Hemodynamically insignificant regurgitation on valves

The left ventricle provides the pumping function of the heart. When he relaxes, the blood from the atrium through the mitral opening flows into his cavity. This is the diastole phase. During systole, the ventricle contracts, pushing the blood it contains into the vascular bed.

From refluxing blood back into the atrium, tightly closed fibrous plates, the mitral valve flaps, protect. If their edges do not touch with systole, part of the volume of fluid moves back, and regurgitation occurs.

This condition is called mitral regurgitation.

The reasons for the reverse casting of blood can be degenerative processes in the valves. Changing the structure of the valve violates the shape of its edges and negatively affects the amplitude of movement.

  • systemic connective tissue lesions (e.g., scleroderma);
  • congenital hereditary diseases (Ehlers-Danlos syndrome);
  • rheumatism;
  • endocarditis of infectious etiology;
  • rupture of chords (thin strings that connect the edge of the valve and the bottom of the left ventricle; the main function is to prevent inversion (prolapse) of the valves in the direction of the atrium);
  • dysfunction of the papillary muscles (located at the base of the chords);

Valvular mitral regurgitation can cause a change in the myocardium with the normal structure of the valves:

  • expansion of the mitral ring;
  • pathological enlargement of the cavity of the left ventricle (with heart failure);
  • hypertrophic cardiomyopathy (characteristic of hypertension 2, 3 stages).

The atrioventricular foramen has a rounded shape. The basis for the valves is a fibrous ring, soldered to the myocardium. If the heart muscle is stretched, the shape of the hole will change. In this case, unchanged valves will not be able to fulfill their function (close this outlet for blood tightly with systole) and regurgitation will occur.

If the bicuspid valve does not close completely, this triggers a cascade of pathological processes:

  1. The return of part of the volume of blood to the left atrium causes the extension of its walls (dilatation) and overflow with blood.
  2. The myocardium has to push out a larger volume, muscle fibers compensatory hypertrophy, contract more.
  3. Since blood enters the left atrium from the pulmonary circulation, pressure in the lungs rises (here the first characteristic symptom is shortness of breath).
  4. The right ventricle pumps blood into the lungs, and to overcome the increased resistance, it also hypertrophies, but to a lesser extent.
  5. The left ventricle is gradually stretched by an increased incoming blood volume.

1 What are heart valves?

First of all, let’s understand how the heart works. This is an organ divided into 4 chambers: two ventricles and two atria. Between the atria and the ventricle are membranes of connective tissue – the valves. In the left half of the heart, the valve is represented by two cusps, which is why it is called bicuspid or mitral, and in the right half of the heart – three cusps, this is a tricuspid or tricuspid valve.

Valves are attached by thin threads or chords to the papillary muscles of the ventricles. The heart chambers contract alternately. With atrial contractions, the valves open toward the ventricles, blood flows from the atria to the ventricles, after which the atria relax, and the turn of the ventricular contractions occurs.

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At this point, the elastic valves are closed, not allowing the retrograde passage of blood to the atria, and blood from the ventricles enters the large vessels and is carried throughout the body. Accordingly, the role of valves is to provide blood flow in one direction: from the atria to the ventricles, and to prevent blood flow in the opposite direction.

6 When should mitral regurgitation be treated?

Diagnosis of mitral regurgitation

But if the reverse blood flow is 50% and reaches the middle of the atrium, there is a 2nd degree of mitral regurgitation. The load on the left atrium at the same time increases, as a result of which it increases in size, pumping more blood than it should, then the left ventricle hypertrophies.

  1. This is a pathological condition in which there are patient complaints of shortness of breath with moderate physical exertion, palpitations, periodic chest pain, cough, general weakness and fatigue.
  2. With percussion, the borders of the heart are shifted down and to the left.
  3. During auscultation, systolic murmur and attenuation of the I tone at the apex are heard.
  4. On the electrocardiogram – hypertrophy of the left heart.

Diagnostic assistance is provided by echocardiography with Doppler, this research method allows you to visualize the movement of the valves, the size of the holes between the valves and the degree of reverse blood flow.

Treatment is carried out by the main groups of drugs: ACE inhibitors, beta-blockers, diuretics, anticoagulants, etc. Surgical treatment at 2 degrees, as a rule, is not shown.

Types of tricuspid regurgitation

There are 2 main classifications of this pathology – by the time of occurrence and by the causes of occurrence.

  • By the time of appearance: congenital and acquired.

Congenital is recorded during intrauterine development of the child or in the first months after birth. In this case, the heart valve may return to normal over time. In addition, a congenital anomaly is much easier to control if you take care of your heart and follow preventative measures for cardiovascular diseases.

Acquired appears in adults already during life. Such a pathology almost never occurs in isolation, a variety of diseases can become its cause – from dilatation (expansion) of the ventricle to obstruction of the pulmonary arteries.

  • For a reason: primary and secondary.

The primary tricuspid anomaly is diagnosed against a background of heart disease. With this diagnosis, the patient has no problems with the respiratory system. The main cause of secondary blood flow disturbance in the tricuspid valve is pulmonary hypertension, that is, too much pressure in the pulmonary artery system.

Tricuspid valve regurgitation traditionally goes hand in hand with valve insufficiency. Therefore, some classifications share the types of blood reflux based on the form of tricuspid insufficiency, that is, directly valve disease:

  1. Organic (absolute) failure, when the cause is in the defeat of the valve cusps due to congenital illness.
  2. Functional (relative) when the valve is stretched due to problems with the pulmonary vessels or diffuse damage to the heart tissue.

Treatment and prevention

Therapy of tricuspid regurgitation includes 2 large blocks – conservative and surgical treatment. When the disease is at the first stage, no special therapy is required, only regular monitoring by a cardiologist.

When the disease reaches the second degree, conservative treatment already involves taking special medications. These are diuretics (diuretic), vasodilators (means for relaxing the muscles of blood vessels), potassium preparations, etc.

Surgical treatment of the tricuspid valve is the following types of operations:

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The prognosis of life with tricuspid regurgitation is quite favorable, provided that the patient leads a healthy lifestyle and takes care of his heart. And when the disease is detected in the very first stage, and when the valve operation has already been performed.

Doctors in this case are advised to use standard measures for the prevention of heart failure. These are body weight control and regular physical activity, proper nutrition, giving up cigarettes and alcohol, regular rest and as little stress as possible. And most importantly – constant monitoring by a cardiologist.

Degrees of tricusp >

Mitral Valve Regurgitation Degrees

There are several degrees:

    Mitral valve regurgitation 1 tbsp. – the reverse flow of blood from the ventricles to the atrium occurs at the level of the valve cusps. This condition is not pathological. And is cons >

Well-being during physical activity

Bicuspid valve dysfunction of the 1st degree cannot be considered as a pathology. It can be considered the norm, since in isolation it does not cause any clinical manifestations, often regurgitation of the 1st degree is detected by chance and is functional. With regurgitation of 1 degree, the return flow of blood from the ventricle to the atrium is less than 25%.

Patients tolerate physical activity well, they have no complaints from the cardiovascular system, this regurgitation is not hemodynamically significant, there are no changes on the ECG. When conducting Doppler echocardiography, reverse blood reflux can be observed. The method of echocardiography with doppler is the main when detecting regurgitation of 1 degree.

Regurgitation can occur in 4 different stages (degrees). But sometimes doctors distinguish a separate, fifth, so-called physiological regurgitation. In this case, there are no changes in the myocardium, all three valve cusps are completely healthy, just a barely noticeable violation of the blood flow in the cusps themselves (“swirl” of blood) is observed.

  • First stage. In this case, the patient has a small flow of blood backward, from the ventricle to the atrium through the valve flaps.
  • Second stage. The length of the jet from the valve reaches 20 mm. Tricuspid regurgitation of the 2nd degree is already considered a disease that requires special treatment.
  • Third stage. Blood flow is easily detected during diagnosis, in length exceeds 2 cm.
  • Fourth stage. Here, the blood flow already goes a considerable distance deep into the right atrium.

This condition does not threaten life at all, does not affect the well-being in any way and is accidentally detected during the examination. Unless, of course, does not begin to progress.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.