Mitral stenosis with changes in the lungs. Some features of the ECG in acquired heart defects. What symptoms should alert the patient

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

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

mitral valve insufficiency

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

Symptoms

Mitral insufficiency has specific signs:

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

Forms

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

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

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

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

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

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

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

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

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

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

Causes

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

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

Acquired mitral heart disease occurs for the following reasons:

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

Acquired functional mitral insufficiency occurs as a result of:

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

Diagnostics

Mitral valve disease is diagnosed in the following ways:

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

Treatment

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

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

Mitral valve prolapse

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

Causes

The causes of the development of mitral valve prolapse is the formation of folded leaflets caused by a change connective tissue. This phenomenon is caused by Marfan, Ehlers-Danlos syndromes, elastic pseudoxanthoma and other pathologies.

Prolapse can be:

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

Symptoms

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

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

Patients have additional symptoms:

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

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

Often, patients experience:

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

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

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

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

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

Diagnostics

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

Stenosis

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

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

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

The following stages of development of stenosis are noted:

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

Symptoms

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

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

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

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

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

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

The patient has:

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

During the inspection are determined:

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

When percussion and listening to heart sounds are determined:

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

Patients with stenosis are often diagnosed with:

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

Mitral valve stenosis is complicated by recurrent rheumatism and thromboembolism pulmonary artery that lead to death.

Diagnostics and treatment of defects of the mitral valve

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

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

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

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

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

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

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

After surgical treatment patients are prescribed a rehabilitation course, including:

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

Forecast

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

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

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

Prevention

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

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

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Physical examination

Palpation. The apex beat in mitral stenosis is most often normal or reduced, reflecting normal LV function. In the position on the left side, diastolic trembling can be determined. With the development of pulmonary hypertension, a cardiac impulse is detected along the right border of the sternum.

Auscultation. There are auscultatory signs characteristic of mitral stenosis:

• enhanced (clapping) I tone, the intensity of which decreases as the stenosis progresses;
• mitral valve opening tone (disappears with valve calcification);
• diastolic murmur with a maximum at the apex (mesodiastolic, presystolic, pandiastolic), which must be heard in the position on the left side.

With the development of severe decompensation of heart failure, dacies mitralis (bluish-pink blush on the cheeks due to a decrease in ejection fraction, systemic vasoconstriction and right ventricular heart failure), epigastric pulsation and signs of right ventricular heart failure (edema in the legs, enlarged liver, swelling of the neck veins, etc.) .)

Laboratory research

Data laboratory research non-specific.

Instrumental Research

Electrocardiography. There are several signs characteristic of mitral stenosis:

• the appearance of P-mitrale (wide, with a notch P wave in the second standard lead);
• deviation of the electrical axis of the heart to the right, especially with the development of pulmonary hypertension;
• myocardial hypertrophy of the right (with isolated mitral stenosis) and left (in combination with mitral insufficiency) ventricles.

Chest x-ray. They reveal an increase in the shadow of the LA, a posterior displacement of the esophagus (in the lateral image with barium contrast). The method was considered the "gold standard" for the diagnosis of mitral stenosis before the advent of echocardiography, but is currently not used. The LV shadow in isolated mitral stenosis does not change; when combined with mitral insufficiency and progression of the defect, as well as in the presence of pulmonary hypertension, the trunk of the pulmonary artery is expanded, and the waist of the heart is smoothed out.

echocardiography

In order to diagnose mitral stenosis, a two-dimensional, Doppler, stress and transesophageal echocardiography is performed.

• Two-dimensional echocardiography. It is the method of choice for diagnosing mitral stenosis. It allows assessing the mobility of the leaflets, the severity of commissure adhesion, fibrosis and calcification, the presence of subvalvular adhesions (Fig. 1 and 2). EchoCG data are extremely important for the subsequent choice of timing and type of surgical treatment.
• Doppler echocardiography. The severity of stenosis is assessed using a Doppler study. The average transmitral pressure gradient and the area of ​​the mitral valve can be determined quite accurately using the constant-wave technique (Fig. 3). Of great importance is the assessment of the degree of pulmonary hypertension, as well as concomitant mitral and aortic regurgitation.
• Stress echocardiography . Additional information can be obtained using this stress test when registering transmitral and tricuspid blood flow. With mitral valve area<1,5 см² и градиенте давления >50 mmHg (after exercise) should consider performing a balloon mitral valvuloplasty.
• Transesophageal echocardiography. Spontaneous echo contrast during the study is an independent risk factor for embolic complications in patients with mitral stenosis. This method allows you to clarify the question of the presence or absence of an LA thrombus, to determine the degree of mitral regurgitation in the planned balloon mitral valvuloplasty. In addition, it allows you to accurately assess the state of the valvular apparatus, the severity of changes in subvalvular structures and the likelihood of restenosis.

Rice. 1. Mitral stenosis: unidirectional diastolic movement of the mitral valve leaflets; in the four-chamber position, shortening of the posterior leaflet of the mitral valve, marginal thickening of both leaflets, dome-shaped deflection of the anterior leaflet of the mitral valve (patient S., 52 years old; M-modal study)

Rice. 2. Mitral stenosis: parasternal LV short axis at the level of the mitral valve, diastole; planimetric measurement of the mitral valve orifice area (patient P., 54 years old; A1 - mitral orifice area)

Rice. 3. Associated mitral defect with predominance of stenosis: pulsed Doppler study of the transmitral blood flow on the mitral valve from the apical four-chamber position; peak pressure gradient across the mitral valve 10.8 mm Hg, mean pressure gradient 5.0 mm Hg. (patient T., 43 years old).

Catheterization of the heart and great vessels. This study is carried out in cases where surgical intervention is planned, and the data of non-invasive tests do not give an unambiguous result. For direct measurement pressure in the LA and LV requires transseptal catheterization, which is accompanied by unjustified risk. An indirect method for measuring pressure in the LA is the determination of the pulmonary artery wedge pressure.

Differential Diagnosis

With careful examination, the diagnosis of mitral stenosis is usually not in doubt. Differential diagnostic signs of mitral stenosis and other heart defects detected during physical examination are presented in Table. one.

Mitral stenosis is also differentiated with the following diseases:

• myxoma LP;
• other valvular defects (mitral insufficiency, stenosis of the tricuspid valve);
• ASD;
• stenosis of the pulmonary veins;
• congenital mitral stenosis.

Table 1

Differential diagnosis of heart disease based on physical examination

MITRAL STENOSE

Stenosis of the left atrioventricular orifice

(Stenosis ostii atrioventricularis sinistra)

mitral stenosis - common acquired heart disease. It can be isolated or combined with mitral valve insufficiency and damage to other valves.

Etiology. Almost always, mitral stenosis is a consequence of rheumatism and is usually formed at a young age and more often in women.

Pathogenesis and changes in hemodynamics. In humans, the area of ​​the left atrioventricular opening ranges from 4-6 cm 2 and only when its area decreases to 1.5-1 cm 2 (critical area) do distinct disturbances of intracardiac hemodynamics appear.

In most patients requiring surgical treatment, this value is 0.5-1 cm 2 .

The narrowing of the mitral orifice serves as an obstacle to the expulsion of blood from the left atrium. Therefore, in order to ensure normal blood filling of the left ventricle, a number of compensatory mechanisms are activated. In the atrial cavity, the pressure rises (from normal at 5 mm to 20-25 mm Hg). This increase in pressure leads to an increase in the pressure gradient left atrium - left ventricle, resulting in easier passage of blood through the narrowed mitral orifice. Left atrial systole lengthens and blood enters the left ventricle for a longer time. The increase in pressure in the left atrium and the lengthening of the systole of the left atrium at first compensate for the negative effect of the narrowed mitral orifice on intracardiac hemodynamics.

The progressive decrease in the opening area causes a further increase in pressure in the cavity of the left atrium, and this in turn leads to a retrograde increase in pressure in the pulmonary veins and capillaries. The pressure in the pulmonary artery also increases. The degree of its increase is proportional to the increase in pressure in the left atrium, and the normal gradient between them (20 mm Hg. Art.) usually remains unchanged. This method of increasing pressure in the pulmonary artery is passive, and the resulting pulmonary hypertension is called passive (retrograde, venous, postcapillary), since the pressure in the pulmonary vascular system rises first in the venous segment, and then in the arterial. Passive pulmonary hypertension is not high, the pressure in the pulmonary artery usually does not exceed 60 mm Hg. Art. Nevertheless, already at this stage of development of mitral stenosis, hypertrophy of the right ventricle joins the hypertrophy of the left atrium.

In 30% of patients, mostly young, an increase in pressure in the left atrium and pulmonary veins, due to irritation of baroreceptors, causes a reflex constriction of arterioles (Kitaev's reflex). Functional constriction of the pulmonary arterioles leads to a significant increase in pressure in the pulmonary artery, which can exceed 60 mm Hg. Art. and reach 180-200 mm Hg. Art. Such pulmonary hypertension is called active (arterial, precapillary). With the development of active pulmonary hypertension, the pressure gradient between the pulmonary artery and the left atrium increases sharply. Under these conditions, the Kitaev reflex protects the pulmonary capillaries from an excessive increase in pressure and sweating of the liquid part of the blood into the cavity of the alveoli. but prolonged spasm arterioles leads to proliferation of smooth muscles, thickening of the middle membrane, narrowing of their lumen, diffuse sclerotic changes in the branches of the pulmonary artery. Functional, and then anatomical changes in the arterioles of the small circle create the so-called second barrier to blood flow. The inclusion of the second barrier increases the load on the right ventricle. A significant rise in pressure in the pulmonary artery and right ventricle makes it difficult to empty the right atrium. This is facilitated by a decrease in the cavity of the ventricle due to its hypertrophy (rigid walls of the ventricle, poorly relaxed in diastole). Difficulty in expelling blood from the right atrium causes an increase in pressure in its cavity and the development of hypertrophy of its myocardium.

In the future, there is a weakening of the right ventricle, not only due to significant resistance in the pulmonary artery, but also as a result of the development of dystrophic and sclerotic changes in its myocardium. Incomplete emptying of the right ventricle during systole leads to an increase in diastolic pressure in its cavity. The developing dilatation of the right ventricle, causing relative insufficiency of the tricuspid valve, somewhat reduces the pressure in the pulmonary artery, but the load on the right atrium increases. As a result, decompensation develops in the systemic circulation.

clinical picture. On the stages of passive pulmonary hypertension, there are complaints of shortness of breath during exercise.

Increased blood flow to the heart during physical stress causes capillary overflow (mitral stenosis prevents its normal outflow from the small circle) and makes it difficult to normal gas exchange. With a sharp rise in pressure in the capillaries, an attack of cardiac asthma may occur. Another complaint of patients at this stage is a cough, dry or with the separation of a small amount of mucous sputum, often with an admixture of blood.

With high pulmonary hypertension, patients complain of rapidly emerging weakness, fatigue and heartbeat. Much less often there are pains in the region of the heart of a aching or stabbing character, without a clear connection with physical activity. Only some patients have typical angina attacks.

The appearance of patients with moderately severe circulatory disorders in the small circle does not present any features.

However, with an increase in the degree of stenosis and an increase in symptoms of pulmonary hypertension, typical facies mitralis is observed; against the background of pale skin, a sharply defined blush of the cheeks with a somewhat cyanotic tinge, cyanosis of the lips and the tip of the nose. In patients with high pulmonary hypertension during exercise, cyanosis increases and a grayish coloration of the skin appears ("ashy" cyanosis).

At a pronounced defect is observed bulging of the heart area ("heart hump"), capturing the lower region of the sternum, and pulsation in the epigastrium. These symptoms are associated with hypertrophy and dilatation of the right ventricle and with its increased impacts on the anterior chest wall.

The apex beat is absent, as the left ventricle is pushed aside by the hypertrophied right ventricle.

If, after preliminary physical activity, the patient is laid on his left side, then when holding the breath at the height of exhalation at the apex of the heart or somewhat lateral to it, diastolic trembling ("cat's purr") can be determined by palpation with the palm of the hand, due to low-frequency fluctuations in the blood when it passes through the narrowed mitral valve. hole.

With percussion of the heart, increased dullness is determined upward due to the auricle of the left atrium and to the right due to the right atrium. There is no enlargement of the heart to the left.

Auscultation of the heart gives the most significant signs for the diagnosis, since the detected phenomena are directly related to impaired blood flow through the mitral orifice and to a change in the functioning of the mitral valve cusps. Changes of tones at this defect are reduced to the following.

The first tone is reinforced (clapping). This depends on the fact that in the preceding diastole, the left ventricle is not completely filled with blood and therefore contracts faster than usual, and the leaflets of the mitral valve by the time of contraction of the left ventricle are at a greater distance from the left venous opening and their movement with a greater amplitude produces a stronger abrupt sound. Clapping I tone is heard only in the absence of gross deformations of the valves.

At the apex, and sometimes in the IV intercostal space to the left of the sternum, the mitral valve opening tone (“opening click”) is heard, which is formed by a different movement of the mitral valve cusps at the beginning of diastole (protodiastole).

The mitral valve opening tone appears 0.03-0.11 s after the second tone. The shorter the interval between the II tone and the opening tone of the mitral valve, the greater the atrioventricular pressure gradient and the more pronounced stenosis. The tone of the opening of the mitral valve does not disappear even with atrial fibrillation.

The clapping I tone in combination with the II tone and the tone of the opening of the mitral valve creates a three-part melody characteristic of this defect - the "quail rhythm" at the apex of the heart.

As a result of an increase in pressure in the pulmonary artery in the second intercostal space to the left of the sternum, an accent of the II tone is heard, often in combination with its bifurcation, due to the non-simultaneous slamming of the valves of the pulmonary artery and aorta. The most characteristic auscultatory symptoms in mitral stenosis include diastolic murmur. Diastolic murmur may occur at various times during diastole. At the beginning of diastole, after the opening tone (proto-diastolic murmur), in the middle of diastole (meso-diastolic murmur), at the end of diastole (presystolic murmur).

Diastolic murmur is heard at the apex of the heart and, depending on the time of its appearance, has a different duration and different timbre.

Blood pressure usually does not change. In severe cases of mitral stenosis, atrial fibrillation as a result of dilatation of the left atrium, dystrophic and sclerotic changes in its muscles.

X-ray examination. The purpose of x-ray examination is a more accurate determination of the increase in individual chambers of the heart and clarification of the state of the vessels of the small circle.

When examining a patient in the anteroposterior projection, there is a smoothing of the "waist" of the heart, sometimes a bulging of the third arc of the left heart contour due to an increase in the left atrium in the first oblique or left lateral projections. This part of the heart displaces the contrasted esophagus to the right and back. With mitral stenosis, the esophagus deviates along an arc of a small radius (no more than 6 cm).

To determine the degree of enlargement of the left atrium, tomography is used.

In some cases (with high pulmonary hypertension), an increase in the second arc of the left contour is observed - a bulging of the pulmonary artery arc. The right ventricle initially enlarges upward due to outflow tract hypertrophy, followed by hypertrophy and dilatation of the inflow tracts. This leads to a bulging to the right of the lower arc of the right contour of the heart, formed by the right atrium. An increase in the right ventricle is also manifested by a narrowing of the retrosternal space when examining a patient in oblique projections.

Changes on the part of the pulmonary vessels are expressed by the expansion of the roots, which give a homogeneous shadow with blurred boundaries. Sometimes with passive pulmonary hypertension, linear shadows from the periphery of the lung fields depart from the roots in different directions.

With active (arterial) pulmonary hypertension, there is an expansion of the shadow of the roots of the lungs with clear contours due to the bulging of the arch of the pulmonary artery and the expansion of its branches. Since the small branches of the pulmonary artery are narrowed, there is, as it were, a sudden breakage of the expanded branches instead of their gradual transition to smaller branches - a symptom of "amputation" of the roots.

Electrocardiogram(ECG). The purpose of an electrocardiographic study is to identify hypertrophy of the left atrium and right ventricle, to assess emerging cardiac arrhythmias.

Signs of left atrial hypertrophy are as follows:

1) the appearance of a two-peak P wave in leads I, aVL, V 4-6. In these leads, the second peak, due to the excitation of the left atrium, exceeds the first, due to the excitation of the right atrium;

2) in lead V 1 there is a sharp increase in amplitude and duration of the second phase of the P wave;

3) an increase in the time of the internal deviation of the P wave by more than 0.06 s (the interval from the beginning of the P wave to its top).

As the degree of hypertrophy of the left atrium increases, the amplitude of the P wave (especially its second part) increases, the P wave exceeds the normal duration - 0.10 s, the time of the internal deviation of the P wave increases even more. more. With severe dilatation of the left atrium, the amplitude of the P wave can be significantly reduced.

There is no clear relationship between changes in the P wave and the degree of mitral stenosis.

Signs of right ventricular hypertrophy:

1) deviation of the electrical axis of the heart to the right in combination with a shift in the S-T interval and a change in the T wave in leads aVF, III (less often II);

2) in the right chest leads, the R wave increases, and in the left - S;

3) in the right chest leads with hypertrophy of the right ventricle S-T interval shifts down and a negative T wave appears.

ECG changes in the right chest leads correlate with the severity of pulmonary hypertension. Sometimes complete blockade is detected on the ECG right leg bundle of His.

Phonocardiogram(FCG). At the apex of the heart, I tone has a large amplitude of oscillation. The duration of the interval from the beginning of the second tone to the opening tone of the mitral valve (II -QS) ranges from 0.03 to 0.12 s, depending on the degree of stenosis. The interval Q-I tone, as the pressure in the left atrium increases, lengthens and reaches 0.08-0.12 s.

As a rule, various diastolic murmurs (presystolic, meso- and proto-diastolic) are recorded.

Diastolic (proto-diastolic) murmur begins immediately after the "opening tone" or at some interval after this tone.

Presystolic murmur (presystolic component) usually goes into I tone.

The value of FKG increases with atrial fibrillation, since auscultation does not allow attributing the heard noise to one or another phase of the cardiac cycle.

Echocardiogram. Signs of mitral stenosis will be: a) unidirectional diastolic movement of the mitral valve leaflets; b) a pronounced decrease in the rate of early diastolic closure of the anterior mitral leaflet; c) decrease in the general excursion of the movement of the mitral valve; d) an increase in the size of the cavity of the left atrium.

Two-dimensional echocardiography reveals: 1) a decrease in the area of ​​the mitral orifice (less than 3 cm 2); 2) an increase in the size of the left atrium with a normal left ventricle; 3) friendly movement of the mitral valve leaflets towards the IVS; 4) compaction (up to calcification) of the structures of the valve and the annulus fibrosus.

Diagnostics. Among the complaints of patients and objective symptoms, one should distinguish between a group of signs caused by the presence of mitral stenosis itself ("direct" signs) and a group of signs caused by a hemodynamic disorder in the systemic and pulmonary circulation ("indirect" signs).

If a defect is diagnosed on the basis of "direct" signs, then the presence and severity of "indirect" signs characterize the severity of the disease.

The "direct" signs include valvular symptoms: a) flapping I tone; b) mitral valve opening tone ("opening click"); c) diastolic noise (during auscultation); d) diastolic trembling (palpation).

The "indirect" signs include three groups of symptoms.

1. Left atrial: a) X-ray signs of enlargement of the left atrium; b) electrocardiographic syndrome of left atrial hypertrophy.

2. Pulmonary(as a result of stagnation in a small circle):

a) shortness of breath on exertion; b) cardiac asthma; c) bulging of the trunk of the pulmonary artery; d) expansion of the branches of the pulmonary artery.

3. Right ventricular(changes in the right heart due to pulmonary hypertension): a) pulsation in the epigastrium due to the right ventricle; b) X-ray signs of enlargement of the right ventricle and right atrium; c) electrocardiographic syndrome of right ventricular hypertrophy (in some cases, right atrium); d) violation of blood circulation in a large circle (right ventricular failure).

Flow. According to the evolution of hemodynamic disorders during mitral stenosis, 5 stages are distinguished (classification by A. N. Bakulev and E. A. Damir, 1955).

Stage I - complete compensation of the valvular defect by the left atrium. Patients make an impression completely healthy people and make no complaints. However, an objective study reveals direct signs of a defect, and primarily auscultatory ones.

There are no "indirect" symptoms.

Stage II - signs of circulatory disorders in the small circle are detected only during physical exertion.

Stage III - in a small circle, pronounced signs of stagnation, in a large initial one.

Stage IV - pronounced signs of stagnation in the systemic and pulmonary circulation, atrial fibrillation.

Stage V - "dystrophic", corresponds to stage III of circulatory disorders according to the classification of N. D. Strazhesko and V. X. Vasilenko.

With the development of right ventricular failure, a decrease in the contractile function of the right ventricle can reduce pressure in the pulmonary artery, which leads to some change in subjective sensations. Shortness of breath, hemoptysis, cough decrease, but there are complaints associated with stagnation in the systemic circulation: heaviness and dull pain in the right hypochondrium, swelling in the legs, oliguria, and later - ascites. A significant expansion of the right ventricle causes the development of relative insufficiency of the tricuspid valve. In such patients, there is an expansion of the heart to the right (due to hypertrophy and dilatation of the right atrium), swelling and pulsation of the cervical veins, sometimes a positive venous pulse, and a systolic murmur is heard at the base of the xiphoid process, which increases at the height of inspiration (Rivero-Corvallo symptom). With significant tricuspid insufficiency, there may be a pulsation of the liver.

Complications of mitral stenosis due to: 1) stagnation of blood in the small circle; 2) dilatation of the heart.

To the first group of complications include hemoptysis, cardiac asthma, high pulmonary hypertension (arterial), pulmonary artery aneurysm.

In patients with pulmonary hypertension, the orifice of the pulmonary artery may be distended, causing the valve cusps to not close, and a diastolic murmur of relative pulmonary valve insufficiency (Graham-Still murmur) may appear. This gentle in timbre, blowing proto-diastolic murmur is best heard along the left edge of the sternum with the epicenter of the sound in the second intercostal space on the left.

To the second group of complications include cardiac arrhythmias in the form of atrial fibrillation or flutter, thromboembolic complications, symptoms of compression of the mediastinal organs (mediastinal syndrome).

With the development of atrial fibrillation, their active systole falls out. This can change the auscultatory symptoms of mitral stenosis: the presystolic murmur disappears, which is precisely due to the increased passage of blood through the narrowed mitral orifice under the influence of active atrial contraction.

Atrial fibrillation contributes to the formation of blood clots in the left atrium. Broken blood clots can be a source of embolism of the vessels of the extremities, kidneys, brain, and abdominal cavity. The source of thromboembolism of the vessels of the pulmonary circulation is phlebothrombosis of the veins of the lower extremities, which develops due to congestion in the systemic circulation and low physical activity of patients. In the vessels of the small circle, there may also be local thrombosis, which is facilitated by local congestion.

A significant increase in the size of the left atrium sometimes leads to compression of the recurrent nerve located near and the development of vocal cord paralysis and hoarseness as a result (Horner's symptom).

Compression of the subclavian artery by an enlarged left atrium causes a decrease in the filling of the pulse on the left radial artery (Popov's symptom).

Pressure on the sympathetic nerve can cause anisocoria.

Prognosis for mitral stenosis depends on the severity of the defect, the state of the heart muscle, its contractility, the frequency of rheumatic attacks, the magnitude of pulmonary hypertension.

With moderate degrees of stenosis, rare rheumatic attacks, patients can remain able to work for a long time.

Progressive stenosis of the mitral orifice, repeated attacks of rheumatic heart disease lead to circulatory disorders. High pulmonary hypertension, thromboembolism, atrial fibrillation aggravate circulatory disorders, in these conditions the gnosis worsens, the ability to work is significantly reduced, up to a complete loss.

Treatment. There are no specific methods of conservative treatment of patients with mitral stenosis. Circulatory failure is treated according to generally accepted signs: cardiac glycosides, diuretics, drugs that correct water-salt balance disorders and eliminate metabolic disorders in the myocardium, peripheral vasodilators, inhibitors are prescribed. ACE. With an active rheumatic process - antirheumatic drugs. A radical method of treating this heart disease is mitral commissurotomy.

The operation is indicated for patients with severe mitral stenosis ("pure" or predominant) in the presence of symptoms that significantly limit the patient's physical activity and reduce the ability to work. These are patients with stage II, III, IV according to A. N. Bakulev and E. A. Damir. At stage I of mitral stenosis, surgery is not indicated, since patients can lead an active lifestyle.

The operation is especially indicated for patients suffering from cardiac asthma, hemoptysis. The presence of thromboembolic complications in a large circle suggests thrombosis in the left atrial appendage. Timely commissurotomy saves such patients from repeated embolism.

Atrial fibrillation is not a contraindication to surgery. The exacerbation of the rheumatic process is a relative contraindication: the operation should be postponed until the symptoms of exacerbation subside. It is possible only 2-3 months after the normalization of activity indicators. It is impossible to delay the referral of patients with mitral stenosis for surgery, since myocardial wear, repeated rheumatic attacks, and the formation of an organic second barrier worsen the results of commissurotomy

Commissurotomy can be performed according to vital indications if the patient has severe pulmonary hypertension with attacks of cardiac asthma, hemoptysis and the development of pulmonary edema.

Concomitant mitral insufficiency, expressed to a small extent, is not a contraindication to surgery, just like minor aortic valve insufficiency or aortic stenosis.

With a combination of mitral stenosis with severe mitral insufficiency, aortic insufficiency, organic insufficiency of the tricuspid valve, commissurotomy is contraindicated.

In some of these patients, implantation of an artificial mitral valve is possible.

Mitral valve stenosis is a heart defect that is caused by thickening and immobility of the mitral valve cusps and narrowing of the atrioventricular orifice due to fusion of the junctions of the cusps to each other (commissures). Many have heard about this pathology, but not all cardiologist patients know why the disease occurs and how the disease manifests itself, and many are also interested in whether mitral valve stenosis can be completely cured. We'll talk about this.

Causes and stages of development

In 80% of cases, mitral valve stenosis is provoked by previous rheumatism. In other cases, damage to the mitral valve can be caused by:

• other infective endocarditis;
• syphilis;
• heart injuries;
• systemic lupus erythematosus;
• hereditary reasons;
• mucopolysaccharidosis;
• malignant carcinoid syndrome.

The mitral valve is located between. It is funnel-shaped and consists of cusps with chords, annulus fibrosus, and papillary muscles that are functionally connected to the left atrium and ventricle. With its narrowing, which in most cases is caused by rheumatic lesions of the heart tissues, the load on the left atrium increases. This leads to an increase in pressure in it, its expansion and causes the development of a secondary one, which leads to right ventricular failure. In the future, such a pathology can provoke thromboembolism and atrial fibrillation.

With the development of mitral valve stenosis, the following stages are observed:

• Stage I: the heart disease is completely compensated, the atrioventricular orifice is narrowed to 3-4 square meters. see, the size of the left atrium does not exceed 4 cm;
• Stage II: hypertension begins to appear in, venous pressure rises, but there are no pronounced symptoms of hemodynamic disturbances, the atrioventricular orifice is narrowed to 2 square meters. see, the left atrium hypertrophies up to 5 cm;
• Stage III: the patient has pronounced symptoms of heart failure, the size of the heart increases dramatically, venous pressure rises significantly, the liver increases in size, the atrioventricular orifice is narrowed to 1.5 square meters. cm, the left atrium increases in size by more than 5 cm;
• Stage IV: symptoms of heart failure worsen, congestion is observed in the pulmonary and systemic circulation, the liver increases in size and becomes compacted, the atrioventricular orifice is narrowed to 1 sq. cm, the left atrium is enlarged by more than 5 cm;
• Stage V: characterized by end-stage heart failure, the atrioventricular opening is almost completely obstructed (closed), the left atrium increases in size by more than 5 cm.

In the degree of change in the structure of the mitral valve, three main stages are distinguished:

• I: calcium salts settle along the edges of the valve cusps or are located focally in the commissures;
• II: calcium salts cover all cusps, but do not extend to the annulus fibrosus;
• III: Calcification affects the annulus fibrosus and nearby structures.

Symptoms

Mitral valve stenosis can be asymptomatic for a long time. From the moment of the first infectious attack (after rheumatism, scarlet fever or tonsillitis) to the appearance of the first characteristic complaints of a patient living in a temperate climate, about 20 years can pass, and from the moment of severe shortness of breath (at rest) to the patient's death, about 5 years pass. In hot countries, this heart disease progresses faster.

With mild mitral valve stenosis, patients do not complain, but their examination may reveal many signs of a violation in the functioning of the mitral valve (increased venous pressure, narrowing of the lumen between the left atrium and ventricle, an increase in the size of the left atrium). A sharp rise in venous pressure, which can be caused by various predisposing factors (physical activity, sexual intercourse, pregnancy, thyrotoxicosis, fever, and other conditions), is manifested by shortness of breath and cough. Subsequently, with the progression of mitral stenosis, the patient's endurance to physical exertion sharply decreases, they subconsciously try to limit their activity, episodes of cardiac asthma, tachycardia, arrhythmias appear (, atrial flutter, etc.) and may develop. The development of hypoxic encephalopathy leads to the appearance of dizziness and fainting, which are provoked by physical activity.

A critical moment in the progression of this disease is the development of a permanent form of atrial fibrillation. The patient has an increase in shortness of breath and hemoptysis is observed. Over time, signs of congestion in the lungs become less pronounced and flow easier, but the ever-increasing pulmonary hypertension leads to the development of right ventricular failure. The patient complains of edema, severe weakness, heaviness in the right hypochondrium, cardialgia (in 10% of patients) and signs of ascites and hydrothorax (usually right-sided) may be detected.

When examining a patient, cyanosis of the lips and a characteristic raspberry-cyanotic blush on the cheeks (mitral butterfly) are determined. During percussion of the heart, a displacement of the borders of the heart to the left is revealed. When listening to heart sounds, an amplification of the I tone (clapping tone) and an additional III tone (“quail rhythm”) are determined. In the presence of severe pulmonary hypertension and the development of tricuspid valve insufficiency in the second hypochondrium, a bifurcation and amplification of the II tone is detected, and a systolic murmur is determined above the xiphoid process of the sternum, which increases at the peak of inspiration.

These patients often present with respiratory system(bronchitis, bronchopneumonia and lobar pneumonia), and the detachment of blood clots formed in the left atrium can lead to thromboembolism of the vessels of the brain, limbs, kidneys or spleen. When the lumen of the mitral valve is blocked by blood clots, patients develop severe chest pain and fainting.

Also, mitral valve stenosis can be complicated by relapses of rheumatism and. Repeated episodes of pulmonary embolism often end in the development of a pulmonary infarction and lead to the death of the patient.

Diagnostics

A preliminary diagnosis of mitral valve stenosis can be established clinically (i.e., after analyzing complaints and examining the patient) and conducting an ECG, which shows signs of an increase in the size of the left atrium and right ventricle.

To confirm the diagnosis, the patient is assigned a two-dimensional and Doppler Echo-KG, which allows to establish the degree of narrowing and calcification of the mitral valve leaflets, the size of the left atrium, the volume of transvalvular regurgitation and pressure in the pulmonary artery. To exclude the presence of blood clots in the left atrium, it may be recommended to perform. Pathological changes in the lungs are established using x-rays.

Patients with no signs of decompensation should be examined annually. The diagnostic complex includes:

• Holter ECG;
• Echo-KG;
• blood chemistry.

When deciding to implement surgical operation the patient is prescribed catheterization of the heart and main vessels.

Treatment

Mitral valve stenosis can only be eliminated surgically, since reception medicines can not eliminate the narrowing of the atrioventricular orifice.

The asymptomatic course of this heart disease does not require an appointment. drug therapy. When symptoms of mitral valve stenosis appear, the patient may be prescribed to prepare for surgery and eliminate the cause that caused the disease:

In the presence of atrial fibrillation and the risk of blood clots in the left atrium, it is recommended to take indirect anticoagulants(Warfarin), and with the development of thromboembolism, Heparin is prescribed in combination with Aspirin or Clopidogrel (under the control of INR).

Patients with rheumatic mitral stenosis must undergo secondary prevention of infective endocarditis and rheumatism. Antibiotics, salicylates and pyrazoline preparations can be used for this. After that, the patient is recommended a year-round course of taking Bicillin-5 (once a month) for two years.

Patients with mitral stenosis need constant monitoring by a cardiologist, compliance with healthy lifestyle life and rational employment. With this disease, pregnancy is not contraindicated in women who have no signs of decompensation and the area of ​​​​the hole in the mitral valve is at least 1.6 square meters. see In the absence of such indicators, termination of pregnancy may be recommended (in exceptional cases, balloon valvuloplasty or mitral commissurotomy may be performed).

With a decrease in the area of ​​the mitral orifice to 1-1.2 sq. see recurrent thromboembolism or the development of severe pulmonary hypertension, the patient is recommended surgical treatment. The type of surgical intervention is determined individually for each patient:

• percutaneous balloon mitral valvuloplasty;
• valvotomy;
• open commissurotomy;
• mitral valve replacement.

Forecast

The results of treatment of this pathology depend on many factors:

• patient's age;
• severity of pulmonary hypertension;
• associated pathologies;
• degree of atrial fibrillation.

Surgical treatment (valvulotomy or commissurotomy) for mitral stenosis allows restoring the normal functioning of the mitral valve in 95% of patients, but in most cases (in 30% of patients) repeated surgical treatment (mitral recommissurotomy) is required within 10 years.

In the absence of adequate treatment of mitral valve stenosis, the period from the manifestation of the first signs of heart disease to the patient's disability can be about 7-9 years. The progression of the disease and the presence of severe pulmonary hypertension and persistent atrial fibrillation increase the likelihood of a fatal outcome. In most cases, the cause of death of patients is severe heart failure, cerebrovascular or pulmonary thromboembolism. The five-year survival rate of patients diagnosed with mitral valve stenosis, in the absence of its treatment, is about 50%.

Medical animation "Stenosis of the mitral valve"

TV "Capital Plus", the program "Be healthy" on the topic "Mitral stenosis"

Mitral valve stenosis (misleadingly called neutral valve stenosis by some) is a disorder of the heart, and often occurs along with another, incomplete closure of the leaflets, due to which there is a partial backflow of blood.

Isolated or pure mitral valve stenosis occurs according to experts in 30-60% of cases. Also, its narrowing is manifested along with vascular hypertension.

The value of the valve apparatus

The chambers of the left half of the heart, the atrium and the ventricle, have a “septum” between them, consisting of two halves (the so-called valves), with the help of which it “regulates” the blood flow.

The mitral valve (or atrioventricular orifice) is part of the heart muscle located at the mouth of the left annulus fibrosus. The valve has its own muscles with which it regulates the flow of blood into the left ventricle.

The valvular apparatus, whose functions are impaired by wall thickening, scarring, narrowing of the opening and low muscle mobility, various cardiac pathologies occur, including mitral insufficiency and mitral valve stenosis.

What is mitral stenosis?

Mitral valve stenosis is a pathological decrease in the diameter of the fibrous ring of the atrioventricular valve, which develops rather slowly, but with a critical narrowing leads to disruption of the heart, hypertension and, if no measures are taken, to death.

The area of ​​the hole is normal in an adult is 4-6 cm2.

With a decrease in the valve ring in size, an acquired pathology of the valve tissues develops, intracardiac thrombi appear: the left atrioventricular or atrioventricular orifice decreases in size, hemodynamics develops (reverse blood flow to the left atrium).

Often this disease is typical for older people (after 55 years) and manifests itself in 90 out of 100 cases of acquired heart defects.

Causes of mitral valve stenosis

Narrowing of the orifice of the mitral valve refers to an acquired disorder associated with the pathology of the orifice itself, other disorders in the cardiac or papillary muscles.

The main reason for the acquisition of such valve pathology is the rheumatic process. Most often manifested in children who have had a sore throat.

The initial stage of mitral valve stenosis can be hidden for 20 years without causing discomfort, without showing itself in any way and successfully compensated by the heart on its own.

And in adulthood, the problem of the valve is already making itself felt. Doctors believe that girls are more susceptible to infections, and boys often develop mitral insufficiency (due to impaired operation of the valve leaflets, partial blood flow in the opposite direction occurs).

Atrioventricular narrowing may also have signs:

Narrowing of the left venous orifice can be caused by streptococci and other bacteria that enter the bloodstream of HIV-infected people, a patient with reduced immune system and those who use drugs.

Types and degrees of development of atrioventricular stenosis

As the mitral valve stenosis progresses, it is customary to distinguish between its stages of development:

• Minor stenosis- the size of the hole narrows to no more than 3 cm2, and there are no symptoms, manifesting only during the study.
• Moderate- narrowing of the hole from 2.3 to 2.9 cm2
• Expressed- narrowing of the bicuspid valve from 1.7 to 2.2 cm2
• Critical- narrowing of the hole from 1.0 to 1.6 cm2

It is important for doctors to determine the exact degree, because the way the valve treatment is determined will depend on this.

According to the type of anatomical form, it is customary to distinguish:

1. Funnel mitral stenosis, the so-called fish mouth: this type is the most difficult to change online;
2. Jacket loop stenosis- the stenotic process splices only the valve leaflets with the annulus fibrosus;
3. Type of stenosis with double constriction- adhesions appear not only as a jacket loop, but connect separate parts of the diameter of the fibrous ring.
   In children, the second type of atrioventricular stenosis is considered the most common.

Symptoms

The manifestation of mitral valve stenosis depends on the degree of its damage to the atrioventricular orifice.

First stage(compensation) is asymptomatic, when the functionality of the heart is compensated by its own forces and a person for many years (from 5 to 20) may not feel the presence of a problem.

It is characterized by a decrease in activity, weakness, increased heart rate after physical or emotional overload, shortness of breath, and a characteristically pale face (facies mitralis) with a cyanotic blush, lips and nose are intensely colored. blush photo

At the second stage, subcompensation, shortness of breath and fatigue is already manifested with a smaller amount of work and movement, with clinical diagnostics there is venous hyperemia (partial or complete suspension of blood outflow in a separate part of the vein).

At the third stage(decompensation) it is difficult for the patient to do household chores, and shortness of breath accompanies even the most elementary actions (such as tying shoelaces).

Blood stasis occurs in the lungs and internal organs. There is swelling, which indicates damage to the lungs (life-threatening).

Fourth stage(severity of decompensation) - edema is pronounced in lower limbs, fluid accumulates in the chest or abdominal cavity, hemoptysis appears, due to stagnant processes, an increase in the liver, cough occurs.

Fifth stage(terminal) - is the most severe and a sign of its onset is the manifestation of the above symptoms already at rest, swelling (anasarca) occurs throughout the body.

The heart is not able to pump blood, which stagnates in the lungs, the internal organs experience oxygen starvation (their dystrophy occurs). These symptoms are fatal.

All stages proceed very slowly, and with the right behavior and treatment, stagnation of blood can be prevented both in the lungs (small circle) and in the internal organs (large circle).

Diagnostics

If you feel symptoms characteristic of mitral valve stenosis, you need to contact a general practitioner or a cardiologist who will conduct an examination using special devices.
Diagnostics occurs in the following ways.

At the initial appointment and clinical study (collection of data on past illnesses, determination external signs diseases, palpation, percussion and auscultation) perform the following manipulations:

Without obstructing the narrowing of spacemitral valve death in the near future can not be avoided. People with this disease live on average for about 50 years, and the constant use of medications and surgery significantly improve this life.

Drugs for the medical treatment of mitral valve disease

For the treatment of mitral valve stenosis, medical and surgical treatment is used, and they are used simultaneously, since additional stimulation with drugs is necessary before and after surgery.

The therapeutic prescription for a particular case depends on the results of diagnosis and hemodynamic parameters, and the own method of restoring a patient with mitral stenosis depends on the general condition of his body, the degree of impairment and the state of the heart as a whole.

If the narrowing of the mitral valve has reached 1.5-2 cm. and less, then surgical intervention cannot be avoided. And since the question is already about human life, then the risk is considered justified. After all, only thanks to the operation in conjunction with medications we can talk about its extension.

Surgical method

He has a large number of indications and contraindications. In the early stages of mitral valve stenosis, classical therapy, and only when the narrowing becomes less than 3 cm, then a decision is already made on a possible operation.

Operative methods of treatment are resorted to if the danger to life is higher than the risk of surgery.

• Balloon valvuloplasty- sedative drugs are injected, after which a probe with a balloon is inserted through the femoral artery, reaching the place of narrowing of the ring, the catheter is inflated and causes the destruction of the fused valve leaflets, after which it is removed back;
• Open commissurotomy- is performed in case of impossible balloon plastic surgery, and is performed by dissecting the site of narrowing of the valve with a scalpel and increasing the opening of the ring on the open heart;
• Valve replacement (replacement)- transplantation of a valve of foreign or artificial origin is used, the method is used if the violation of the valve is so severe that it cannot be restored by previous methods.

Contraindications for surgery

There are a number of rigid contraindications for such an operation:

• Infectious lesions;
• Defeats of cardio-vascular system(stroke, myocardial infarction, etc.);
• Terminal heart failure and severe maladjustment (decrease in blood ejection to the level of 20 percent);
• General diseases that exhaust the body's vitality, such as diabetes, bronchial asthma and etc.

Postoperative complications

• Infectious foci on the valves of the mitral ring;
• The occurrence of thrombus formation at the site of mechanical intervention;
• Rejection by the body artificial prosthesis and further increase in mitral insufficiency.

Mitral valve replacement surgery can be done in any major city in the country. At the same time, by submitting a turnout with the necessary documentary evidence, you can get it on a quota. Otherwise, it will cost you from 100 to 300 thousand rubles.

Complications without surgery

Some patients are skeptical about surgical intervention. But the lack of timely effective compensation of mitral valve stenosis can lead to extremely negative consequences.

These include:

Forecast

Predicting the development of mitral valve stenosis depends on many factors. First of all, it has great importance treatment. If the necessary measures were taken to restore valve function, then the prognosis will be favorable.

The main feature of mitral valve stenosis is the long-term development of the disease. But if there was no adequate treatment, then the patient's disability can occur in about 8 years.

Important factors in predicting the disease are the general health of the patient, his age and the presence of concomitant diseases.

Pathologies such as atrial fibrillation and arterial hypertension significantly worsen the prognosis and reduce the likelihood of survival of a patient with mitral valve stenosis.

About 80% of patients successfully pass the 10-year survival threshold. But this is only possible if quality treatment.If the patient has pulmonary hypertension, then the survival time can be reduced to three years.

It should be noted that even those patients who received the necessary procedures to restore valve function, over time, there may be a need to repeat them.

Lifestyle with mitral stenosis

For patients with mitral valve stenosis, it is important to adhere to some lifestyle requirements. plays a key role in risk reduction proper nutrition, being outdoors and keeping calm.

In addition, for patients with mitral stenosis there are requirements for the drinking regimen. It is necessary to reduce the amount of salt consumed and drinking water. This reduces the load on the valve.

Particular attention should be paid to women suffering from mitral stenosis who are pregnant or planning it. In this case, the patient must be registered in the antenatal clinic. If the stenosis is qualitatively compensated, then you can count on a good course of pregnancy. Otherwise, pregnancy is strictly contraindicated.

Usually, for patients suffering from mitral valve stenosis, caesarean section is chosen as the mode of delivery.

Prevention

If you have been ill serious illness caused by hemolytic staphylococcus aureus (for example, tonsillitis, otitis media, abscess, urogenital disease, intestinal dysbacteriosis), then you need to be extremely careful and take a course of antirheumatic therapy.

For this, there are special drugs. Consult a therapist and get professional advice and adequate treatment in order to avoid serious exacerbations in the future.

Video: Mitral stenosis. Hemodynamics in heart defects