Stenosis and failure
- Stenosis is a narrowing of the valve opening. The heart has to push blood through a narrow gap, and its wall thickens. The most common and dangerous is aortic stenosis.
- Insufficiency - the valves do not close, the blood returns back. The heart chamber gradually expands. Mitral regurgitation is common
- Combined defect - a combination of stenosis and insufficiency on one valve
- Combined defect - damage to several valves
Reasons
- Degenerative changes with age - calcification of the aortic valve, the most common cause in the elderly
- Rheumatic heart disease is a consequence of a streptococcal infection; in our region remains a significant reason
- Congenital anomalies, such as bicuspid aortic valve
- Infective endocarditis - destruction of the leaflets by infection
- Dilation of the heart chambers after a heart attack or with cardiomyopathy - relative insufficiency
- Mitral valve prolapse - sagging of the leaflets; often a harmless condition
Пролапс митрального клапана находят у многих здоровых людей. Сам по себе, без значимой регургитации, он не является болезнью, не требует лечения и не ограничивает физическую активность. Значение имеет только выраженная недостаточность по ЭхоКГ.
Symptoms
It takes a long time for a defect to be corrected, and the first complaints often mean that the process has gone far. The triad, especially important in aortic stenosis:
- Fatigue, weakness
- Palpitations and interruptions, often accompanied by atrial fibrillation
- Swelling of the legs, heaviness in the right hypochondrium in late stages
- Night attacks of suffocation, inability to lie down
- Одышка при нагрузке, постепенно снижающая переносимость активности.
- Боль в груди при нагрузке — сердце не получает достаточно крови.
- Головокружение и обмороки при нагрузке — крайне тревожный признак.
Diagnostics
- Аускультация: шум в сердце — первый и часто единственный признак на бессимптомной стадии.
- Эхокардиография — main метод: определяет клапан, вид порока, степень тяжести, размеры камер и функцию сердца.
- ЭКГ и суточное мониторирование — выявление гипертрофии и аритмий.
- Чреспищеводная ЭхоКГ — при недостаточной информативности обычной и перед операцией.
- МСКТ сердца и коронарография — перед хирургическим вмешательством.
The frequency of control echocardiography is determined by the severity of the defect: for a mild one - once every 2-3 years, for a severe asymptomatic one - every 6-12 months. A missed control means a missed moment for the operation.
Treatment
There are no medications that eliminate the defect: drugs relieve symptoms and treat complications, but do not restore the valve. The only radical method is surgical.
- Monitoring with regular echocardiography - in mild to moderate cases without symptoms
- Valveplasty is preferable where possible, especially on the mitral valve: the native valve is preserved
- Prosthetics with a mechanical prosthesis - lasts a long time, but requires lifelong use of an anticoagulant
- Prosthetics with a biological prosthesis - does not require constant anticoagulation, but wears out over time
- Transcatheter aortic valve implantation (TAVI) - without opening the chest, for patients at high surgical risk
- Prevention of infective endocarditis during dental interventions in patients with dentures
