Acquired Heart Defects
A healthy heart is a strong, continuously working organ, the size of a fist and a weight of about half a kilogram. In addition to maintaining a steady, normal blood flow, it quickly adapts and adapts to the ever-changing needs of the body.
For example, in a state of activity, the heart pumps out more blood, and less – at rest. During the day, the heart produces an average of 60 to 90 contractions per minute – 42 million beats per year!
The heart is a two-way pump that circulates blood throughout the body. It consists of 4 cameras.
The muscular wall, called the septum, divides the heart into the left and right halves. In each half there are 2 cameras. The upper chambers are called the atria, the lower chambers are the ventricles. The right atrium receives all the blood returning from the upper and lower parts of the body.
Then, through the tricuspid valve, it sends it to the right ventricle, which in turn pumps blood through the valve of the pulmonary trunk to the lungs. In the lungs, the blood is enriched with oxygen and returns to the left atrium, which sends it through the mitral valve into the left ventricle.
The left ventricle through the aortic valve through the arteries pumps blood through the body, where it supplies the tissue with oxygen.
Depleted with oxygen, blood flows through the veins into the right atrium. Four valves (tricuspid, pulmonary trunk valve, mitral, aortic) act as a door between the cameras, opening in one direction.
These valves help move the blood forward and prevent it from moving in the opposite direction. The healthy valve petals are a thin, flexible tissue of perfect shape. They open and close when the heart contracts or relaxes.
Heart valves may have a pathology due to birth defects. They may be damaged or scarred due to rheumatic fever, infection, hereditary factors, age or heart attacks.
Mitral valves are most susceptible to such changes. Regardless of the case, the heart valve may become stenotic (narrowed inlet) or insufficient (not fully closed). With valve stenosis, the heart must work harder to pump the required amount of blood through a narrowed opening.
Insufficiency of the valve causes the blood to flow back through the valve after it closes. And again, the heart has to work harder to pump enough blood for the needs of the body to make up for the deficiency caused by the reverse outflow of blood.
Both cases – stenosis and insufficiency – make the heart work harder to pump the necessary amount of blood. Such additional work can weaken the heart, lead to its increase and cause various diseases.
Some symptoms of heart disease include chest pain, lack of air, malaise, fainting, chronic fatigue, and swelling of the limbs. Acquired (or valvular) heart defects are disturbances in the functioning of the heart that are caused by structural and functional changes in the functioning of one or more heart valves.
Such disorders can be manifested by stenosis or valve insufficiency (or a combination thereof) and develop as a result of damage to their structure by infectious or autoimmune factors, overload and dilatation (increased lumen) of the heart chambers.
Most valvular defects are triggered by rheumatism. Most often, mitral valve lesions are observed (about 50-70% of cases), and somewhat less often, aortic valve injuries (about 8-27% of cases).
Malformations of the tricuspid valve are detected much less frequently (in no more than 1% of cases), but they can be detected quite often in the presence of other valvular defects. This pathology is provoked by the inflammatory process, which, arising in the valve wall, leads to its destruction, cicatricial deformation, perforation or gluing of the valves, papillary muscles and chords.
As a result of such changes, the heart begins to function under increased load, increases in size, and the weakening contractile function of the myocardium leads to the development of heart failure.
Causes of pathology
Violation of the anatomical integrity of the structures of the heart develops as a result of various changes in the connective tissue of the valve base under the influence of several main reasons, which include:
- Endocarditis is an inflammatory reaction of the inner layer of the heart wall, which gradually spreads to the valves and leads to a change in their properties and structure.
- Rheumatism is a systemic autoimmune pathology characterized by the fact that the immune system begins to produce autoantibodies that affect their own connective tissue, especially the area of the heart valves and joints.
- Past chest injuries (bruises, fractures of the ribs or sternum), which in varying degrees affected the heart and led to a gradual disruption of its anatomical structure.
- Atherosclerosis – damage to the arteries due to the deposition of cholesterol in their walls with the formation of atherosclerotic plaques and changes in the properties of the walls of blood vessels. The development of such a pathological process can take place in the valve apparatus, which leads to its defects.
- Tertiary syphilis is a long course of this infectious disease with sexual transmission, in which pathogenic (pathogenic) microorganisms spread throughout the body, partially settle in the heart valves, leading to the formation of specific foci of inflammation and tissue destruction (gumma) with a violation of integrity.
- Sepsis is a purulent process, which is a consequence of the development of a bacterial infection process in the blood with frequent damage to the heart structures.
Simultaneous exposure to several causes at once leads to a more rapid formation of acquired heart disease, as well as its severe course with severe heart failure.
The most common and main reason for the development of the disease is rheumatism, it accounts for about 60-70% of all cases of acquired heart defects.
There are four chambers in the human heart: the left and right atria and ventricles, between which there are heart valves. An aorta emerges from the left ventricle, and a pulmonary artery from the right ventricle.
Between the left heart chambers there is a bicuspid valve, mitral. And between the right sections there is a tricuspid valve, another name is tricuspid valve. An aortic valve is located in front of the aorta, and another pulmonary valve in front of the pulmonary artery.
The efficiency of the heart muscle depends on the functioning of the valves, which, when the heart muscle contracts, pass blood to the next section without obstacles, and when the heart muscles relax, they do not allow blood to flow back. If the function of the valves is impaired, then the function of the heart is also impaired.
Defects are divided depending on how much they disturb the dynamics of the heart.
- Not significantly affecting cardiac dynamics. This is due to the fact that everything in our body is inherent with a kind of “margin of safety”, which for some time provides compensation for the process.
- Moderately expressed.
You can also share vices depending on how much they are compensated.
For formation reasons, defects are classified as follows:
- degenerative, or atherosclerotic, they occur in 5,7% of cases; more often these processes develop after forty to fifty years, there is a deposition of calcium on the valves of the generated valves, which leads to the progression of the defect;
- rheumatic, forming against the background of rheumatic diseases (in 80% of cases);
- malformations arising as a result of inflammation of the inner lining of the heart (endocarditis);
- syphilitic (in 5% of cases).
The main classification criterion is which valve is affected.
- Mitral defect (stenosis or insufficiency).
- Aortic malformation (stenosis and insufficiency).
- Tricuspid malformation (stenosis and insufficiency).
A combined lesion is also possible when several valves are affected.
Moderately or minimally expressed heart defects of the acquired type often do not manifest themselves clinically in any way, since the compensatory mechanisms of our body are turned on.
Sometimes compensated heart defects can accompany the following symptoms:
- moderate shortness of breath after exercise;
- heart palpitations;
- mild pain or discomfort in the cardiac region;
- sometimes moderate dry cough.
After decompensation of the defect (with the progression of the disease), symptoms and signs of hemodynamic disorders in both circles of blood circulation may appear.
The following symptoms are characteristic of the progress of pathology:
- the appearance of shortness of breath at rest;
- moderate or severe cyanosis (blue) of the skin;
- the appearance of moderate or severe edema;
- palpitations, some rhythm disturbances;
- the appearance of intense pain in the heart;
- the appearance of a dry cough or with a slight secretion of sputum, hoarseness, in some cases, hemoptysis;
- general weakness or excessive fatigue.
It cannot be said that the symptoms of acquired heart defects always depend not only on the severity of the pathology, but also on its type, on which particular defect takes place.
Aortic heart defects
The presence of symptoms of moderate or severe aortic stenosis is an indication for aortic valve replacement. Indications for surgery are cases of asymptomatic disease with severe aortic stenosis, in which there is an increased risk of ventricular ectopia and sudden death.
The condition of most patients who have severe aortic stenosis and left ventricular dysfunction improves significantly after valve replacement.
In patients with severe aortic stenosis, congestive heart failure, and severe damage to left ventricular contractility, surgery also improves the condition due to an increase in ejection fraction and improved hemodynamics.
Thus, congestive heart failure, angina pectoris, syncope are indications for aortic valve prosthetics for its stenosis. During catheterization, the pressure gradient exceeds 50 mm Hg. Art., and the area of the aortic valve is less than 0,75 cm.
In patients without symptoms, the indication for surgery is the severity of hemodynamic manifestations: a progressive increase in the left ventricle and a decrease in its contractility. The optimal time for surgical treatment of patients with aortic regurgitation still causes some controversy.
The operation is clearly indicated for patients with severe symptoms.
Patients in functional classes III and IV should be operated on immediately. Usually for patients who do not have clinical manifestations, the recommendation for surgical treatment is to start dysfunction of the left ventricle at rest.
Thus, the indication for aortic valve replacement surgery during regurgitation in this valve in asymptomatic patients is a constant or recurring left ventricular dysfunction.
In patients on the verge of an asymptomatic condition or minimal manifestation of the disease, it is recommended that the operation be performed with the manifestation of dysfunction of the left ventricle at rest.
In symptomatic patients, an indication for surgery is the III — IV functional classes, pronounced dilatation of the left ventricle (progressive increase in the end-systolic and end-diastolic sizes), rapid depression of fractional shortening (less than 29%), progressive change in the size of the left ventricle (end-systolic size over 55 mm, end-diastolic size over 80 mm, ejection fraction alone less than 50%), end-systolic volume over 300 ml.
The combination of stenosis and insufficiency is also a common situation in patients with lesions of this valve. The indication for surgery is based on whether stenosis or regurgitation predominates. Often there is severe stenosis with slight regurgitation.
The decision about the operation is made on the basis of the above indications for stenosis or valve insufficiency.
To replace the aortic valve, surgeons now have the widest selection of biological and mechanical heart valves, allografts, and autographs. Frameless valves, which in their physiological properties differ little from the patient’s natural valves, are becoming more widespread in surgical practice.
The surgical technique for replacing the aortic valve with mechanical prostheses and biological valves on the support ring is described in detail in heart surgery manuals.
Frameless prosthesis implantation belongs to new sections of cardiosurgery, technically it requires strict observance of the aspect ratio of the resected and implantable valves, very good visualization and preservation of the anatomical ratio of the neo-valve sinuses and the mouths of the coronary arteries.
Given the rather high complexity of these operations, frameless prostheses for the aortic position are still used mainly in clinics that have very extensive experience in open heart surgery.
A serious problem in the pathology of the aortic valves are cases with the so-called narrow fibrous ring. Fundamentally, in such patients two methods of aortic root expansion can be used: the Nyx – Manukyan operation involves posterior access, and the operation of Kohn et al.
In both cases, a synthetic patch is sewn into the defect being formed, to which the seams of the implanted valve are attached. Despite the advantage of these physiological operations, numerous studies have shown that the small size of the valve does not affect the quality and life span, despite the fact that with small aortic valves, a higher transplant prosthesis remains.
Therefore, most surgeons continue to perform simple valve prosthetics without expanding the aortic root.
Recent achievements include operations of simultaneous correction of aortic insufficiency with damage to the ascending aorta and its arch.
Such an operation is performed with stratified aneurysms with different genesis. Very often, Marfan syndrome is at the heart of the disease. During operations, valve-containing vessels, the so-called conduits, are used.
The operation is performed under typical cardiopulmonary bypass surgery: the aortic valve is resected and a conduit is implanted from the aortic root to healthy areas of its ascending department with reimplantation of the coronary artery mouths into this conduit.
If the stratification extends to the aortic arch and there is a need for reimplantation of the vessels supplying the brain to the conduit, then this operation is performed to stop blood circulation at the stage when resection of the aortic arch is necessary.
Modern methods of treating aortic valve pathology and lesions of its arch are often not limited to this. In a significant percentage of cases in patients simultaneously with the above lesions, there is also damage to the coronary vessels. In rare cases, this pathology can be combined with post-infarction heart aneurysm and ischemic mitral valve dysfunction.
Mitral heart defects
Indications and contraindications for operations on the mitral valve in recent years have changed little. We can only note the tendency to perform operations in the period preceding the development of complications such as atrial fibrillation, thromboembolism, decompensated heart failure.
Based on the fact that since the onset of clinical signs in patients with mitral valve stenosis, life expectancy for 5 years is observed in no more than 50% of patients, for 10 years – for 34% and 14% for 20 years, it is believed that even with the initial manifestations of the disease, a patient with mitral stenosis should be considered a candidate for surgery.
A mitral valve area of 1 cmg is considered critical. Prevention of mitral commissurotomy is performed in women with an asymptomatic course of the disease, but in case they want to have a pregnancy or in the early stages of pregnancy.
If there is a history of thromboembolic episodes, one should also immediately raise the question of the preventive nature of the operation, even with minimal manifestations of the disease. Finally, the current level of transesophageal echocardiography allows even small thrombi in the left atrium to be detected.
In case of ineffective drug treatment of these blood clots, an operation to eliminate mitral stenosis and thrombus of the left atrium or left atrium should be performed. Patients with manifestations of mitral regurgitation are referred for surgery before severe disorders, before the appearance of systolic dysfunction of the left ventricle.
In patients with severe mitral regurgitation, surgery is indicated with an increase in heart size or end-systolic volume, even in cases where the quality of life is still satisfactory.
Surgical correction allows maintaining high myocardial contractility in patients with normal preoperative ejection fraction and minimal ventricular dilatation; on the other hand, in patients with impaired myocardial contractility, it is difficult to expect a significant improvement in left ventricular function before surgery.
Factors affecting the outcome of the operation are old age, a higher functional class, the presence of congestive heart failure, reoperation and preservation of valve structures. In favor of the latter is the fact that during reconstructive operations on the mitral valve, mortality is lower than with prosthetics of the mitral valve.
All operations on the mitral valve are divided into reconstructive and prosthetics. Currently, there is a coordinated manual for reconstructive surgery of the mitral valve regarding the reconstruction of the valve ring, cusps of the mitral valve, chordal apparatus and papillary muscles.
Various forms of partial resection of valve flaps are used very effectively to restore the obturator function of the valve. In these cases, it is considered mandatory to use alloplastics using a support ring of the appropriate size.
The percentage of mitral regurgitation is very high due to dysfunction of the chordal apparatus. In plastic surgery, shortening chords, moving chords, or replacing them with synthetic prostheses are used.
Intraoperative monitoring of the results of reconstructive surgery is very important. A satisfactory result with mitral regurgitation at 1+ is considered generally accepted. In most cases, however, it is possible to achieve the complete closure function of the mitral valve.
If regurgitation exceeds 2+, additional reconstruction options should be sought or valve prosthetics performed. In about 8% of cases, during the reconstruction of the mitral valve, the results are unsatisfactory and valve replacement is necessary.
Hospital mortality in a large series of observations (more than 3000 patients) was 3,4%. Despite the fact that reconstructive operations take much longer in duration, mortality after these operations is significantly lower.
Clinics with thousands of observations demonstrate the advantage of reconstructive operations compared with valve prosthetics by almost 3 times.
So, for example, according to the Cleveland Clinic, mortality during reconstructive operations was 4%, and during prosthetics – 11%. Unfortunately, the surgeon cannot always perform reconstructive surgery. This is especially true for patients with rheumatic heart diseases.
In our practice, patients are referred for surgical treatment in such a neglected state, when one does not have to think about any mobility of the mitral valve cusps, and calcification is often the cause of disturbances in intraventricular conduction.
In these cases, the surgeon’s arsenal has a large selection of mechanical and biological valves.
Biological valves are preferable because they do not require the use of anticoagulants and are most often used in elderly patients or in patients living in very remote regions where the control of anticoagulant therapy is difficult.
Of mechanical valves, butterfly valves are preferred. Currently, in our country, double-leaf valves from MedInzh and Roskardiks are used. The mitral valve replacement results are influenced by many factors, such as reduced contractile myocardial function before surgery, multiple organ damage, a history of thromboembolism, and age.
Deteriorating results are combined lesions of the mitral valve and coronary vessels.
Hospital mortality during mitral valve replacement varies from 5 to 9% in different clinics of the world. At our Center, the hospital mortality rate for mitral valve prosthetics is 4,4%, and for combined operations with coronary artery bypass grafting, 6,2–6,5%.
Diagnosis and assessment of the severity of the disease
Approaches to the diagnosis and assessment of the severity of acquired heart defects (adapted from recommendations of experts AAK / EOK, 2006-2007).
- Conversation with the patient (complaints, medical history, exercise tolerance, implementation of recommendations for the prevention of infectious endocarditis and rheumatic fever, with chronic oral anticoagulants – an assessment of bleeding, possible thromboembolic manifestations).
- Objective research.
Auscultation of the heart is the most widely used and effective method for detecting damage to the valvular apparatus of the heart. Assessment of the dynamics of the melody of the heart (including in patients with prosthetic valves).
- Assessing the severity of stenotic malformations should include determining the area of the valve orifice and parameters of the blood flow on the valve such as the average pressure gradient or maximum flow rate.
- Valuation of valvular regurgitation should include the determination of such quantitative Dopplerographic indices as the effective regurgitant orifice area, the regurgitant volume and the regurgitant fraction. These indicators are more accurate than the parameters for estimating the size of the regurgitant flow using color Doppler studies.
- To assess the severity of valvular lesions, a combination of different echocardiographic approaches should be used. It is also necessary to take into account the structural features of the valves, the mechanisms of development of valve lesions, and the clinical picture.
- It is necessary to perform studies of all valves, as well as the ascending aorta.
- The parameters of the structure and function of the left ventricle should be evaluated (they are especially important for predicting patients with aortic and mitral regurgitation). Indexing of LV sizes by body surface area is usually used.
- Transesophageal echocardiography is used with insufficiently high quality of transthoracic images, as well as with suspected presence of thrombosis, prosthetic dysfunctions, infectious endocarditis.
It is also used intraoperatively to monitor valve plastic results.
Coronary angiography may not be performed in young patients without risk factors, as well as in cases where the risk of it exceeds the possible benefits, for example, with acute aortic dissection, the presence of large vegetations before entering the coronary arteries, with occlusive prosthetic thrombosis with unstable hemodynamics.
The differential diagnosis is sometimes difficult. Sometimes it is difficult to distinguish between systolic noise of an organic nature from functional and physiological.
As a rule, organic noise is more pronounced, of a blowing nature, is carried out beyond the region of the heart, is heard not only in the horizontal, but also in the vertical position of the patient, while inhaling and exhaling, amplified after physical exertion, is fixed on the phonocardiogram at all frequencies, noise with mitral insufficiency valve adjacent to 1 tone.
In contrast, functional and physiological noises are not carried out beyond the region of the heart, they are better heard in the horizontal position of the child, disappear by inhalation, do not always intensify after physical exertion, very often on FC. G lag behind I tone.
It is very important to take into account the changes in noise when observed in dynamics (organic noise is amplified, functional and physiological – decreases or disappears).
To differentiate systolic murmur, a sample with amyl nitrite is used. After inhalation of amyl nitrite vapor, functional and physiological noises are amplified, organic noise (with mitral valve insufficiency) is reduced.
The latter is due to regurgitation of less blood from the left ventricle to the left atrium due to the facilitated and enhanced blood flow to the aorta and large vessels as a result of their expansion, a sharp decrease in pressure, and therefore a decrease in resistance to blood flow in them.
For the treatment of valvular heart defects, medical and surgical techniques are used. Drug therapy is used to correct the condition of the patient during a condition of compensation of a defect or preparation of the patient for surgery.
It may include a complex of drugs of various pharmacological groups (diuretics, beta-blockers, anticoagulants, ACE inhibitors, cardiac glycosides, antibiotics, cardioprotectors, antirheumatic drugs, etc.).
Also, drug treatment is used when it is impossible to conduct a surgical operation.
For the surgical treatment of subcompensated and decompensated acquired heart defects, the following types of interventions can be performed:
- replacement (prosthetics) of the valve with biological and mechanical prostheses;
- valve replacement in combination with coronary artery bypass grafting in CHD;
- valve replacement while maintaining subvalvular structures;
- reconstruction of the aortic root;
- restoration of sinus rhythm of the heart;
- atrioplasty of the left atrium;
- valve replacement for defects caused by infectious endocarditis.
After surgical treatment, patients undergo rehabilitation and after discharge from the hospital should be registered with a cardiologist.
To recover from such treatment, they may be prescribed:
- Exercise therapy;
- breathing exercises;
- medications to prevent relapse and maintain immunity;
- control tests to evaluate the effectiveness of treatment with indirect coagulants.
Drug therapy is used in the active stage of rheumatism, in the stage of subcompensation (if it is possible to correct hemodynamic disorders with drugs or if the operation is contraindicated due to concomitant diseases – acute infectious diseases. Acute myocardial infarction. Repeated rheumatic attack, etc.), in the stage severe decompensation.
Of the medications, the following groups are prescribed:
- antibiotics and anti-inflammatory drugs to stop the active rheumatic process in the heart, mainly a group of penicillins is used (injection bicillin, ampicillin, amoxicillin, amoxiclav, etc.), non-steroidal anti-inflammatory drugs (NSAIDs) – diclofenac, nimesulide, ibuprofen, aspirin, indium;
- cardiac glycosides (digoxin, digitoxin) are prescribed in certain cases to improve the contractile activity of the myocardium (heart muscle);
- drugs that improve trophic (nutrition) of the myocardium – panangin, magnerot, magne B 6, etc .;
- diuretics (furosemide, indapamide, etc.) are indicated to reduce volume overload of the heart and blood vessels;
- ACE inhibitors (captopril, lisinopril, ramipril, etc.) have cardioprotective properties, contribute to the normalization of blood pressure;
- B-adreno-blockers (bisoprolol, carvedilol, etc.) are used to reduce blood pressure and rhythm, if the patient develops heart rhythm disturbances with an increase in heart rate;
- antiplatelet agents (aspirin and its modifications – cardiomagnyl, aspirin Cardio, thrombo Ass, etc.) and anticoagulants (heparin, fraxiparin) are prescribed to prevent increased blood coagulation with the formation of blood clots in blood vessels or the heart;
- nitrates (nitroglycerin and its analogues – nitromint, nitrospray, nitrosorbide, monochinque) are prescribed if a patient with heart disease develops angina (due to insufficient blood supply to hypertrophied heart muscle).
Open heart surgery is performed under cardiopulmonary by means of median sternotomy. The median sternotomy creates optimal conditions for the cardiac surgeon to work – to perform the necessary surgical interventions for various pathologies and to connect the heart-lung machine.
The incision of the soft tissues along the length is approximately equal to the length of the sternum (about 20 cm), and the sternum is dissected along the entire length. The main two types of operations that are currently used in PPS are the reconstruction of affected valves (plastic) or their prosthetics.
A valve-saving operation is performed to eliminate the cause of valve dysfunction.
If the valves do not close (valve insufficiency), then the cardiac surgeon in the course of the operation achieves normalization of the closure of the valve cusps by performing resection of the valve cusps, annuloplasty, commissural plastic surgery, prosthetics of the chords.
If valvular stenosis exists, then those sections of the valves that are fused due to the pathological process are separated – an open commissurotomy is performed. If it is impossible to perform plastic surgery, when there are no conditions for this, perform valve replacement surgery for prosthetics of the heart valves.
In the case of an intervention on the mitral valve, prosthetics is performed with full or partial preservation of the front or rear valve flaps, and if it is impossible without their preservation.
For valve replacement surgery, prostheses are used:
Dentures can be made from animal or human tissue.
Such prostheses are called biological. Its main advantage is that the patient does not need to take anticoagulant drugs during the next years of life, and their main disadvantage is a limited service life (10-15 years).
Dentures, consisting entirely of mechanical elements (titanium and pyrolytic carbon, are called mechanical.
They are very reliable and able to serve without fail for many years, without replacement, but after such an operation the patient must always, for life take anticoagulants, this is the negative point of using a mechanical prosthesis.
Thanks to the creation of new instruments, modern surgery has gained the ability to modify operative accesses to the heart, which leads to the fact that operations become minimally traumatic for the patient. The meaning of such operations is that access to the heart is through small incisions on the skin.
In minimally invasive operations on the mitral valve, a right-sided lateral mini-thoracotomy is performed, while a skin incision is made no more than 5 cm, this allows you to completely abandon the sternum dissection and provides convenient access to the heart.
To improve visualization, endoscopic video support is used, which has a multiple increase. With minimally invasive access to the aortic valve, the incision on the skin is approximately two times smaller (the incision length is 8 cm), and the sternum is dissected along the length in its upper part.
The advantage of this method is that the non-dissected section of the sternum provides greater stability after surgery, as well as in the best cosmetic effect by reducing the size of the seam.
Endovascular surgery – transcatheter aortic valve replacement (TAVI). Methods of transcatheter aortic valve implantation:
- The entire operation is carried out through a blood vessel (femoral or subclavian artery). The meaning of the procedure is to puncture the femoral or subclavian artery with a catheter guide and deliver the stent valve against blood flow to the site of its implantation (aortic root).
- Through the aorta. The essence of the method consists in a small section of the sternum (mininotomy) and a puncture of the aortic wall in the ascending section and implantation of a stent valve into the aortic root. The method is used when it is impossible to deliver the valve through the femoral and subclavian arteries, as well as with severe bending of the artery.
- Through the top of the heart. The meaning of the procedure is to apply a small incision in the fifth intercostal space on the left (minithoracotomy), puncture the apex of the heart with a catheter guide and install a stent valve. As soon as a new valve is implanted, the catheter is removed. The new valve starts working immediately.
There are two types of stent valves:
- The self-expanding stent valve opens to the desired size after removing the coupling restriction shell from it.
- Ballon-dilatable stent valve, which expands to the desired size when the balloon is inflated; after the final installation of the stent valve, the balloon is deflated and removed.
To determine if TAVI surgery is possible, the patient must undergo a series of examinations, including ECG, echocardiography, computed tomography (CT), and angiography.
Currently, the TAVI procedure finds wider application not only with aortic stenosis, but also with aortic insufficiency, as well as their combination. In addition, TAVI surgery is used for dysfunction of the biological prosthesis of the aortic valve.
TAVI surgery is performed under general anesthesia and requires an interdisciplinary approach. The procedure is performed by a specialized team, which includes an interventional cardiologist, cardiac surgeon, anesthetist, radiologist.
The presence of a stent valve is not an indication for a patient receiving an anticoagulant of indirect action of Warfarin (in the absence of other indications).
Gymnastics will help improve the condition of a patient with heart defects, but certain limitations must not be forgotten. Excessive activity can only worsen the condition.
Therefore, it is recommended to perform sets of exercises under the supervision of a doctor (at least in the first stage) and stop at the first malaise. Physiotherapy exercises may include the following exercises (following the sequence):
- exercises for the upper limbs and shoulder girdle; warming up the muscles of the body;
- lower limbs warm-up;
- breathing exercises;
- exercises for the lower extremities;
- warming up the muscles of the body;
- breathing exercises;
- exercises for the upper limbs and shoulder girdle;
- breathing exercises.
Walking is a basic exercise that must be included in each activity. It allows you to activate the work of the whole organism, preparing it for subsequent loads.
First, walking is performed at a slow pace, then it is necessary to do a gradual acceleration. At the end of the lesson, they also walk slowly – this helps to normalize blood circulation. When performing exercises on the muscles of the trunk, the main thing is not to be zealous and also do everything at a calm pace.
These exercises are performed no more than 2 times. Exercises on the upper limbs and shoulder girdle are designed to develop the skill of proper breathing and strengthen the muscles of these zones.
Exercises on the lower extremities are necessary for the expansion of blood vessels that are removed from the heart, thus managing to eliminate stagnation. Breathing exercises are of great importance, as they stimulate the flow of blood to the lungs and heart muscle, nourishing it with oxygen, ensuring normal nutrition of the brain.
Prophylaxis and prognosis
It is believed that in order to prevent the development of acquired heart defects, it is sufficient to adequately treat those diseases that can be complicated by heart diseases, valvular apparatus in the first place, cause damage to the heart valves.
Rheumatism, which is often accompanied by heart defects, can occur after infectious diseases – tonsillitis, pneumonia, bronchitis. That is why physicians constantly warn patients against self-medication of such serious diseases.
In addition, the prevention of heart defects requires:
- lead a healthy lifestyle;
- do not abuse alcohol;
- give up bad habits;
- Do not take medications without a doctor’s prescription;
- eat right.
It should be understood that moderate changes in the valve structures of the heart, which are not complemented by serious myocardial lesions, can be compensated for a long time by the forces of the body.
In such situations, the patient can lead a familiar lifestyle while maintaining working capacity. With regular preventive measures, while monitoring the condition, a patient with such moderate heart defects can live quite a long time.
But forecasting the development of decompensated stages of a problem can be quite difficult!
Such forecasts can be determined by the following factors:
- the progress of rheumatism or relapses of other diseases that provoked the defect;
- the onset of powerful intoxication of the body;
- new infection;
- physical or nervous overload;
- for women, the onset of pregnancy and delivery.
Unfortunately, the progress of damage to the heart valves can lead to a fairly rapid formation of heart failure, which in the end can even lead to the death of the patient.
Mitral stenosis is considered the most prognostically unfavorable, since the left atrium is often unable to maintain the compensated stages of the disease for a long time. It is mitral stenosis that is faster than other acquired defects leads to stagnation in the pulmonary circulation and subsequent heart failure.
The prospect of disability when detecting valvular defects is strictly individual, it can be determined by functional responsibilities in a particular position.
It is important to remember that, having such a diagnosis, it is necessary to constantly observe the mode of moderation in everything, and especially in physical activity. But the rejection of bad habits (smoking and alcohol primarily), spa and preventive treatment can significantly extend the life of a patient with valvular heart defects.
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