Mitral valve of the heart signs in a child. Symptoms and treatment of mitral valve prolapse in children. Treatment of mitral valve prolapse in children and adolescents

Today, diseases of the cardiovascular system are detected during examination not only in the older generation, but also in children. The most common is mitral valve prolapse in children (MVP). What kind of disease, what are its symptoms, and how is it treated? Let's figure it out.

MVP is a pathology of the heart, during the operation of the organ, the leaflets of the mitral valve bend, and there is a partial return of blood from the ventricle to the left atrium. The greater its flow, the more severe the degree of the disease. When using a stethoscope, systolic clicks are heard, noises are sometimes absent.

The disease was first discovered and the symptoms described in 1887. But scientists did not know what the disease is connected with, why it occurs and how it is treated. They heard systolic clicks and a late heart murmur. Already later, namely in 1963 and 1981, after the conducted research, answers to these questions were obtained. In 1979, the disease was given the name "prolapse", it is still used today.

In adolescents, MVP occurs in 2 - 15% of cases, in girls after 10 years - 2 times more often than boys. Prolapse is diagnosed even in infants, the average age of sick children is 6-15 years.

Depending on the origin, the following forms of PMK are distinguished:

Primary. The pathology is not so serious, but the consequences caused by it are significant and should not be ignored by physicians. Complications include arrhythmia, thromboembolism, mitral insufficiency (in adolescents, it occurs due to damage to the chest).
Secondary. It manifests itself as a complication due to heart disease and accounts for up to 5% of all cases.

The valve with an anomaly passes more blood - the pathology is more difficult. By the magnitude of the prolapse of the sash, the following degrees are distinguished:

1 degree - deflection by 3 - 6 mm;
2 degree - 6 - 9 mm;
3 degree - more than 9 mm.

The reasons

Primary prolapse in children most often occurs due to disorders in the growth (dysplasia) of the connective tissues. Not only the valve itself changes, but also its structure, dimensions, attachment. Zinc and magnesium deficiency, infectious diseases of a pregnant woman, metabolic disorders are the culprits of this condition.

There are many causes of secondary MVP in children. In the first place is heredity, most often transmitted from the mother, also acts as complications of such diseases: arrhythmia, rheumatism, endo- and myocarditis. In adolescents, chest injuries can be a source of pathology. Other congenital heart defects affect the change in the geodynamics of its left side. Vegetovascular dystonia, thyrotoxicosis, neurosis are common causes of anomalies.

Manifestation

Usually, prolapse goes unnoticed and is detected only during a preventive examination. Doctors distinguish several symptoms of the disease:

Feeling of lack of air (sometimes you want to inhale as deeply as possible).
Headache at night and in the morning.
Rapid fatigue, general weakness of the body.
The presence of pain and discomfort in the region of the heart.
Dizziness, fainting.
Sleep disturbance.

The main symptoms of MVP are systolic clicks, occurring alone or accompanied by noises. These sounds are heard when examining a child in a standing position or after physical exertion (usually 20 squats).

If you experience any of the symptoms, seek the advice of a pediatrician, cardiologist or rheumatologist.

To diagnose the pathology, an ECG is performed, an ultrasound of the heart zone, an x-ray is prescribed, and blood is taken for analysis. A complex of examinations will reveal the inflammatory process. Additionally, phonocardiography is used, which makes it possible to analyze clicks, noises and a "chordal squeak" in the region of the heart.

Therapy

Treatment of children with prolapse is individual. Pay attention to the age of the child, his gender, heredity, signs of dysplasticity. Compare the results of ultrasound, ECG and other examinations.

In children with congenital MVP, treatment is not carried out. Primary prolapse has a favorable prognosis. There are no restrictions on physical activity. Teenagers are not recommended to engage in professional sports, it is worth consulting with your doctor.

If a child has symptoms of prolapse (insomnia, increased heart rate), doctors prescribe sedative herbal remedies. They have a beneficial effect on the activity of the nervous system.

If a child with MVP suffers from shortness of breath, pain in the region of the heart, general weakness during physical exertion, the doctor will prescribe a more serious drug that normalizes the heart.

With secondary prolapse resulting from previous diseases, the child should be hospitalized. Inflammation of the heart valves due to bacteria is treated with antibiotics of the penicillin group. If the work of the organ is impaired or there is severe regurgitation, other drugs are prescribed by the rheumatologist.

For any symptoms accompanying the disease, medicines are taken only after consulting a doctor.

In severe form of rheumatic inflammation of the heart and valve insufficiency, not amenable to drug treatment, surgical intervention is performed. The valve is replaced or prosthetic.

Prevention and forecasting

MVP in children usually proceeds without any complications and symptoms. But supportive care is needed. Without it, the development of valve insufficiency, the occurrence of severe complications in the future, can occur. These side effects only worsen the prognosis of the disease.

It is important to monitor the condition of a teenager with prolapse, to perform all the therapeutic and preventive actions prescribed by the doctor.

A set of measures:

If there are no complaints about the child's well-being, it is necessary to undergo an examination by a cardiologist once every 2 years. If the baby is worried about something, then an ECG and ECHOCG are performed every year.
Do not get involved in sports with a high load on the body. Avoid overwork.
Attend massage sessions, swimming pool. Such procedures have a beneficial effect on the cardiovascular system and the general condition as a whole.
Providing your child with a complete and healthy diet high in magnesium.
If you experience any of the symptoms of the disease, immediately consult a doctor.

Summary

A common ailment of the heart system in children - mitral valve prolapse, may be asymptomatic and does not require treatment. Without supportive therapy, prolapse can provoke other serious diseases at an older age. Parents whose children have this pathology need to have information about methods of treatment and methods of prevention. After all, it is mom and dad who constantly stay with the child and help prevent the occurrence of complications.

Often, during the period of intrauterine development, children develop features in the structure of the heart, which in no way interfere with his life and do not affect his health. These include mitral valve prolapse (or MVP). Often it is detected as an accidental finding during ultrasound in adolescents or children of different ages, but in some cases it is combined with disorders in the functioning of the nervous system, manifesting itself in various types of chest pain and ailments. Do I need medications or any medical interventions in this case?

Anomaly in children: origin

Often, during the period of intrauterine development, various external or internal influences lead to changes in the structure of the heart, which in children then manifests itself in the MARS syndrome. These are small anomalies in the development of some organs, including the heart, which do not lead to the formation of defects and circulatory disorders, but give a specific picture on ultrasound. Children with such abnormalities, which can manifest themselves not only in the form of MVP, but also in the form of false or additional chords, anomalies in the structure of the papillary (papillary) muscles, grow and develop quite normally, do not suffer from any problems. Or, upon reaching adolescence, children may complain of malaise and transient pain in the chest area, often associated not with the heart itself and its characteristics, but with a combined VVD (pathology of the nervous system).

A frequent combination of such small anomalies in the structure of the heart with the development of vegetative-vascular dystonia in adolescents was noted. This is often associated with age-related changes in metabolic processes, hormonal influences and changes in the functioning of the nervous system against the background of higher loads (both physical and neuropsychic) typical of adolescents. Therefore, adolescents in the period of puberty often suffer not from the symptoms of the MVP itself, but from the manifestations of the IRR, which are erroneously attributed to the anomaly. Usually, for people with MVP or other minor developmental anomalies, physique features are typical - this is high growth and the predominance of longitudinal body dimensions, adolescents have long and thin arms and legs, an elongated face, a narrow chest, increased mobility in the joints. Often, this is accompanied by a lack of weight. Adolescents, in addition to PMK, due to the peculiarities of the structure of the connective tissue, may suffer from a decrease in visual acuity and strabismus, “looseness” of the joints, which threatens with high injuries and low pressure. Such general symptoms of VVD are typical, such as headaches with periods of subfebrile temperature without signs of infections, abdominal discomfort with unstable stools, and reactions to the weather.

Features of pain on the background of MVP

As mentioned above, against the background of a combination of valve anomalies with VVD, various types of periodic pain in the chest area and the projection of the heart can occur. At the same time, the pain is functional in nature, that is, it is not associated with cardiac disorders, but with disorders in the regulation of the nervous system. Often, teenagers or younger children complain of pain after experiences and stresses, emotional events or physical exertion. The nature of the pains is always different - they are described as stabbing or aching, last a few seconds and release, less often they can be longer and more pronounced.

It should be noted that, unlike organic pain in the heart, such sensations do not have an increase on the background of physical activity, they do not have shortness of breath and dizziness, fainting attacks. If such combinations appeared, it is no longer about MVP or dystonia, a full examination is important.

Often, children may indicate that during work the heart seems to freeze or “fail”, which is explained by an imbalance in the work of the parasympathetic and sympathetic departments, increased excitability of the nervous system. There may also be attacks of palpitations that occur spontaneously and also suddenly disappear. With them there is no dizziness or impaired consciousness, fainting is not typical. According to the ECG data, the heart of children works quite normally and adequately, without problems with conduction and contractility.

In rare cases, especially emotional children may faint due to fear or hypoxia, they happen in stuffy hot rooms and quickly pass. Usually you can bring children to their senses by lightly patting their cheeks or going out into the fresh air.

What treatment is needed: drugs, procedures

Actually, MVP of congenital origin does not require treatment, children may not even know about their diagnosis, and they are not shown any restrictions in terms of physical activity or stress. For adolescents with MVP, active physical education and sports, swimming and mobility are even recommended in order to eliminate the effects of VVD and normalize metabolic processes, excitability and hormonal levels. Professional sports are also not limited if there are no concomitant pathologies.

Against the background of complaints typical of VSD and increased nervous excitability, emotionality, sedative herbal medicines may be required - motherwort, valerian, Novo-Passit tablets or others selected by a doctor. They are taken in courses to reduce the excitability of the nervous system and relieve stress. Medicines containing magnesium in combination with vitamin preparations can also be additionally used. They have an anti-stress and sedative effect.

More serious drugs can be used only in cases where there are serious disturbances in the functioning of the organ during MVP, leading to attacks of shortness of breath and weakness, pain in the heart. Then it is necessary to conduct an ultrasound with an assessment of blood flow and the control of a cardiologist with the appointment of more antiarrhythmic, cardiotonic and other drugs. PMK without complications does not require any procedures or surgical interventions, only dynamic monitoring of the development of children is necessary.

The mitral valve is located between the left atrium and ventricle. Its function is to keep blood from entering the atrium. To do this, the valve must be durable. However, in some children, one or both leaflets of the mitral valve are very flexible and bend into the region of the left atrium. This condition is called mitral valve prolapse. This pathology in children refers to small cardiac anomalies.

The reasons

Minor heart disease in newborns can occur for a number of reasons. If the disease is primary, then the following factors can provoke it:

intrauterine anomalous elasticity of the soft tissues of the heart, including the leaflets of the mitral valve,
pathological metabolism caused by a deficiency of minerals and vitamins,
dysfunction of the regulation of nerve endings that give signals to the mitral valve.

Secondary mitral valve prolapse can be caused by a number of genetic disorders:

genetic pathologies of connective tissues, among them the most common syndromes are Marfan and Elres-Danlos,
congenital and hereditary heart defects,
abnormal conditions of the organs of the endocrine system,
colds, especially tonsillitis and pneumonia.

Among the reasons for the development of a small cardiac anomaly, it should also be noted:

birth and infant trauma
childbirth problems,
complications during pregnancy.

Symptoms

Symptoms of mitral valve prolapse in newborns can manifest themselves in various ways. Significant differences in the clinical picture are associated with the nature and type of development of the disease. With the primary type of heart disease in infants, the following signs are noted:

the appearance of shortness of breath,
low blood pressure,
very fast pulse
general weakness,
increased excitability and whims.

If mitral valve prolapse is a consequence of the underlying disease, then its manifestations occur much later. At the beginning, signs of the underlying disease appear, which can also be very diverse.

Diagnosis of mitral valve prolapse in a newborn

To check the work of the cardiovascular system of the baby, the following methods are used:

echocardiography,
heart ultrasound,
listening to the heart.

You can determine the failure of the mitral valve by primary listening, which reveals:

heart clicks,
chordal squeak,
systolic murmurs.

Complications

The prognosis of this pathology with its timely detection is the most favorable. Detection of anomalies allows you to maintain the state of the heart muscles in sufficient tone. In the absence of proper treatment and prevention, dangerous deviations may develop that cannot be corrected.

The most dangerous complication is the reverse flow of blood, which in most cases is fatal.

Surgery and other therapies are also fraught with complications.

Treatment

What can you do

In newborns, mitral valve prolapse is most often detected at birth. For this reason, a young mother immediately after childbirth and in the first three months of a baby's life should definitely visit a cardiologist and carry out all the mandatory procedures.

Diagnosis of the functionality of the cardiovascular system is absolutely harmless to the baby. And the benefits of timely detection of pathology are obvious. Small cardiac pathology, if detected in time, does not entail dangerous consequences. It is only important to protect the baby from possible negative factors that can contribute to the development of the disease.

In order to avoid the progression of the disease, parents must fully comply with all the appointments of children's doctors. Only in the case of a complete treatment course can we talk about the effectiveness of therapy.

You should stop using traditional medicine recipes. Children's immunity during this period is very weak, so it is impossible to guess all the side effects of self-medication.

Regular visits to the cardiologist and preventive measures will also help maintain the pathology in remission.

What does a doctor do

After making a diagnosis, a pediatric cardiologist and pediatrician conduct a series of additional studies that allow you to determine the causes of the disease and its stage.

In the presence of the underlying disease, its treatment and procedures to strengthen the walls and cusps of the mitral valve are prescribed.

In the primary type of pathology, treatment is directed to the removal of symptoms. Only in the event of a threat of blood entering the atria, doctors prescribe surgical intervention. Depending on the individual characteristics of the baby, they may prescribe:

plastic surgery aimed at strengthening the tissues of the mitral valve,
prosthetics of one or two valves,
valve replacement.

Prevention

There are a number of general preventive measures aimed at strengthening the heart and the entire cardiovascular system. Parents must:

keep breastfeeding as long as possible,
strengthen children's immunity,
timely treat emerging colds and other diseases,
see a cardiologist regularly
conduct heart examinations in a timely manner,
follow the baby's daily routine,
support a healthy sleep crumbs.

For the first time in 1887, the phenomenon of valve prolapse was described in the form of a heard "click" in the region of the apex of the heart. In 1963, thanks to a cardiographic study, sagging of the mitral valve leaflets into the atrial cavity was revealed.

The frequency of occurrence in children is up to 14% in the population, more common in girls aged 6-15 years.

The results of research by the American scientist Fremingheim showed that prolapse of the heart valves occurs with the same frequency in both boys and girls, and does not depend on age categories.

Mostly mitral valve prolapse occurs in children. But also in 4% of cases there may be prolapse of the tricuspid valve, and prolapse of the aortic and pulmonary valves is very rare.

Prolapses are classified as minor cardiac anomalies. Only the development of valve insufficiency, which subsequently requires prosthetics, can be attributed to defects.

What is a valve body?

The heart pumps up to 5 liters of blood per minute. For optimal performance, it needs messages between cameras.

Thanks to the valves, blood flows from one chamber to another and does not return back.

Tight closure is due to the pressure difference. There are four valves in the heart: mitral, tricuspid, aortic, and pulmonary.

The valves are structurally very strong and can withstand a fairly large volume of blood. During relaxation of the heart chambers, the valves should normally close tightly.

The main reason is changes in the connective tissue, which becomes loose.

As you know, the valvular apparatus, chords of the heart, valve rings consist of it.

Connective tissue structure changes are determined by:

congenital pathology or primary prolapse (this type of pathology is called myxomatous degeneration);
hereditary factor;
rapid growth spurt;
additional or elongated chords.

It is also very important to find out cardiac pathology from close relatives, to exclude the so-called cardiomyopathy. This is a disease characterized by early death of cardiac cells, an increase in heart cavities and a decrease in myocardial contractility.

Rapid heartbeat, or tachycardia. Appears in a calm state, not accompanied by a feeling of fear and torrential sweat.
Headaches, dizziness, more often in the evening.
Do not allow children to stay near computer monitors, phones for a long time. This is a huge load on the visual apparatus, hence there may be headaches.
Pre-fainting states. Very often, teenagers experience discomfort in stuffy rooms.
Pain in the region of the heart, chest. With prolapses, this often happens, this is due to the influence of the sympathetic department of the nervous system. Pain intensifies during psycho-emotional stress.
Sensation of interruption in the heart. Feeling of fading of cardiac activity, and then quickening or slowing down of the rhythm.
Panic attacks. At the same time, the child suddenly develops a fear of something.
hyperventilation syndrome. This feeling of lack of air. As a rule, it is more often observed in impressionable children. When the child begins to worry, there is an attack of suffocation. In this case, it is worth differentiating the state with .
Frequent nosebleeds. This is due to the fact that blood clotting is reduced due to the low content of connective tissue fibers.
If the prolapse is of an acquired nature, then it often develops after suffering a sore throat, confirmed rheumatism. May be accompanied by joint pain.

In most cases, mitral valve prolapse can only "give" an auscultatory picture.

This means that the pediatrician, when listening to the chest, will note a noise or "click" in the area of \u200b\u200bthe heart. Moreover, it is better to listen to children with this pathology lying down.

The nervous system is also very important in the appearance of complaints. The mitral valve has a slight automatism, and under the influence of catecholamines (adrenal hormones), produced when the state of the nervous system changes, it can sag.

The nervous system is divided into sympathetic and parasympathetic. With their imbalance, complaints arise.

Diagnostics

One of the most important examinations is an ultrasound of the heart, which gives a complete picture of the anatomical structure of the heart.
ECG. Assesses rhythm and conduction.
Blood electrolytes (magnesium, potassium, calcium).
General analysis of blood and urine.
24-hour ECG monitoring in case of arrhythmias and conduction disturbances.
Stress tests ECG - treadmill test or bicycle ergometry.

Mitral valve prolapse treatment

Grade 1 prolapse does not need to be treated. Children have no restrictions in sports, physical education.

With prolapse of 2, 3 degrees, therapy is indicated that improves metabolism in the myocardium.

Cardiotrophic therapy:

Kudesan. An antioxidant drug, indicated for children from 1 year old, improves the metabolism of trace elements in the heart muscle. It has dosages both preventive and therapeutic;
Elkar. The drug carnitine, tonic, stimulates metabolism in the myocardium. Can be given from birth. Improves appetite;
Riboxin. Vitamin-like drug. Good effect when administered to athletes;
Pantogam. It improves metabolic processes, can reduce blood pressure, reduces excitability, improves physical performance and mental activity.

Drugs that improve cerebral circulation:

Cavinton. Works great for headaches. Representatives of this group are Oksibral, Cinnarizine;
preparations of magnesium, potassium - Magnelis, Panangin. These drugs increase the level of electrolytes important for the heart cell, hence the rhythm and conduction of the heart improves;
Calcemin. Calcium preparation, strengthens the connective tissue of the valves;
omega-3 fatty acids. They have a beneficial effect on heart rate.
Norwegian scientists have proven that sleep disturbance, irritability, mood swings are caused precisely by omega-3 deficiency. It is also important to include sea fish, vegetable oils (especially flaxseed) in the diet;
nootropic drugs (Aminalon, Picamilon, Piracetam, Phezam). Increase the resistance of brain cells to hypoxia.

Basically, it is aimed at regulating the functioning of the nervous system:

Valerian rhizome is the best sedative. Enhances the processes of inhibition in the cortical structures of the central nervous system. The calming effect occurs on average after 2 weeks. As a rule, sedative therapy is prescribed for at least a month. Phytotherapy should be administered in courses, 3 times a year.
Lemon juice is useful for strengthening heart tissue. But it should be used carefully if the child has an allergic mood.
General tonic: nettle, echinacea, fennel, dandelion, centaury.
Stimulants: ginseng, Rhodiola rosea, Schisandra chinensis.
Physiotherapy procedures. Electrosleep, electrophoresis on the cervical-collar zone, galvanization - all this contributes to muscle relaxation.
Don't forget about lifestyle changes. The most important thing for children is physical activity. It helps to strengthen the muscular frame and connective tissue of the valvular apparatus of the heart. Exhausting loads are optional. Even morning exercises for 15 - 30 minutes a day, outdoor games are great. Cycling and skiing have a good dynamic load.
It is also important to create psychological comfort for the child in the family. Indeed, in fact, with the right attitude towards your baby, this will help maintain the balance of the nervous system, which means avoiding many problems.

As a conclusion

Mitral valve prolapse can resolve on its own due to changes in the constitutional features of the child. For example, if the baby was tall and thin, but then gained weight, the valve can return to its previous structure.

In this article, we analyzed the cause and treatment of prolapse. It can be concluded that the prolapse of the valves of the first degree can be attributed to the borderline state of health. And timely treatment will prevent the progression of a negative condition.

Mitral valve prolapse (MVP) - bending of one or both of its valves into the cavity of the left atrium during left ventricular systole. In this article, you will learn the main causes and symptoms, how mitral valve prolapse is treated in children, and what preventive measures you can take to protect your child from this disease.

Causes of mitral valve prolapse

MVP is one of the most common forms of violation of the valvular apparatus of the heart. It may be accompanied by prolapse of other valves or be combined with other minor anomalies in the development of the heart. Consider the causes of this disease in children.

Prevalence. Detected in 2-18% of children and adolescents, i.e. significantly more frequently than in adults. In heart diseases, MVP is recorded much more often: up to 37% in CHD, up to 30-47% in patients with rheumatism and up to 60-100% in patients with hereditary connective tissue diseases. Prolapse can be detected at any age, including the neonatal period, but most often it is observed in children older than 7 years. Up to 10 years, it is found with the same frequency in boys and girls. In the older age group, the symptoms of mitral valve prolapse are detected 2 times more often in girls.

Causes of the origin of prolapse

By origin, primary (idiopathic) and secondary prolapse are distinguished.

Primary PMK associated with connective tissue dysplasia, which is also manifested by other microanomalies in the structure of the valvular apparatus (changes in the structure of the valve and papillary muscles, impaired distribution, improper attachment, shortening or lengthening of the chords, the appearance of additional chords, etc.) Connective tissue dysplasia is formed under the influence of various pathological factors acting on the fetus during its intrauterine development (preeclampsia, acute respiratory viral infections and occupational hazards in the mother, unfavorable environmental conditions, etc.)

In 10 - 20% of cases, it is inherited through the maternal line. At the same time, relatives with signs of connective tissue dysplasia and/or psychosomatic diseases are detected in 1/3 of proband families. Connective tissue dysplasia may also present with myxomatous transformation of the valve leaflets associated with a hereditary disorder of the collagen structure, especially type III. At the same time, due to the excessive accumulation of acid mucopolysaccharides, the tissue of the valves (sometimes also the valve ring and chords) proliferates, which causes the effect of prolapse.

Secondary PMK accompanies or complicates various diseases. In secondary MVP, as in primary, the initial inferiority of the connective tissue is of great importance. So, it often accompanies some hereditary syndromes (Marfan syndrome, Ehlers-Danlo-Chernogubov syndrome, congenital contracture arachnodactyly, osteogenesis imperfecta, pseudoxanthoma elastic), as well as CHD, rheumatism and other rheumatic diseases, non-rheumatic carditis, cardiomyopathy, some forms of arrhythmia, SVD , endocrine pathology (hyperthyroidism), etc. Mitral valve prolapse can be the result of acquired myxomatosis, inflammatory damage to valvular structures, impaired contractility of the myocardium and papillary muscles, valvular ventricular disproportion, asynchronous activity of various parts of the heart, which is often observed in congenital and acquired diseases of the latter.

Dysfunction of the autonomic nervous system undoubtedly takes part in the formation of symptoms. In addition, metabolic disorders and micronutrient deficiencies, in particular magnesium ions, are important.

Structural and functional inferiority of the valvular apparatus of the heart leads to the fact that during the period of left ventricular systole there is a deflection of the valves into the cavity of the left atrium. With prolapse of the free part of the valves, accompanied by their incomplete closure in systole, isolated mesosystolic clicks are auscultated, associated with excessive tension of the chords. Loose contact of the valve leaflets or their divergence in systole determines the appearance of systolic murmur of varying intensity, indicating the development of mitral regurgitation. Changes in the subvalvular apparatus (elongation of the chords, a decrease in the contractile ability of the papillary muscles) also create conditions for the onset or intensification of mitral regurgitation.

Degrees of mitral valve prolapse

There is no generally accepted classification. In addition to distinguishing prolapse by origin (primary or secondary), it is customary to distinguish auscultatory and "silent" forms, indicate the localization of prolapse (anterior, posterior, both valves), its severity:

Mitral valve prolapse of the 1st degree - from 3 to 6 mm,
Mitral valve prolapse of the 2nd degree - from 6 to 9 mm,
Mitral valve prolapse grade 3 - more than 9 mm

The time of occurrence in relation to systole (early, late, holosystolic), the presence and severity of mitral regurgitation. The state of the autonomic nervous system is also assessed, the type of MVP flow is determined, and possible complications and outcomes are taken into account.

Mitral valve prolapse symptoms

It is characterized by a variety of symptoms, depending primarily on the severity of connective tissue dysplasia and autonomic changes.

Complaints in children about the symptoms of MVP are very diverse: increased fatigue, headaches, dizziness, fainting, shortness of breath, pain in the heart, palpitations, a feeling of interruptions in the work of the heart. Characterized by reduced physical performance, psycho-emotional lability, increased excitability, irritability, anxiety, depressive and hypochondriacal reactions.

Signs of mitral valve prolapse

In most cases, the child finds various manifestations of connective tissue dysplasia:

asthenic physique,
high growth,
reduced body weight,
increased skin elasticity,
poor muscle development
joint hypermobility,
posture disorder,
scoliosis,
chest deformity,
winged blades,
flat feet,
myopia.

You can find hypertelorism of the eyes and nipples, the peculiar structure of the auricles, the gothic palate, the sandal-shaped gap and other minor developmental anomalies. Visceral symptoms of connective tissue dysplasia include nephroptosis, anomalies in the structure of the gallbladder, etc.

Complications. Complications are ruptures of the chords, infective endocarditis, left ventricular hypertrophy due to the resulting overload with progressive blood regurgitation, persistent arrhythmias.

Diagnosis of mitral valve prolapse

Clinical and instrumental criteria are used to diagnose the disease. The main criteria are characteristic auscultatory and echocardiographic signs, which is of decisive importance. History data, complaints, manifestations of connective tissue dysplasia, ECG and X-ray results contribute to the diagnosis, but are of secondary importance.

PMK must be differentiated, first of all, from congenital or acquired insufficiency, systolic murmurs caused by other variants of small anomalies in the development of the heart or valvular dysfunction. Echocardiography is the most informative, contributing to the correct assessment of the detected cardiac changes.

Often, with prolapse, a change in heart rate and blood pressure is observed, mainly due to hypersympathicotonia. The borders of the heart are usually not expanded. Auscultatory data are the most informative: isolated clicks or their combination with late systolic murmur are more often heard, less often - isolated late systolic or holosystolic murmur. Clicks are recorded in the middle or end of systole, usually at the apex or at the fifth point of auscultation of the heart. They are not carried out outside the region of the heart and do not exceed the second tone in volume, can be transient or permanent, appear or increase in intensity in a vertical position and during physical activity. Isolated late systolic murmur (rough, "scratching") is heard at the apex of the heart (preferably in the position on the left side); it is carried out in the axillary region and is enhanced in an upright position. Holosystolic murmur, reflecting the presence of mitral regurgitation, occupies the entire systole, is stable. In some patients, a "squeak" of chords associated with the vibration of valvular structures is heard. In some cases (with the "silent" variant of MVP), auscultatory symptoms are absent. Symptoms that manifest secondary mitral valve prolapse are similar to those in the primary and are combined with manifestations characteristic of a concomitant disease (Marfan's syndrome, congenital heart disease, rheumatic heart disease, etc.)

Mitral valve prolapse in a child - instrumental studies

As a rule, a normal or reduced size of the heart is determined on an x-ray. Often, a moderate bulging of the pulmonary artery arch associated with inferiority of the connective tissue is found. On the ECG, transient or persistent disturbances in the processes of repolarization of the ventricular myocardium (decrease in the amplitude of the T wave, displacement of the ST segment), various arrhythmias (tachyarrhythmia, extrasystole, slowing of atrioventricular conduction), more often detected with Holter monitoring, are recorded on the ECG. Possible lengthening of the QT interval. EchoCG is the most informative, revealing systolic displacement of one (mainly posterior) or both valve leaflets, changes in the excursion of the mitral annulus, interventricular septum and other parts of the heart, thickening and uneven contours of the leaflets (signs of myxomatous degeneration), microanomalies in the structure of the valvular apparatus, as well as signs of mitral regurgitation . Sometimes, echocardiography reveals dilatation of the aorta, pulmonary artery trunk, open foramen ovale, prolapse of other valves, which indicates widespread connective tissue dysplasia.

Differential diagnosis of mitral valve prolapse

The diagnosis is based on the detection of mesosystolic or "late" systolic murmurs and clicks during auscultation and on FCG, taking into account anamnestic, general clinical and laboratory data. It is specified by ultrasound diagnostics, which reveals a picture of late systolic or pansystolic prolapse of the posterior or both valves.

Most often, the symptoms of mitral valve prolapse are differentiated from rheumatism, from functional changes in the heart, damage to the valvular apparatus in infective endocarditis, and diffuse connective tissue diseases (see the relevant sections). It differs from rheumatism in the absence of an etiological connection with streptococcal infection, frequent development against the background of hereditary pathology of the connective tissue, the functional nature and variability of clinical manifestations, the absence of progression of the course and laboratory signs of inflammation. Changes on the ECG concern mainly the posterior diaphragmatic sections of the left ventricle. The extratons and noises detected on the FCG when examined in a standing position or squatting approach the I tone. Echocardiography detects leaflet sagging and chorda dysfunction with unchanged valve structure.

Treatment of MVP is carried out, first of all, in relation to the underlying disease. With concomitant rhythm disturbances, antiarrhythmic drugs are prescribed as a means of treatment. Physiotherapy exercises, symptomatic and restorative therapy are obligatory.

Mitral valve prolapse treatment

Treatment of prolapse depends on its form, the severity of clinical symptoms, including the nature of cardiovascular and autonomic changes, as well as on the characteristics of the underlying disease.

How to treat mitral valve prolapse?

With a "silent" form, treatment is limited to general measures aimed at normalizing the vegetative and psycho-emotional status of children, without reducing physical activity.
With the auscultatory variant, children who satisfactorily endure physical activity and do not have noticeable disorders according to ECG data can go in for physical education in the general group. Exclude only exercises associated with sudden movements, running, jumping. In some cases, exemption from participation in competitions is necessary.
When mitral regurgitation, pronounced violations of repolarization processes on the ECG, distinct arrhythmias are detected, a significant limitation of physical activity with an individual selection of the exercise therapy complex is necessary.

Mitral valve prolapse - drug treatment

In order to successfully carry out the treatment, the correction of vegetative disorders, both non-drug and medication, is of great importance.

In case of violations of ventricular repolarization (according to ECG data), agents that improve myocardial metabolism are used for treatment [potassium orotate, inosine (for example, riboxin), vitamins B 5, B 15, levocarnitine, etc.] To treat the mitral valve, drugs that correct magnesium metabolism, in particular orotic acid, magnesium salt (magnerot). In some cases (with persistent tachycardia, frequent ventricular extrasystoles, the presence of an extended QT interval, persistent violations of repolarization processes), the appointment of radrenoblockers (propranolol), if necessary, antiarrhythmic drugs of other classes, is justified.

With pronounced changes in the valvular apparatus, prophylactic courses of antibiotic therapy are indicated (especially in connection with surgical intervention) in order to prevent the development of infective endocarditis. Necessarily conservative or surgical treatment of foci of chronic infection.

With mitral insufficiency, accompanied by severe, treatment-resistant cardiac decompensation, as well as with the addition of infective endocarditis and other serious complications (pronounced arrhythmias), it is possible to perform surgical correction of the MVP (restorative surgery or valve replacement).

Prevention of mitral valve prolapse

Primarily secondary prevention is carried out. i.e. prevention of complications. Children with prolapse should be exempted from participation in competitions and heavy physical exertion; they should create a calm environment in the family and school. For any surgical intervention, including dental, antibiotics should be used.

Prevention is aimed mainly at preventing the progression of existing valvular disease and the occurrence of complications. For this purpose, an individual selection of physical activity and the necessary medical and recreational activities, adequate treatment of other existing pathologies (with secondary MVP) are carried out. Children are subject to dispensary observation with regular examinations (ECG, echocardiography, etc.)

Treatment prognosis will depend on its origin, the severity of morphological changes, the degree of regurgitation, the presence or absence of complications. In childhood, the disease proceeds favorably. Complications occur quite rarely. It is possible to develop acute (due to detachment of chords, with pulmonary venous hypertension) or chronic mitral insufficiency, infective endocarditis, severe forms of arrhythmias, thromboembolism, sudden death syndrome, most often of an arrhythmogenic nature.

The development of complications, the progression of valvular disorders and mitral regurgitation adversely affect the prognosis. Mitral valve prolapse that occurs in a child can lead to difficult-to-correct disorders at a more mature age. In this regard, timely diagnosis, accurate implementation of the necessary therapeutic and preventive measures in childhood are needed.

Mitral valve prolapse video