One of the main conditions for the proper functioning of the human heart is the flow of blood through the heart chambers and vessels in one direction. This is due to the anatomical structure of the heart itself and the presence of valves in it, which act as "doors" that open only one way.
If a heart valve does not fulfill its function as a "regulator" of blood flow, a heart defect called "valve stenosis" occurs. Among such vices, the most frequent is stenosis of the mitral valve.
Description of the disease
Mitral stenosis is the often diagnosed acquired defect of the mitral cardiac valve : the
- disease is detected in approximately 90% of all patients with acquired heart defects;
- 1 person from 50-80 thousand suffers from this ailment;
- is an isolated pathology in 40% of cases, in others - it is combined with other anatomical defects in the structure of the heart;
- , the risk of clinical manifestation of the disease increases with age: the most "dangerous" age is 40-60 years;
- , women are predisposed to this disease more than men: among patients with this defect 75% of people of the weaker sex.
The pathology mechanism is as follows:
- The mitral valve is located on the atrial and ventricular boundary of the on the left .His role is to pass the blood from the left atrium into the left ventricle. Normally this valve is a 4-6 cm2 hole with two wedges of connective tissue.
When the blood fills the left atrium - the valves of the valve under pressure open in the direction of the ventricle and let in a portion of blood, and then tightly close.
- For a variety of reasons, the connective tissue valve flaps can be subjected to organic damage, resulting in the scarring of their tissue.
- Scars, adhesions and adhesions lead to a gradual narrowing of the valve opening - at least 2-3 times. This pathological condition is called stenosis.
- The narrowed aperture prevents the normal flow of blood , since the portion of its one-stage ejection from the atrium into the ventricle decreases. Because of this, not all blood from the atrium is pumped into the ventricle - a situation is created in which the left atrium overflows and stagnation begins in it.
- As a result of a constant overflow of blood, the left atrium begins to stretch and increase in size - so it "adapts" to the situation. After this, the right ventricle - the previous link of the blood circulation - also hypertrophies.
- Gradually compensatory mechanism of hypertrophy of the left atrium and right ventricle exhausts itself - develops heart failure and persistent circulatory disorders , including pulmonary hypertension.
This video tells about hemodynamics with mitral stenosis:
Causes and risk factors of
The causes of the disease in most cases are:
- rheumatic diseases( rheumatic fever, systemic lupus erythematosus, scleroderma) - 80-90% of cases;
- atherosclerosis - 6%;
- infectious diseases( sore throat, syphilis and other venereal diseases, sepsis, tick disease) - 6%;
- trauma to the heart muscle;
- calcification valve non-rheumatic nature;
- heart tumor.
Classification of species and stages of
The disease is classified on 2 grounds. As the area of the mitral orifice of the decreases, 5 sequentially worsening degrees of are identified:
| Degree | Qualitative definition of stenosis | Area of mitral opening( in cm2) | Clinical features of |
| First | minor | greater than 3 | no symptoms |
| Second | moderate | 2,3-2,9 | symptoms of the disease appear after physical exertion |
| Third | expressed | 1,7-2,2 | symptoms appear even at rest |
| Chet | acute | 1-1,6 | severe pulmonary hypertension and heart failure |
| fifth | terminal | clearance almost completely blocked | the patient dies |
Depending on the type of anatomical narrowing of the valve opening, these forms of mitral stenosis are distinguished:
- as a "jacket loop" - valve flaps thickened and partially fused together, easily separated during surgery;
- by the type of "fish mouth" - as a result of the proliferation of connective tissue, the valve opening becomes narrow and funnel-shaped, such a defect is more difficult to surgically correct.
Stages of the disease( according to A.N.Bakulev):
- compensatory - the degree of constriction is moderate, the defect is compensated for by hypertrophy of the heart, complaints are practically absent;
- subcompensator - the narrowing of the hole progresses, the compensatory mechanisms begin to exhaust themselves, the first symptoms of trouble appear;
- Decompensation - pronounced right ventricular failure and pulmonary hypertension, which are rapidly aggravated;
- terminal is a stage of irreversible changes with a lethal outcome.
Dangers and complications
If pathology is not detected on time and not treated - complications in the form of progression of heart failure and pulmonary hypertension are imminent.
Adequate treatment can significantly reduce the risk of all these complications of and reduce the likelihood of a tragic event by 90-95%.
In rare cases, the following postoperative complications occur:
- infective endocarditis - 1-4%;
- thromboembolism - 1%;
- restenosis or re-narrowing after surgical correction - in 20% of patients for 10 years after surgery.
Symptoms of
Symptoms of the disease appear gradually: first they disturb the patient only after physical exertion, then they are observed even at rest. For the mitral valve stenosis clinic, it is characteristic that patients complain of:
- shortness of breath or cardiac asthma;
- cough, which can be initially dry, and then becomes wet - with increased sputum content, foamy and even with an admixture of blood;
- increased fatigue and weakness;
- frequent dizziness and light-headedness;
- thermoregulation disorders;
- hoarseness of voice;
- frequent bronchitis and pneumonia;
- pain in the region of the heart - more often from the side between the shoulder blades;
- tachycardia.
The appearance of the patient is characterized by : it is pale, and on his cheeks feverish blush, nose, lips and fingers cyanotic, veins on the neck are swollen, swelling on the body and bloated abdomen can be seen.
When to see a doctor and to what?
The cardiologist or the district therapist should be contacted immediately if the first signs of heart disease are found - shortness of breath and fatigue with frequent dizziness.
Diagnosis
The doctor diagnoses, based not only on the history and examination data, but also on the results of such instrumental studies:
| Type of diagnostic study | Characteristic signs of mitral stenosis |
| Electrocardiogram | Increased left atrium and right ventricle. Tachyarrhythmia. |
| Phonocardiogram | Characteristic noise with mitral stenosis. Clicking the valve sound. |
| Radiography | Increased left atrium and right ventricle. Expansion of the shadow of the hollow veins and pulmonary artery. Changing the pattern of the lungs. Calcification of the valve. |
| Ultrasound of the heart with doppler or transesophageal ultrasound | Change in blood flow to the heart. Reduction of the area of the mitral orifice. Increased individual chambers of the heart. |
| Invasive methods with cardiac catheterization | Elevated pressure in the left atrium and right ventricle. |
To clarify the diagnosis and determine the tactics of treatment, sometimes may require computerized tomography and diagnostic shunting .As a rule, the diagnostic methods given in the table are sufficient to correctly diagnose and perform differential diagnosis of mitral stenosis with such pathologies:
- aortic valve stenosis or aortic insufficiency;
- pulmonary hypertension;
- heart tumor;
- pericarditis;
- thyrotoxicosis.
Treatment methods
Conservative drug therapy for this blemish is of secondary importance to .Its main purpose:
- Treatment of diseases that provoked pathology( autoimmune, infectious).
- Neutralization of the symptoms of the disease with the impossibility of surgical intervention or in the preoperative period. To this end, diuretics are prescribed( Furosemide, Veroshpiron), cardiac glycosides( Digoxin, Celanide), adrenoblockers( Atenolol), anticoagulants( Warfarin, Heparin), vitamins and minerals.
But more often patients turn to the doctor when the symptoms of the disease are already strongly pronounced - in this case the classic treatment is a surgical intervention. In this case, the following types of operations can be performed:
- Baloon valvuloplasty is a minimally invasive operation bypassing the coronary vessels under the control of X-ray and ultrasound. It is performed with uncomplicated mitral stenosis of 2-3 degrees.
- Comissorotomy is an operation to dissect valve flaps with restoration of the hole area. It can be performed transthoracally or on the open heart. Indications for this method of surgical intervention are a high degree of narrowing of the mitral orifice and complication of stenosis( adhesions, blood clots, stagnation of blood in the lungs).
- valve replacement, using mechanical or biological prostheses, is used in the case of severe stenosis and the impossibility of its elimination by dissecting valve flaps.
In the case of a stage of severe decompensation of pathology( grade 4-5), any corrective surgery is contraindicated by , and patients are prescribed only palliative drug treatment.
Prognosis and prevention measures
The prognosis is unfavorable only if there is no proper treatment for - 65% of such patients will die in the next 10 years. After the corresponding operation, this figure is reduced to 8-13%.
Learn more about the topic from the video:
Prevention of pathology and its recurrence is timely treatment of rheumatic and infectious diseases , adherence to a healthy lifestyle and attentive attitude to one's own health.
If these conditions are met, the risk of mitral stenosis, if not completely disappears, is significantly reduced, and the likelihood of a lethal outcome of an early detected defect is reduced almost completely to zero.
