina pectoris, arterial hypertension (so-called relative mitral regurgitation).
Systemic diseases (amyloidosis, rheumatoid arthritis, Marfan syndrome, etc.).

Clinical symptoms and diagnosis

Chronic mitral regurgitation does not manifest itself for a long time, although the disease only progresses over time.

There are four degrees of the disease:

MK insufficiency of the 1st degree. No complaints. Auscultation reveals a quiet, soft systolic murmur at the apex of the heart, which is better heard when the patient lies on his left side. On R-graphy and ECG, the changes are nonspecific. On echocardiography, grade 1 mitral regurgitation is manifested by slight divergence of the leaflets and minimal reverse blood flow.
MK insufficiency of the 2nd degree. The first complaints appear: weakness, fatigue, shortness of breath during physical activity (due to the load on the pulmonary circulation). The systolic murmur at the apex persists, and the first sound weakens. The R-graph and ECG still show no signs of the disease. Ultrasound of the heart with a doler detects the reverse movement of blood to a distance of 1.5 cm and below.
Insufficiency of MK 3 degrees. Complaints intensify: shortness of breath with slight exertion, accompanied by a cough with difficult to separate viscous sputum, a feeling of palpitations, вЂњsomersaultsвЂќ of the heart in the chest. On examination, there is a pallor of the face with cyanosis of the lips and tip of the nose. On the ECG and R-graphy, the first signs of left ventricular hypertrophy appear: levogram, expansion of the heart shadow. Echocardiography indicates a backflow of blood occupying half of the atrium.
Insufficiency of uric acid 4 degrees. Terminal stage of the disease: clear signs of heart failure, pulmonary hypertension, painful cough streaked with blood. A typical appearance of the patient: a pale face with a bright bluish blush caused by a lack of oxygen in the peripheral tissues. A вЂњheart humpвЂќ appears - a pulsating projection of the heart on the left side of the chest. ECG and X-ray indicate an increase in the left volumes of the heart: a sharp deviation of the EOS to the left, smoothing of the waist of the heart and a displacement of the border (the outline of the organ takes the shape of a shoe). Ultrasound records the complete filling of the atrium with blood during cardiac ejection.

Treatment

In case of decompensation, surgical treatment is indicated. In cases where restoration of the mitral valve is impossible, they resort to transplantation. Prostheses can be either biological (mostly made from animal aorta) or mechanical. Mitral regurgitation of 2-3 degrees and minor changes in the papillary muscles make it possible to perform plastic surgery that restores the integrity of the valve leaflets.

The prognosis of the disease is associated with many factors: the severity of valve insufficiency, the previous cause - but is generally favorable. Attentive attention to your health and compliance with the cardiologistвЂ™s recommendations guarantee a rapid restoration of hemodynamics and a return to an active lifestyle.

asosudy.ru

Description of the disease

MVR (mitral valve insufficiency) is the most common cardiac anomaly. Of all the sick 70% suffer from an isolated form of cerebrovascular accident. Typically, rheumatic endocarditis is the main underlying cause of the disease. Often, a year after the first attack, the heart condition leads to chronic failure, the cure of which is quite difficult.

The highest risk group includes people with valvulitis.. This disease damages the valve leaflets, as a result of which they undergo processes of wrinkling, destruction, and gradually become shorter than their original length. If valvulitis is at an advanced stage, calcification develops.

Septic endocarditis leads to the destruction of many cardiac structures, so NMC has the most severe manifestations. The valve flaps do not fit together tightly enough. When they are not completely closed through the valve, too much blood coming out, which provokes its reboot and the formation of stagnant processes, an increase in pressure. All signs lead to increasing insufficiency of uric acid.

Causes and risk factors

NMC affects people with one or more of the following pathologies:

Congenital predisposition.
Connective tissue dysplasia syndrome.
Mitral valve prolapse, characterized by regurgitation of 2 and 3 degrees.
Destruction and breakage of the chords, rupture of the valves of the mitral valve due to injuries in the chest area.
Rupture of the valves and chords with the development of infectious endocarditis.
Destruction of the apparatus that unites the valves in endocarditis resulting from connective tissue diseases.
Infarction of part of the mitral valve with subsequent scar formation in the subvalvular region.
Changes in the shape of the valves and tissues located under the valves when rheumatism.
Enlargement of the mitral annulus during dilatation cardiomyopathy.
Insufficiency of valve function in the development of hypertrophic cardiomyopathy.
MK insufficiency due to surgery.

Mitral regurgitation is often accompanied by another defect - mitral valve stenosis.

Types, forms, stages

With NMC the total stroke volume of the left ventricle is estimated. Depending on its quantity, the disease is divided into 4 degrees of severity (the percentage indicates the part of the blood that is redistributed incorrectly):

I (the softest) - up to 20%.
II (moderate) - 20-40%.
III (medium form) - 40-60%.
IV (heaviest) - over 60%.

According to the forms of its course, the disease can be divided into acute and chronic:

When determining the features of movement of the mitral valves, there are 3 types of pathology classification:

1 - standard level of mobility of the leaflets (in this case, painful manifestations consist of dilatation of the fibrous ring, perforation of the leaflets).
2 - destruction of the valves (the chords take the greatest damage, as they are stretched or ruptured, and a violation of the integrity of the papillary muscles also occurs.
3 - decreased mobility of the valves (forced connection of commissures, reduction in the length of the chords, as well as their fusion).

Danger and complications

With the gradual progression of NMC, the following disorders appear:

The development of thromboembolism due to constant stagnation of a large part of the blood.
Valve thrombosis.
Stroke. Previously occurring valve thrombosis is of great importance in the risk factors for stroke.
Atrial fibrillation.
Symptoms of chronic heart failure.
Mitral regurgitation (partial failure of the mitral valve to perform functions).

Symptoms and signs

The severity and severity of MCT depends on the degree of its development in the body:

Stage 1 the disease has no specific symptoms.
Stage 2 does not allow patients to carry out physical activity in an accelerated mode, since shortness of breath, tachycardia, pain in the chest, loss of heart rhythm, and discomfort immediately appear. Auscultation with mitral insufficiency determines increased tone intensity and the presence of background noise.
Stage 3 characterized by left ventricular failure and hemodynamic pathologies. Patients suffer from constant shortness of breath, orthopnea, increased heart rate, chest discomfort, and their skin is paler than in a healthy state.

Find out more about mitral regurgitation and hemodynamics with it from the video:

When to see a doctor and which one

When identifying symptoms characteristic of MCT, it is necessary contact a cardiologist immediately, to stop the disease in its early stages. In this case, you can avoid the need to consult with other doctors.

Sometimes there is suspicion of a rheumatoid etiology of the disease. Then you should visit a rheumatologist for diagnosis and proper treatment. If there is a need for surgical intervention, treatment and subsequent the problem is resolved by a cardiac surgeon.

Diagnostics

Common methods for detecting NMC:

Learn more about symptoms and diagnosis from the video:

It is necessary to distinguish NMC from other heart pathologies:

Myocarditis in severe form.
Congenital and acquired heart defects of related etiology.
Cardiomyopathies.
MK prolapse.

Therapy methods

If symptoms of cervical urinary tract are severe, surgical intervention is indicated for the patient. The operation is performed urgently for the following reasons:

In the second and later stages, despite the fact that the volume of blood ejected is 40% of its total amount.
In the absence of effect from antibacterial therapy and worsening of infectious endocarditis.
Increased deformation, sclerosis of the valves and tissues located in the subvalvular space.
In the presence of signs of progressive left ventricular dysfunction together with general heart failure occurring at 3-4 degrees.
Heart failure in the early stages can also be a reason for surgery, however, to form an indication, thromboembolism of large vessels located in the systemic circulation must be detected.

The following operations are practiced:

Valve-sparing reconstructive surgeries are necessary to correct cerebrovascular accidents in childhood.
Commissuroplasty and decalcification of the leaflets are indicated for severe MV insufficiency.
Chordoplasty is intended to normalize the mobility of the valves.
Translocation of cords is indicated when they fall off.
Fixation of parts of the papillary muscle is carried out using Teflon gaskets. This is necessary when separating the head of the muscle from the remaining components.
Prosthetics of the chords is necessary when they are completely destroyed.
Valvuloplasty avoids leaflet rigidity.
Anuloplasty is intended to relieve the patient of regurgitation.
Valve replacement is carried out when it is severely deformed or when fibrosclerosis develops irreparably and interferes with normal functioning. Mechanical and biological prostheses are used.

Learn about minimally invasive operations for this disease from the video:

What to expect and preventative measures

With the development of cerebrovascular accident, the prognosis determines the severity of the disease, that is, the level of regurgitation, the occurrence of complications and irreversible changes in cardiac structures. Survival rate 10 years after diagnosis is higher than for similar severe pathologies.

If valve insufficiency is mild or moderate, women have the ability to bear and give birth to children. When the disease becomes chronic, all patients should undergo an annual ultrasound and visit a cardiologist. If worsening occurs, you should visit the hospital more often.

Prevention of NMC consists in preventing or promptly treating diseases that cause this pathology. All diseases or manifestations of mitral valve insufficiency due to an abnormal or reduced valve must be quickly diagnosed and promptly treated.