Mitral insufficiency development symptoms diagnosis how to treat prognosis

NMC (mitral valve insufficiency) is the most common cardiac abnormality. Of all cases, 70% suffer from an isolated form of NMC. Usually rheumatic endocarditis is the main root cause of the development of the disease. Often, a year after the first attack, the state of the heart leads to chronic failure, which is quite difficult to cure.

The greatest risk group includes people with valvulitis. This disease damages the valve flaps, as a result of which they undergo processes of wrinkling, destruction, gradually become shorter compared to the original length. If valvulitis is at a late stage, calcification develops.

Additionally, due to these diseases, the length of the chords is reduced, dystrophic and sclerotic processes occur in the papillary muscles.

Septic endocarditis leads to the destruction of many cardiac structures, therefore, NMC has the most severe manifestations. Valve flaps do not adjoin to each other tightly enough.

When they are incompletely closed through the valve, too much blood is released, which provokes its reloading and the formation of stagnant processes, an increase in pressure.

All signs lead to increasing insufficiency of MK.

NMC affects people who have one or more of the following pathologies:

  1. Congenital predisposition
  2. Syndrome of connective tissue dysplasia.
  3. Mitral valve prolapse, characterized by regurgitation of 2 and 3 degrees.
  4. Destruction and breakage of chords, rupture of MK valves due to injuries in the chest area.
  5. Rupture of valves and chords with the development of endocarditis is infectious in nature.
  6. The destruction of the apparatus that combines the valves, with endocarditis, which occurred due to diseases of the connective tissue.
  7. Mitral valve infarction with subsequent formation 891ecd637adce4186c71743b4ba223bc - Mitral insufficiency development symptoms diagnosis how to treat prognosisscar in the subvalvular region.
  8. Changing the shape of the valves and tissues under the valves with rheumatism.
  9. An increase in the mitral ring in dilated cardiomyopathy.
  10. Insufficiency of valve function in the development of hypertrophic cardiomyopathy.
  11. MK deficiency due to surgery.

Mitral insufficiency is often accompanied by another defect – mitral valve stenosis.

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Types, forms, stages

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

  • I (the mildest) – up to 20%.
  • II (moderate) – 20-40%.
  • III (middle form) – 40-60%.
  • IV (the most severe) – over 60%.

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

  • 1 – standard level of leaflet mobility (in this case, the painful manifestations are dilation of the fibrous ring, perforation of the leaflet).
  • 2 – the destruction of the valves (the greatest damage is taken by the chords, since they are stretched or torn, a violation of the integrity of the papillary muscles also manifests itself.
  • 3 – reduction of leaflet mobility (forced connection of commissures, reduction in the length of chords, as well as their fusion).

With the gradual progression of NMC, such violations appear:

  1. The development of thromboembolism due to the constant stagnation of a large part of the blood.
  2. Thrombosis of the valve.
  3. Stroke. Of great importance in the risk factors for stroke is the valve thrombosis that occurred earlier.
  4. Atrial fibrillation.
  5. Symptoms of chronic heart failure.
  6. Mitral regurgitation (partial refusal to perform functions by the mitral valve).

Mitral valve insufficiency is a type of valvular heart disease. Pathogenesis is due to incomplete closure of the mitral orifice, which is preceded by violations of the structure of the valves, tissues under the valves. The pathology is characterized by regurgitation of blood into the left atrium from the left ventricle.

Symptoms and signs

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

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

Mitral valve insufficiency is a condition that is accompanied by blood overflow of the left atrium and gradually leads to a significant violation of hemodynamics. The reason is the incomplete closure of its wings.

The initial stage of the disease can be asymptomatic, therefore, mitral insufficiency of the 1st degree does not cause concern for the patient, while the steady progression of the disease results in serious complications and death.

Deficiency of the mitral valve with reverse blood flow (regurgitation) from the left ventricle to the atrium as a result of incomplete closure of the valves is called mitral insufficiency.

In an independent form, an acquired disease is rare and for a long time is benign.

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But as part of combined and combined defects, it is detected in half of all cases of cardiac defects and quickly leads to serious complications.

Under pressure, the bicuspid valve closes and prevents reverse movement. If there is a hole during contraction, regurgitation occurs, and part of the blood comes back, stretching the left atrium.

As the condition progresses, there is a steady increase in the volume of the heart cavities, increased pressure, and stagnation in the vessels of the lungs.

The formation of a defect can occur in the prenatal period, in which case it is considered congenital. The causes of this pathology can be:

  • alcoholism, drug use, and maternal smoking during pregnancy;
  • ionizing radiation;
  • poisoning and taking certain drugs (antibiotics, non-steroidal anti-inflammatory);
  • systemic and infectious diseases.

Etiological factors of the acquired deviation are usually:

  • streptococcal and staphylococcal infections with the development of septic endocarditis;
  • autoimmune diseases (lupus, multiple sclerosis);
  • myocardial damage as a result of a heart attack;
  • mitral valve prolapse;
  • Marfan syndrome;
  • chest injuries with rupture of the cusps or fibers that hold them.

Relative mitral valve insufficiency is observed with a marked increase in the left ventricle. The cause of this condition may be dilated cardiomyopathy, aortic defect, myocarditis and hypertension.

symptomatology

At the initial stage of the disease, there are no clinical signs. Identify the problem is obtained only during an instrumental examination of the heart.

The prognosis depends on the size of the hole through which blood returns to the left atrium.

Those who are not lucky have stagnation in the pulmonary vessels, and signs of myocardial ischemia and other organs appear. Such a patient usually presents the following complaints:

  • lack of air during exercise, and then at rest;
  • cardiac asthma;
  • fatigue in the performance of ordinary activities;
  • cough, which is worse when lying down;
  • the appearance of sputum with blood;
  • pastility or swelling of the legs;
  • pain on the left side in the chest;
  • increased heart rate, atrial fibrillation;
  • hoarseness of the voice (as a result of compression of the laryngeal nerve with the dilated pulmonary trunk or left atrium);
  • heaviness in the right hypochondrium due to enlarged liver.

When examining such a patient, I try to note the presence of such signs of mitral regurgitation:

  • acrocyanosis (blueness of the limbs and tip of the nose, ears) against a background of general pallor;
  • bulging veins on the neck;
  • trembling of the chest upon palpation, determination of a cardiac impulse and pulsation in the epigastrium;
  • with percussion, an increase in the boundaries of cardiac dullness is noted;
  • during auscultation – weakening of the first, amplification and splitting of the second tone, noise during systole.

Degrees of mitral regurgitation:

  1. The first (I). The reverse blood flow does not exceed 25%, the human condition is characterized as satisfactory. Hypertrophy of the heart muscle (left departments) is observed, which helps to temporarily compensate for the failure. For a while, this mechanism allows you to restrain the increase in pressure in a small circle. Symptoms are absent.
  2. The second (subcompensated, II). Casting is 50%, congestion in the lungs develops. The first signs of the disease appear.
  3. Third (decompensated, III). Blood return increases to 60 – 90% of the total. A high load on the right ventricle leads to its dilatation. Acute grade 3 mitral valve insufficiency can cause pulmonary edema.

Diagnostics

The problem can be identified by the following methods:

  1. ECG. It will show signs of hypertrophy of the left parts of the myocardium, and later of the right ventricle. Sometimes it is possible to fix tachycardia and rhythm disturbance.
  2. Chest x-ray. On it, you can see an increase in the left departments, displacement of the esophagus, in later stages – hypertrophy of the right ventricle. Congestion in the lungs is manifested by the expansion of blood vessels and the fuzziness of their outlines.
  3. Phonocardiogram. A very informative examination, in which it is possible to determine all the noise produced by the heart muscle. A sign of the disease will be a decrease in the sound of ventricular contraction, systolic murmur, a click closing of the valves.
  4. Violation is confirmed by echocardiography. The ultrasound method reveals an increase in the chambers of the heart and incomplete closure of the mitral orifice.

Therapies

Treatment of mitral valve insufficiency at the stage of compensation consists in constant monitoring of the patient, reducing physical activity and using means to prevent the progress of the disease. If complications appear, and there is no way to solve the problem surgically, symptomatic therapy is used:

  • cardiac glycosides;
  • diuretics;
  • beta-blockers;
  • calcium antagonists;
  • ACE inhibitors;
  • anticoagulants and disaggregants.

Symptoms

Symptoms of this pathological process increase with the development of insufficiency. During a period of compensated mitral regurgitation, symptoms may not occur. This stage can give a long course (up to several years) without any symptoms.

Subcompensated degree of insufficiency is accompanied by:

  • development of dyspnea in the patient;
  • fatigue appears during physical and mental work;
  • weakness;
  • heart palpitations even at rest;
  • dry cough and hemoptysis.

In the process of development of stagnation in the venous circle of blood circulation, cardiac asthma develops, which manifests itself in the form of nocturnal cough, the patient “does not have enough air”. Patients complain of pain behind the sternum in the region of the heart, radiating to the left shoulder, forearm, shoulder blade and hand (anginal pain).

With the further course of the pathology, insufficiency of the right ventricle of the heart develops. Symptoms appear such as:

  • acrocyanosis – cyanosis of the limbs;
  • swelling of the legs and arms;
  • neck veins swell;
  • ascites (accumulation of fluid in the abdominal cavity) develops.

On palpation, an increase in the liver is felt. The enlarged atrium and pulmonary trunk squeeze the laryngeal nerve, hoarseness appears – Ortner’s syndrome.

In a decompensated stage, more patients are diagnosed with atrial fibrillation.

In case of mitral valve insufficiency, only a cardiologist should prescribe treatment. You can not self-medicate and resort to folk methods!

Treatment should be aimed at eliminating the cause of mitral insufficiency, that is, at the disease preceding the pathological process.

Depending on the degree of mitral insufficiency and severity of the condition, drug treatment can be performed, in some cases, surgery is necessary.

A mild to moderate degree requires the use of drugs, the action of which is aimed at reducing the heart rate, vasodilator drugs (vasodilators). It is important to lead a healthy lifestyle, not to drink or smoke, to avoid states of physiological overwork and psychological stress. Showing walks in the fresh air.

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With mitral valve insufficiency of the 2nd degree, as well as in the third, anticoagulants are prescribed for life to prevent vascular thrombosis.

Mitral valve insufficiency can sometimes occur without any symptoms. A vivid expression of symptoms is determined by several factors – the size of the lumen between the valves and the volume of returning blood.

The main symptoms of the disease are:

  • the occurrence of shortness of breath both when performing physical exercises, and at rest;
  • cough worse in horizontal position. At the initial stage of the development of the disease, it is an ordinary dry cough, but as the pathological process spreads, sputum production is observed, often with blood impurities;
  • soreness in the heart, aching and oppressive in nature;
  • swelling of the lower extremities;
  • fatigue and weakness of the body, which reduces the level of performance;
  • heaviness in the abdomen, in the region of the right rib – due to an increase in the size of the liver;
  • pulse rhythm disturbance.

Signs that only a specialist can detect include an increase in the volume of veins in the neck, a specific elevation in the left side of the chest, the appearance of a bluish tint on the skin of the fingers of the upper and lower extremities.

Mitral insufficiency in children is diagnosed quite often, often in combination with other heart diseases. As they grow older, some children experience a slight or moderate decrease in the volume of the reverse blood flow, up to the normalization of the condition.

simptomy mitralnoy nedostatochnosti - Mitral insufficiency development symptoms diagnosis how to treat prognosis

Symptoms of mitral regurgitation

The basis of therapeutic measures is taking medications aimed at removing the causes and signs of the disease. In addition, this method of therapy is recommended for the development of complications. Mitral valve insufficiency of the two initial stages of development does not require medical intervention. A more complex course involves performing surgical operations, of which there are several. The first type of intervention is plastic, used in cases of illness in the second and third stages. There are three ways to implement it:

  • sash plastic – the support ring is sutured at the base of the sash;
  • chord length reduction;
  • elimination of the elongated portion of the posterior leaflet.
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The second type of operation is based on valve prosthetics. Dentures can be made of biological material, for example, an aorta of an animal. They are often used to treat mitral regurgitation in children and women who want to have a baby in the future. In addition, there are mechanical valve prostheses that are made from medical alloys.

In the postoperative period, patients need to take anticoagulants, which are aimed at reducing blood coagulation. In cases of implantation of a mechanical valve, medications must be taken throughout life; when an biological valve is implanted, drug therapy lasts no more than three months. With valve plastic, the use of drug therapy is not required.

Carrying out any type of operation is strictly prohibited in the presence of serious diseases that will inevitably lead to death, as well as in the course of heart failure, which is not amenable to drug treatment.

In an independent form, an acquired disease is rare and for a long time is benign.

But as part of combined and combined defects, it is detected in half of all cases of cardiac defects and quickly leads to serious complications.

Under pressure, the bicuspid valve closes and prevents reverse movement. If there is a hole during contraction, regurgitation occurs, and part of the blood comes back, stretching the left atrium.

As the condition progresses, there is a steady increase in the volume of the heart cavities, increased pressure, and stagnation in the vessels of the lungs.

With good compensation for mitral valve insufficiency, symptoms do not appear. Severe mitral regurgitation is characterized by the following symptoms:

  • Shortness of breath and heart rhythm disturbance during physical activity (then at rest);
  • Cardialgia;
  • Fatigue;
  • Cardiac asthma (attacks of shortness of breath);
  • Pain, swelling in the right hypochondrium, caused by an increase in the liver;
  • Swelling of the lower extremities;
  • Dry cough with a small sputum, in rare cases with impurities of blood;
  • Pain in the area of ​​the heart stitching, pressing, aching in nature, not associated with physical activity.

With compensated mitral regurgitation, symptoms may not appear for several years. The severity of symptoms is due to the power of regurgitation.

f472049ccdd9ce44de7cffe3004f250a - Mitral insufficiency development symptoms diagnosis how to treat prognosis

The following methods are used to diagnose mitral regurgitation:

  • An ECG allows you to identify signs of overload and hypertrophy of the left ventricle and atrium, in the third stage – the right heart;
  • Echocardiography – determination of hypertrophy and dilatation of the left heart;
  • X-ray examination of the chest organs – determining the degree of pulmonary venous hypertension, the degree of protrusion of the arches of the atria;
  • Ventriculography – determination of the presence and degree of regurgitation;
  • Ventricular catheterization – determination of the dynamics of pressure in the ventricles of the heart.

Currently, there is overdiagnosis of mitral regurgitation. Modern research methods have shown that a minimal degree of regurgitation can be present in a healthy body.

The treatment of mitral valve insufficiency is governed by the only rule: a patient with diagnosed mitral insufficiency is a surgical patient. This pathology is not subject to medical correction. The task of a cardiologist is to properly prepare the patient for surgery.

Conservative treatment of mitral valve insufficiency is aimed at controlling heart rate, as well as preventing thromboembolic complications and reducing the degree of regurgitation. Symptomatic treatment is also used.

During surgery, the mitral valve is implanted.

Predictions for mitral regurgitation completely depend on the degree of regurgitation, the severity of the valve defect and the dynamics of the disease.

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The prescription of treatment for mitral valve insufficiency is possible after determining the severity and from which of the five stages the development of the disease is.

The two initial stages – the first degree (compensation) and moderate (subcompensation) – do not require any serious intervention. Symptoms practically do not appear or they can be felt with intense physical exertion. At these steps, preventive measures play an important role.

The third stage – decompensation – is characterized by obvious cardiac abnormalities, especially manifested after physical exertion. When signs of mitral valve insufficiency appear, surgical treatment can be used. At this time, patients are usually prescribed:

  • anti-arrhythmia drugs;
  • vasodilators that reduce the tone of arterioles and reduce the tension of the walls of the aorta;
  • drugs that reduce peripheral vascular resistance;
  • antiplatelet agents and anticoagulants to normalize blood coagulation and blood clots;
  • nitrates, which reduce blood flow to the right atrium and reduce the load on it;
  • antibiotics that prevent repeated rheumatic attacks.

Therapy at this step is aimed at preparing for a possible surgical intervention.

The fourth stage (dystrophic) – implies the performance of mandatory surgical operations. At this stage, the functioning of the heart muscle is disrupted, which leads to a deterioration in blood supply, shortness of breath, edema and impaired functioning of the internal organs are disturbing.

The fifth (terminal) stage, as a rule, is no longer amenable to medical and surgical intervention due to violations. Drugs are prescribed that only alleviate the condition, but do not affect life expectancy.

Surgical treatment of mitral valve insufficiency of the 1st, 2nd degree is not required, in contrast to the 3rd and 4th degrees.

Classification

Mitral valve insufficiency is usually divided in accordance with its etiology. So the disease can be classified due to its formation:

  • Organic form – regurgitation is associated with damage to the bicuspid valve.
  • Relative (or functional) form – there is no change in the bicuspid valve, but regurgitation is present.

Since the disease may not bother the person and not manifest in an acute form, then according to the clinical picture, there are:

  • Sharp shape. It is manifested by hemodynamic disturbances and symptoms of stagnation in the smaller circle of blood circulation. Moreover, the prognosis is often unfavorable and the condition is life-threatening.
  • Chronic form. It can occur without symptoms, but over time, the volume and mass of the left ventricle increases.

A classification is also proposed in accordance with the degree of mitral valve insufficiency, which is now widely used and is based on the type of valve movement: from the first to the Thursday degree.

Mitral valve insufficiency of the 1st degree: clinical picture

  1. Insignificant;
  2. Moderate
  3. Expressed;
  4. Heavy.

With a slight degree, regurgitation is observed directly at the cusps of the mitral valve. It is also found in healthy people. A moderate degree means regurgitation occurring one to one and a half centimeters from the valve.

With the third degree, the reverse movement of blood reaches the middle of the atrium. This leads to some expansion of the atrium. A severe degree of insufficiency leads to the fact that regurgitation occupies the entire left atrium.

The characteristic noise that the doctor notes when listening to the heart is the main symptom. It is caused by the return of blood from the left ventricle to the left atrium.

With a more serious development of the defect, the left ventricle is forced to pump more blood in order to take one that returns back to the atrium. As a result, it gradually increases, hypertrophies. At the same time, its contractions intensify, which is felt by a person as an increased heartbeat. These symptoms are especially noticeable when the patient lies on his left side.

Since as a result of regurgitation, blood returns to the atrium, it must contain a larger volume of blood, and it also gradually increases. With a significant degree of increase, the atrium does not cope with its function, because fibrillation and frequent irregular contractions occur. The pumping function of the heart is therefore reduced.

Further development of the degree of pathology leads to the fact that the atria generally do not contract normally, but only tremble. These problems can be fraught with more serious disorders, for example, the formation of blood clots, because there is no normal blood flow. Blood clots that form in the heart are very dangerous, because they can block large vessels, and this leads to damage to various organs, a stroke.

At degrees 3 and 4, regurgitation is very pronounced, which gives an additional burden on the heart. A person runs the risk of heart failure, which has symptoms such as shortness of breath, swelling, coughing. Damaged heart tissues become more vulnerable, less resistant to infections, so the risk of infective endocarditis increases.

A person with a moderate and severe degree does not have a full blood supply to the organs, since such a violation leads to a decrease in the pumping function of the heart. Since the organs do not receive normal nutrition, the whole body suffers, and this can affect its general condition and the patient’s well-being.

Symptoms

  • Increased heart rate
  • Arrhythmia
  • Fatigue,
  • Swelling
  • Dyspnea,
  • Cough,
  • Cyanosis,
  • Mitral blush.

Symptoms may occur in various combinations. With a small degree of severity, the problem of obvious manifestations may not be. A person may feel that he has become tired more quickly, manages to do less in a day, and tolerates physical exertion worse.

All this is usually not perceived as symptoms of a heart problem, so the pathological process continues to progress.

If symptoms are identified and diagnosed, then you need to find out the cause of heart valve disease. First of all, it is necessary to treat the disease that led to this condition. If the problem is mild or moderate, then, as a rule, additional treatment is not required.

If the degree of the lesion is more serious or complications (heart failure, arrhythmia) have occurred, then medication will be needed.

Surgically treated with operations performed during cardiopulmonary bypass.

During plastic surgeries, which are performed at the 2-3 degree of the disease, a special support ring can be installed near the cusps, chords and cusps are shortened. After the operation, blood flow is normalized, and its own valve remains.

If the plastic surgery did not bring results or the tissues are badly damaged, then prosthetics are necessary. Biological or mechanical prostheses are used. For the manufacture of biological animal tissues are used, mechanical ones are made of special alloys.

  • After plastic surgery, anticoagulant therapy is not required.
  • After the implantation of a biological prosthesis, taking anticoagulants is necessary for 2-3 months.
  • After installing an artificial prosthesis, anticoagulants are prescribed for continuous use.

The success of treatment and how a person will feel after surgery depends on the degree of manifestations of insufficiency and regurgitation, on the dynamics of the disease and individual characteristics. It is important not to delay the diagnosis and treatment.

When they are incompletely closed through the valve, too much blood is released, which provokes its reloading and the formation of stagnant processes, an increase in pressure.

All signs lead to increasing insufficiency of MK.

With lesions of type 1, the movement of the valves is normal. In such cases, acute failure tends to be central or moderately deviate from the central one. The first type is mainly a consequence of dilatation of the fibrous annulus of the valve, but there may be less common mechanisms. With this type, surgical treatment of mitral valve insufficiency of the 1st degree is not performed. The forecast is favorable.

  • Systemic and autoimmune diseases.
  • Injuries.
  • Rheumatism.
  • Ischemia of the heart.
  • Pain in the left side of the sternum.
  • The impossibility of a full breath and a feeling of lack of air.
  • Disruptions in the rhythm of the heart.
  • The appearance of headaches and dizziness, loss of consciousness is possible.
  • Subfebrile temperature.

With mitral valve insufficiency of the 2nd degree, excessive movement of the valves is noted. The severity can have a wide range. It is possible that only part of the valve leaf protrudes above the line of the fibrous ring into the systole, but the closure point remains below the plane of the fibrous ring.

  • Viral endocarditis.
  • Rheumatic processes.
  • Systemic lupus erythematosus.
  • Tendon rupture due to injury.
  • Changes in valve flaps.
  • The appearance of shortness of breath after physical exertion.
  • On the examination notes the displacement of the borders of the heart.
  • Ripple in the heart and peritoneum may be observed.
  • A slight increase in blood pressure.

If you ignore the symptoms, mitral valve insufficiency of the 1st and 2nd degree can be aggravated.

Type 3 lesion is recorded when restriction of leaflet movement is noted. This type is divided into subtypes 3a and 3b.

  • With subtype 3a, restriction is “structural” (most often a consequence of rheumatism) and the movement of the leaflet is impaired in both systole and diastole.
  • With subtype 3b, the restriction of “functional” and full closure of the valves cannot occur, since the mitral valve in the systole is pulled in the direction of the apex of the left ventricle, this may be due to dilatation and/or displacement of the papillary muscles. The etiological factor in the occurrence of subtype 3b is often cardiac ischemia, and in such cases the term “mitral insufficiency of ischemic genesis” is used. With subtype 3b, the movement of the sash into the diastole is normal.

Grade 3 mitral regurgitation has the following symptoms:

  • Liver enlargement.
  • The appearance of edema.
  • Cough.
  • Increased venous pressure.

The defeat of type 4 is attributed to severe heart disease. The last degree is manifested by regurgitation to the upper part of the atrium. When setting this degree, the patient becomes surgical and he needs a medical correction.

If the patient is planning to perform an intervention on the heart muscle, a preoperative assessment of the degree of mitral valve insufficiency using a transesophageal transducer provides an answer to three key questions:

  • How severe is the pathology?
  • What is the mechanism of the disease and where exactly is the lesion manifested?
  • Is it possible to perform surgical plastic surgery (correction)?
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The severity of valve insufficiency is sometimes classified as trivial, mild, moderate and severe. This corresponds to a classification of 1 to 4.

A two-dimensional study often makes it possible to suspect that there is an insufficiency of a pronounced degree. Some finds may directly indicate this.

For example, signs may be:

  • significant violation of the closing of the valves.
  • sash structural anomaly.
  • hemodynamic consequences of severe mitral regurgitation (volume overload of the left side of the heart or signs of pulmonary hypertension).

To determine the severity of mitral valve insufficiency, the following methods are used:

  • A detailed two-dimensional examination of the heart is extremely important for the exact location of the lesion.
  • Color dopplerography remains the easiest and best method for screening for the presence of MN, since this method has high sensitivity and specificity.
  • Spectral dopplerography also allows an assessment of the severity of failure.

As soon as the presence of severe insufficiency is established, the next is to determine the mechanism of mitral regurgitation and the exact location of the lesion, so that an appropriate surgical plan can be formulated. Accurate localization of lesions requires a systematic study using a two-dimensional image. The purpose of a systematic study of the mitral valve is to obtain numerous images of all parts of the valve and identify each segment of the valves.

Depending on the size of the lumen and the degree of severity of regurgitation, the clinical degrees of manifestation of mitral insufficiency are determined:

  • Mitral valve insufficiency of 1 degree – compensated is characterized by a slight blood flow (less than 25%) and violations only from the valve structure. Well-being at the same time does not change, there are no symptoms and complaints. ECG diagnostics do not reveal pathology to this extent. During auscultation, the cardiologist hears minor noise during systole when the valve flaps are closed, the border of the heart is slightly wider than normal.
  • For mitral insufficiency of the 2nd degree, subcompensated, atrial filling with blood is almost up to half (up to 25-50%). Pulmonary hypertension develops to release the atrium from the blood. A person at this moment suffers from shortness of breath, tachycardia even during rest, dry cough. An ECG diagnoses changes in the atrium. During listening, noises are determined during the systole, the borders of the heart increase, especially on the left (up to 2 cm).
  • Grade 3 mitral valve insufficiency is accompanied by filling of the left atrium with blood up to 90%. Its walls are increasing in size. The decompensated stage begins, in which blood is not removed from the atrium. Symptoms such as edema, an increase in the size of the liver during palpation appear. There is an increase in venous pressure. ECG signs are diagnosed: an increase in the left ventricle, mitral tooth. With auscultation – increased noise in the systole, the expansion of the heart borders, especially the left.
  • 4 degree mitral regurgitation is called dystrophic. There are pathological structural changes in the valve, stagnation of blood in the pulmonary circulation. Symptoms of the third degree significantly increase. Surgical operations are very widely used at this stage and give favorable permission.
  • 5 degree – terminal. Patients have a clinical picture of the third stage of cardiovascular failure. The patient’s condition is very serious and does not allow for surgical interventions. The prognosis of the pathology is extremely unfavorable, most often it is a fatal outcome due to complications.

Diagnosis of mitral valve disease

Patients with mitral valve insufficiency in the heart often have atypical chambers, and cardiac anatomy is distorted. This can make it difficult to perform transesophageal echocardiography, as the appearance of various ultrasound sections from the heart changes.

Changes in preload, afterload, contractility, and myocardial compliance can have a significant effect on the appearance of the regurgitation stream. In addition, in the operating room, all of these factors can be affected by general anesthesia. Several authors have documented that the severity of mitral regurgitation decreases by at least 1 after inducing anesthesia. These changes are least pronounced in the breakage of valve cusps and most pronounced in patients with a functional form of the disease.

Changing the condition of other valves can also affect mitral regurgitation. For example, in patients with significant aortic stenosis, the severity of mitral regurgitation predominantly decreases after aortic valve replacement, since pressure in the left ventricle decreases. Therefore, a doctor who evaluates the severity of mitral valve insufficiency should have a good knowledge of the clinical conditions available at the time of the examination.

Diagnosis of mitral regurgitation should be based on the following comprehensive measures:

  • conversation, examination, palpation and percussion, auscultation of the patient;
  • ECG data (electrocardiogram);
  • chest x-ray data;
  • echocardiography data;
  • ultrasound data of the heart;
  • heart cavity sounding results;
  • ventriculography data.

A competent history taking during a thorough examination, examination, palpation and percussion of the patient can coordinate the doctor for further studies for an accurate diagnosis. With percussion, the expanded borders of the heart are determined, especially on the left side. During auscultation, depending on the degree of mitral insufficiency, systolic murmurs of different intensities are detected.

According to x-ray and ECG, the expansion of the left ventricle and atrium is diagnosed.

The most informative diagnostic method is echocardiography, here you can assess the defect and the degree of damage to the valve itself. For a more specific diagnosis in the presence of atrial fibrillation, trans-food echocardiography is used.

Diagnostic measures for mitral insufficiency are complex and consist of several stages. First of all, the doctor needs to study the patient’s medical history – this is necessary to determine the congenital or acquired form of the disease in adults and children. After this, the presence and degree of intensity of the symptoms should be clarified, which will help the specialist determine the acute or chronic course of the disease.

The next step in the diagnosis is to conduct laboratory tests of the patient’s blood and urine tests. A general study is necessary to detect inflammation or concomitant disorders. A biochemical blood test is performed to determine the concentration of uric acid and cholesterol. Immunological analysis makes it possible to assess the presence of antibodies.

Instrumental diagnostic techniques include:

  • ECG – carried out to detect heart rhythm disturbances;
  • Echocardiography is the main way to study the mitral valve in children and adults;
  • catheterization of the heart cavities;
  • SKT and MRI are techniques that allow the specialist to get an accurate image of the affected organ;
  • phonocardiogram – a technique for detecting noise;
  • CCG – is performed to obtain an accurate image of the blood vessels of the heart, using the contrast medium;
  • radiography of the lungs.

After receiving all the examination results, the doctor prescribes the most effective drug therapy and surgical operation.

  • Inspection
  • Analysis of urine and blood (general, biochemical, immunological);
  • ECG;
  • Doppler echocardiography;
  • Ultrasound of the heart.

Other methods may be used to make a diagnosis, but these are basic, and more often than not, they are enough.

Examination and conversation with the patient allow us to identify the symptoms and suggest the presence of pathology. It is necessary to find out what a person was sick with, what is his heredity. Analyzes can determine the presence of an inflammatory process, the level of cholesterol, sugar, protein in the blood and other important indicators. If antibodies are detected, inflammation or infection in the heart muscle can be assumed.

For diagnosis: an ECG is mandatory, which shows the rhythmicity of the heart, helps to detect the presence of arrhythmia and other failures, to assess whether there is an overload of the heart and whether its departments are enlarged. The main method is ultrasound or echocardiography.

  • Assess the condition of the valve flaps;
  • To see how the shutters close;
  • Understand the size of the ventricles and atria;
  • Measure the thickness of the heart walls;
  • Detect thickening of the inner lining of the heart.

Doppler echocardiography is a study that shows how the blood moves. This diagnostic method makes it possible to identify the reverse blood flow, which is characteristic of such a defect.

Diagnostics

Starting from the third degree, with clearly expressed pathological changes, they resort to surgical restoration of the valve. It is necessary to do as soon as possible so that irreversible dystrophic changes in the left ventricle do not occur.

The following indications for surgery are:

  • the reverse outflow of blood is more than 40% of the ejection of blood by the heart;
  • there is no positive effect in the treatment of endocarditis of an infectious nature;
  • irreversible sclerotic changes of the mitral valve;
  • severe dilatation of the right ventricle, systole dysfunction;
  • vascular thromboembolism (one or many).

ostraya i khronicheskaya mitralnaya nedostatochnost - Mitral insufficiency development symptoms diagnosis how to treat prognosis

Perform reconstructive operations on valve flaps, its ring. If such an operation is not possible, then the valve is reconstructed – removing the damaged and replacing it with an artificial one.

Modern medicine uses the most high-tech xenopericardial and synthetic materials to replace the mitral valve. There are also mechanical prostheses that are made from special metal alloys. Biological prostheses involve the use of animal tissue.

Forecast

The prognosis for the treatment of mitral valve insufficiency of degree 1, 2 is favorable, provided that the attending physician constantly monitors and follows the recommendations. In this case, a person retains his ability to work. For women, the diagnosis is not a contraindication to pregnancy and bearing a child.

The examination is enough to conduct once a year using ultrasound. Since stage 1 is very difficult to diagnose, it is recommended that patients arrive at the appointment and follow the doctor’s instructions in a timely manner.

The prognosis for mitral valve insufficiency of grade 3 and 4 largely depends on the course of the disease. If there is an infection, then this can lead to disturbances in the circulatory system. Also, a chronic form of pathology has an unfavorable prognosis. The danger at these stages is the appearance of heart failure. Statistics show that almost all patients live more than 5 years, and 4/5 of the total number – more than 10 years.

Even in the treatment of mitral valve insufficiency of 1, 2, 3 degrees, a relapse can occur. Therefore, if a person does not show symptoms, then prevention is still necessary.

This ailment is a dangerous pathology, therefore it is extremely important to carry out measures to prevent its occurrence.

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Prevention of mitral regurgitation is divided into the following types:

  • primary – to prevent the disease;
  • secondary, which is used when the disease enters the chronic form.

The rules of primary prevention:

  • prevention of the occurrence of the disease by increasing immunity, conducting hardening measures
  • avoidance of stressful situations;
  • prevention of infectious endocarditis;
  • timely identification of symptoms and the start of treatment at the first clinical signs, so as not to provoke the development of heart disease;
  • limited physical activity;
  • systematic consultation of a cardiologist and rheumatologist;
  • rejection of bad habits;
  • mandatory treatment of infectious foci such as caries and tonsil inflammation.

Secondary prevention involves preventing the development of the disease. For this, a specialist (rheumatologist, cardiologist or cardiac surgeon) prescribes medications aimed at such an action:

  • improvement of blood supply to heart tissues;
  • expansion of blood vessels;
  • an increase in the number of contractions of the heart muscle;
  • decrease in high blood pressure.

Also, the doctor prescribes glycosides, diuretics and antibiotics according to indications.

The work of the heart largely depends on the presence of congenital and acquired pathologies. Not all people know that simple infectious diseases can trigger heart disease. If a mitral valve insufficiency of 1 degree is diagnosed, then the disease requires subsequent consultation with a specialist and the implementation of all recommendations. We can say that with proper timely treatment, a person’s life can be extended.

Prevention of such a disease is divided into primary and secondary, i.e., in the presence of a chronic form of the disease. The rules of primary preventive measures:

  • prevention and timely elimination of diseases, at the stage of the first clinical signs that can lead to the development of such a heart defect;
  • body hardening;
  • regular examination by a rheumatologist and cardiologist.

Secondary prevention consists in preventing the spread of the disease process. For this, it is necessary to undergo drug treatment of such an ailment, in which diuretics and glycosides are often prescribed, as well as drugs to dilate blood vessels and improve the condition of the heart muscles. Prevention of recurrence consists in taking antibiotics, hardening and treatment of infectious diseases.

A favorable prognosis for mitral insufficiency of 1-2 degrees is given in almost 100% of cases. The patient can remain healthy for many years. It is important to be supervised by specialists, undergo consultations and diagnostic examinations. With such phases of the disease, even pregnancy and bearing a child are allowed. Permission from childbirth in these cases is carried out by Caesarean section.

More severe pathological changes in case of insufficiency lead to severe violations of the circulatory system as a whole. Poor prognosis is usually assumed when a chronic course joins a heart failure. Mortality rates in this category are quite high.

Mitral insufficiency is a serious defect, therefore, its identification, diagnosis, treatment should not be delayed.

The main measures for the prevention of this pathology are aimed at preventing the development of complications. First of all, it is:

  • healthy lifestyle of the patient;
  • moderation in food;
  • rejection of fatty and spicy;
  • quitting alcohol and smoking.

Primary prevention begins in childhood and includes elements such as hardening, timely treatment of infectious diseases, including dental caries and inflammatory diseases of the tonsils.

Secondary prevention consists of taking drugs that dilate blood vessels (vasodilators), improve blood flow, and lower blood pressure.

Mitral insufficiency can give a relapse even after surgery. Therefore, you need to take care of yourself, take all the drugs prescribed by the doctor, follow his advice.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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