What is valvular regurgitation. mitral regurgitation

The mitral valve is a leaflet that separates the left ventricular chamber from the atria. Sagging of the leaflets by 6 mm - prolapse of the mitral (left) valve 2nd degree, this creates the conditions for the reverse movement of blood: from the stomach to the atrium. There is primary valve prolapse (idiopathic), without a specific etiology, and secondary (acquired). The first is associated with the individual characteristics of the structure, the second - occurs as a result of complications of known cardiac and systemic diseases.

The idiopathic variant is regarded as a developmental anomaly and remains stable throughout life. Prolapse of the atrioventricular valve (AMV) of the 2nd degree does not bring noticeable discomfort to the patient and is detected during ultrasound diagnostics of the heart during a routine examination for other diseases.

Mitral valve prolapse with grade 2 regurgitation

The degree of deformation of the mitral leaflets is determined by the volume of blood that returns to the atrium. Mitral valve prolapse with grade 2 regurgitation is determined by ultrasound. The level of blood return corresponds to the following parameters:

1 st. -blood reaches the valve

2st. - the atrium is filled by 50%;

3st. - the level reaches 70% of the filling of the left atrium;

4st. – 100% filling of the atrial chamber.

Mitral valve prolapse of the 2nd degree can be determined by auscultation, when the reverse flow of blood (regurgitation) creates a specific noise. It can be determined from ventricular systole. The presence of systolic murmurs indicates prolapse of the atrioventricular leaflet above grade 2.

If the condition does not cause concern to the patient, then medical attention is not required. If the patient complains of fatigue, dizziness, then it will be enough to follow the following recommendations:

• Compliance with the regime of work and rest;
• News active life- classes for fresh air aerobics will benefit, and heavy sports should be avoided (lifting weights, running long distances);
• Sleep should be at least eight hours.

Panic attacks and autonomic disorders can be stopped with sedative herbal medicines:

• Motherwort tincture;
• Valerian tablets;
• Ledum and hawthorn extract;
• Tincture of peony, sage.

If these funds are ineffective, pharmaceutical drugs (persen, novo-passit) will come to the rescue.

PMK medical care algorithm:

• Psycho-emotional stabilization with the help of auto-training, as well as sedatives;
• Application restorative means(eleutherococcus, ginseng, pantocrine).
• The use of physiotherapy (massage, aromatherapy);
• Strengthening the structure connective tissue(increased collagen synthesis by orotic acid);
• The use of magnesium (has a relaxing and antiarrhythmic effect);
• The use of amiodarone and beta-blockers to stop interruptions in the heart.
• Shown in severe cases surgical treatment.

In severe cases, with arrhythmias, severe panic attacks, treatment is reinforced with beta blockers, which remove the effect of excitation sympathetic innervation(palpitations, shortness of breath) and soothe.

Treatment of mitral valve prolapse 2 tbsp. amenable to sanatorium treatment, general strengthening balne / physiotherapy is prescribed. With significant (70%) regurgitation, an operation to replace the mitral valve leaflet is indicated.

For prevention infectious lesions myocardium, one should resort to hardening the body and sanitation of foci of infection (caries, sinusitis, tonsillitis).

Physical activity does not increase valve gaping. But heavy exercise can exacerbate regurgitation and lead to the development of heart failure. school curriculum physical development do not limit, however, before mobilization, all parents ask the question: is it possible to join the army with mitral valve prolapse 2 tbsp. restrictions are determined individually after a thorough examination. The presence of PMK 1 and 2 tbsp. does not prevent military service.

Prolapse of the left atrioventricular valve: causes

An anomaly of the valve develops in people with asthenic physique, and is due to a congenital feature of the structure:

• Loose structure of connective tissue;
• Extension of valve chords;
• Weakness of papillary muscles.

Valve prolapse is a hereditary pathology and is often combined with tall, long limbs and narrow chest. The anomaly is not considered a pathology and does not require special treatment.

Mitral (left atrial) valve prolapse: acquired

Valve pathology develops with damage to the tissues of the valves or chords, as well as in violation of calcium absorption and fragility bone tissue. Damage occurs as a result of the following pathologies:

• myocardial infarction;
• Valve damage of a rheumatic nature;

Connective tissue diseases (lupus erythematosus, scleroderma);

• myocardial ischemia.

Valve prolapse accompanies hyperthyroidism, which is associated with impaired mineral metabolism.

Signs of pathology may not appear, but with a severe degree of MVP, conditions are created for the following symptoms:

• Dizziness due to lack of oxygen;
• Fainting when overheated;
• fatigue;
• Feeling short of breath.

Atrioventricular leaflet prolapse is often associated with autonomic dysfunction nervous system, the symptoms of which coincide with the manifestation of blood regurgitation through the mitral opening.

Symptoms are characterized by constancy, they are not associated with a change in body position and are accompanied by migraine attacks. Symptoms are especially pronounced with defects chest and violation of the structure of the musculoskeletal system.

Mitral valve prolapse stage 2: diagnosis

The diagnostic scheme consists of an examination, a thorough history taking (it is necessary to find out the presence of valve prolapse in the genus) and instrumental studies:

• When listening near the apex of the heart, a murmur is determined at the end of systole;
• Echocardiography (two-dimensional) - displacement of the valves 3 mm above the mitral annulus, as well as detachment of the chords, an increase in the size of the hole and the presence of regurgitation.

Small Criteria:

• Loud systolic murmur
• The displacement of the valves is not more than 3 mm;
• The electrocardiogram displays data that indicates the load of the left atrium, extrasystole.

Mitral valve prolapse: complications

Severe regurgitation leads to insufficiency of the mitral orifice, which entails an increase in the volume of regurgitation. With a compensated course, only the supervision of a cardiologist and compliance with the correct regimen are required.

Pregnancy is not contraindicated. A woman carries a healthy baby without complications. In congenital pathologies, prolapse in children is combined with pathology of skeletal development. Perhaps frequent colds, asthenia, weakness and fainting.

Article publication date: 01/14/2017

Article last updated: 12/18/2018

From this article, you will learn what tricuspid regurgitation is, its causes, symptoms and the choice of treatment (depending on the stage and form of the disease).

When happens incomplete closure tricuspid valve. In this condition, the patient has reversed blood flow from the right ventricle to the atrium.

The human circulatory system provides one-way blood flow. The blood from the ventricle to the atrium moves in one direction thanks to valves that close tightly with each contraction of the heart. If their incomplete closure occurs, then part of the blood returns to the ventricle (regurgitation).

The disease is treated by a cardiologist. The choice of method of therapy depends on the severity of the pathology. So, 1 degree does not need specific treatment, doctors recommend simply monitoring the patient's condition. Patients with grade 2 pathology undergo conservative treatment. And at degrees 3 and 4, it is possible to restore the work of the cardiovascular system only by surgical means.

Causes of the disease

This pathology occurs in two main forms:

1. Primary, the causes of which are such diseases: rheumatism, endocarditis (acute inflammation inner wall heart), myocardial infarction, fibrous plaque formation in cardiac tissues, and genetic predisposition.
2. Secondary. Such valve damage is observed due to its stretching in cardiomyopathy and, which increase the functional load on the right ventricle.

Characteristic symptoms

• The presence of visible pulsation of the cervical veins.
• Swelling of the blood vessels in the left side of the sternum and right hypochondrium.
• Progressive swelling of the soft tissues of the legs.
• Loss of efficiency and fatigue.
• Frequent feeling of "chillness".
• Feeling of rapid heartbeat.
• Frequent urination.
• Shortness of breath, which first disturbs the patient during physical exertion, and then is diagnosed at rest.
• Periodic bouts of abdominal pain.
• Yellow shade of the skin, which is combined with pain in the right hypochondrium.

The severity of the above symptoms depends on individual characteristics organism and degree of damage. So, for example, in a patient diagnosed with tricuspid regurgitation on initial stage missing pathological symptoms. A pronounced clinical picture, as a rule, is observed in the 3rd–4th phase of the disease, when radical intervention is required.

Four degrees of the disease

Diagnosis of the disease

Cardiac patients undergo the following diagnostic measures:

• Visual examination of the patient and listening to heart sounds with a phonendoscope.
• Ultrasound examination, which allows you to find out the condition of the heart tissue and valve.
• Electrocardiography. The method defines early signs enlargement of the right stomach and atrium.
• X-ray of organs chest cavity. Such a study determines violations in the valve system.
• Cardiac catheterization is an innovative minimally invasive procedure that is used to diagnose and treat cardiac diseases.

Treatment methods

In many cases, grade 1–2 tricuspid regurgitation does not require specific therapy, provided there is no comorbidity. internal organs and heart failure.

Treatment of patients in the initial stages is “supportive”, they are taking measures to eliminate high blood pressure. The patient must be under the supervision of a cardiologist.

Further progression of pathology heart valve considered a reason for conservative therapy. Doctors prescribe the following drugs to the patient:

• Diuretics. Diuretics for hypertension stimulate the excretion of salts and excess fluid from the body.
• Venous vasodilators. A decrease in tone and an increase in the lumen of blood vessels helps to lower blood pressure and improve blood circulation.
• ACE inhibitors. The action of drugs is aimed at inhibiting the function of an enzyme that converts angiotensin, which constricts blood vessels and provokes an increase in blood pressure.
• B-blockers. These medicines reduce the heart rate, eliminate hypertension and chronic heart failure.
• that have cardiotonic and antiarrhythmic effects.
• metabolic drugs. These drugs improve the transport of oxygen to all body tissues.
• Anticoagulants as a means of preventing thrombosis.

Tricuspid regurgitation in advanced stages (3 and 4) is treated surgically.

Surgical intervention

Patients perform the following operations:

Prognosis for the disease

Tricuspid regurgitation has a favorable prognosis only in the first degree of the disease. Such patients are full image life - valve operation does not change the function of the cardiovascular system.

In the second stage of the disease, the mortality of patients is associated with concomitant common diseases. These can be: myocardial infarction, chronic heart failure, inflammatory lung disease and thromboembolism.

Tricuspid regurgitation at stages 3–4 of the disease is characterized by an unfavorable prognosis. It requires surgical intervention. Medical statistics show that timely valve plasty increases the patient's life expectancy by 5 years or more. However, prosthetics biological material in 60% clinical cases extended life expectancy by 15 years.

Article publication date: 01/14/2017

Article last updated: 12/18/2018

From this article, you will learn what mitral regurgitation is, why it occurs, and what functions of the heart it disrupts. You will also get acquainted with the clinical manifestations and methods of treatment of this disease.

Mitral regurgitation occurs when blood flows back through the bicuspid (mitral) valve of the heart.

Occurring on average in 5 people out of 10 thousand, this valve ranks second in frequency, second only to.

Normally, blood flow always moves in one direction: from the atria through holes limited by dense connective tissue, it passes into the ventricles, and is ejected through the main arteries. The left half of the heart, in which the mitral valve is located, receives oxygenated blood from the lungs and transports it to the aorta, from where it is more small vessels blood enters the tissues, supplying them with oxygen and nutrients. When the ventricle contracts, hydrostatic pressure closes the valve leaflets. The amplitude of movement of the leaflets is limited by connective tissue threads - chords - which connect the valve leaflets with papillary, or papillary, muscles. Regurgitation occurs when the valve leaflets stop closing, allowing some of the blood back into the atrium.

Mitral regurgitation can be asymptomatic for a long time before the increased workload on the heart manifests itself with the first complaints of fatigue, shortness of breath, palpitations. Progressing, the process leads to chronic heart failure.

Only surgery can fix the defect. The cardiac surgeon either restores the shape and function of the valve leaflets or replaces it with a prosthesis.

Changes in hemodynamics (blood movement) in pathology

Due to the fact that part of the blood that has entered the left ventricle returns back to the atrium, a smaller volume goes into the vessels - a decrease in cardiac output. For supporting normal pressure blood vessels narrow, which increases the resistance to blood flow in peripheral tissues. According to the laws of hydrodynamics, blood, like any liquid, moves to where there is less resistance to flow, due to which the volume of regurgitation increases, and cardiac output decreases, despite the fact that in fact the volume of blood both in the atrium and in the ventricle increases, overloading the heart muscle .

If the elasticity of the atrium is low, the pressure in it increases relatively quickly, increasing, in turn, the pressure in the pulmonary vein, then the arteries, and causing manifestations of heart failure.

If the tissues of the atrium are pliable - this often happens when - the left atrium begins to stretch, compensating for excess pressure and volume, and then the ventricle also stretches. The chambers of the heart can double their volume before the first symptoms of the disease appear.

Causes of pathology

Function bicuspid valve violated:

• with direct damage to the valves (primary mitral regurgitation);
• with damage to the chords, papillary muscles or overstretching of the mitral ring (secondary, relative).

In terms of time, the disease can be:

1. Acute. It occurs suddenly, the cause is inflammation of the inner lining of the heart (endocarditis), acute infarction myocardium, blunt trauma hearts. The chords, papillary muscles, or the valve leaflets themselves are torn. Mortality reaches 90%.
2. Chronic. It develops slowly under the influence of a sluggish process:

• congenital anomalies of development or genetically determined pathologies of the connective tissue;
• inflammation of the endocardium of a non-infectious (rheumatism, systemic lupus erythematosus) or infectious (bacterial, fungal endocarditis) nature;
• structural changes: dysfunction of the papillary muscles, tears or ruptures of the chord, expansion of the mitral ring, cardiomyopathy that occurs with left ventricular hypertrophy.

Symptoms and Diagnosis

Mitral regurgitation of the 1st degree often does not manifest itself in any way, and the person remains practically healthy. Thus, this pathology is found in 1.8% of healthy children aged 3–18 years, which does not interfere with their future life at all.

The main symptoms of pathology:

• fast fatiguability;
• heartbeat;
• shortness of breath, first with exertion, then at rest;
• if the conduction of an impulse from the pacemaker is disturbed, it occurs;
• manifestations of chronic heart failure: edema, heaviness in the right hypochondrium and liver enlargement, ascites, hemoptysis.

Listening to the tones (sounds) of the heart, the doctor finds that the 1st tone (which normally occurs when the valve leaflets close between the ventricle and the atrium) is weakened or completely absent, the 2nd tone (normally appearing due to the simultaneous closing of the aortic valves and the pulmonary trunk) splits into aortic and pulmonary components (that is, these valves close asynchronously), and between them a so-called systolic murmur is heard. It is the systolic murmur that occurs due to the reverse flow of blood that gives reason to suspect mitral regurgitation, which is asymptomatic. In severe cases, a 3rd heart sound is added, which occurs when a large volume of blood quickly fills the walls of the ventricle, causing vibration.

The final diagnosis is made with Doppler echocardiography. Determine the approximate volume of regurgitation, the size of the chambers of the heart and the safety of their functions, the pressure in pulmonary artery. With echocardiography, mitral valve prolapse (sagging) can also be seen, but its degree does not affect the volume of regurgitation in any way, therefore it is not important for further prognosis.

Degrees of mitral regurgitation

Most often, the severity of mitral regurgitation is determined by the area of ​​the reverse flow visible on echocardiography:

1. Mitral regurgitation of the 1st degree - the area of ​​\u200b\u200bthe reverse flow is less than 4 cm 2, or enters the left atrium by more than 2 cm.
2. At grade 2, the area of ​​the reverse flow is 4–8 cm 2, or it reaches half the length of the atrium.
3. With a degree - the flow area is more than 8 cm 2 or goes beyond half the length, but does not reach the atrial wall opposite the valve.
4. At 4 degrees - the flow reaches rear wall atrium, atrial appendage, or enters the pulmonary vein.

Treatment of mitral regurgitation

Mitral regurgitation is treated promptly: either by making the valve plastic, or by replacing it with a prosthesis - the technique is determined by the cardiac surgeon.

The patient is prepared for surgery either after they develop symptoms or if the examination reveals that left ventricular function is impaired, atrial fibrillation has occurred, or pressure in the pulmonary artery has risen.

If a general state the patient does not allow the operation, start drug treatment:

• nitrates - to improve blood flow in the heart muscle;
• diuretics - to remove swelling;
• ACE inhibitors - to compensate for heart failure and normalize blood pressure;
• cardiac glycosides - used in atrial fibrillation to equalize the heart rhythm;
• anticoagulants - prevention of thrombus formation in atrial fibrillation.

Ideally, the goal of conservative therapy is to improve the patient's condition so that it becomes possible to operate on him.

If the pathology has developed acutely, an emergency operation is performed.

If mitral regurgitation was detected during a preventive examination, its volume is small, and the patient himself does not complain about anything, the cardiologist puts him under observation, re-examining once a year. The person is warned that if his health changes, you need to visit a doctor outside the schedule.

In the same way, “asymptomatic” patients are monitored, waiting for either symptoms to appear or the functional disorders mentioned above - indications for surgery.

Forecast

Chronic mitral regurgitation develops slowly and remains compensated for a long time. The prognosis sharply worsens with the development of chronic heart failure. Without surgery, the six-year survival rate in men is 37.4%, in women - 44.9%. In general, the prognosis is more favorable for mitral insufficiency of rheumatic origin compared with ischemic.

If mitral insufficiency appeared acutely, the prognosis is extremely unfavorable.

How dangerous is grade 2 mitral valve prolapse? Is there any special treatment needed? To understand this, let us turn to the basic terminology of pathologists, its causes and manifestations. Prolapse can result in progressive heart failure, arrhythmias, and endocarditis.

It is worth immediately clarifying that prolapse is no longer defined as a disease, but as a clinical and anatomical syndrome. Its course is often benign, without progression. The stability of the condition can be observed throughout the life of the patient.

Basic concepts

The mitral valve consists of two connective tissue plates (cusps) located between the left atrium and the left ventricle. Its task is to monitor blood regurgitation (backflow) during ventricular contraction. The valve leaflets - anterior and posterior - are located so that during the work of the heart muscle, they provide arterial blood exchange between the atrium and the ventricle and prevent reverse flow.

Prolapse (from the Latin "prolapse") is defined as a protrusion of an organ or part of it. In the case of the mitral valve, its cusps sag into the cavity of the left atrium, which in turn is a violation of the structure of the organ.

Mitral (left or bicuspid) valve prolapse (MLV) is a dysfunction of the mitral valve.

Causes of the disorder

Deflection of the valve leaflets can be congenital or acquired. It can occur in isolation or in parallel with any heart disease, as well as other connective tissue defects.

In the first case, the main causes of the anomaly have not yet been fully elucidated. It has only been unequivocally established that PMK is inherited. Most likely, the anomaly is caused by a congenital defect of the connective tissue, from which the valvular apparatus is formed. Appear additional chords or incorrect attachments.

People with a congenital anomaly are tall, thin, with long limbs - a risk group. In the absence of progressive changes, prolapse is not considered by them as a pathology that requires treatment. They continue to live as they lived.

Sometimes the disease develops against the background of congenital hyperthyroidism and osteogenesis imperfecta.

The acquired syndrome can become for several reasons: from a number of heart diseases to post-traumatic disorder organ (trauma in the chest area).

Classification

As mentioned above, the anomaly ends with regurgitation, the degree of MVP depends on the intensity of reverse blood flow. There are three in total.

1. The valve deflection is small, 3-6 mm. The reverse blood flow is weak, which does not lead to the development of a serious pathology associated with circulatory disorders. Symptoms are mild. PMK of the 1st degree does not cause significant harm to the patient's health. Special treatment is not provided. Nevertheless, it is recommended to be observed by a cardiologist. Preventive measures there will be non-power sports, aerobics, gymnastics, physical education. Exercises on simulators are selected only after consultation with a doctor.
2. Valve deflection 6-9 mm. Here it is already recommended not only to be observed by a doctor, but also to undergo symptomatic drug treatment. Regarding the quality of physical activity, you should consult a cardiologist.
3. The sash deflection is more than 9 mm. An anomaly can lead to serious changes in the structure of the heart and the functioning of the cardiovascular system. It provides for surgical treatment for suturing the leaflets or prosthetics of the mitral valve. Exercise therapy exercises are selected by the attending physician.

The anomaly is also distinguished by the time of occurrence: early and late prolapse. They are also classified by origin: primary and secondary (or congenital and acquired, as already mentioned).

Symptoms

Many patients are not even aware that they have MVP until they pass. special survey(when diagnosing other diseases). Stages 1 and 2 are almost asymptomatic. Sometimes a person may complain of pain in the heart area. This is especially true during emotional stress.

The nature of pain in the heart is non-aggressive, but prolonged. There is a feeling of anxiety and palpitations. Interruptions in the work of the body are possible.

In the third degree of MVP, the following symptoms are observed:

• weakness and general malaise;
• constant temperature at the level of 37-37.5 degrees;
• hyperhidrosis;
• headaches in the morning and evening;
• feeling of lack of air;
• heart pain does not go away even after taking the medicine;
• stable arrhythmia develops;
• murmurs appear in the heart (detected during hardware listening to the organ).

The intensity of the abnormal reverse blood flow is well diagnosed by dopplerography.

Therapeutic measures

If the anomaly does not manifest itself in any way, then the person is unlikely to need treatment. Observed patients should follow the following instructions:

• compliance day mode, healthy sleep;
• active image life, proper physical activity;
• regular examination by a cardiologist.

If signs of dystonia are found, the patient is prescribed a sedative. Drug treatment is also provided for developing arrhythmia and mitral insufficiency. The drugs will not correct the defect of the valve, but will help ease the manifestation.

Radical measures are applicable with pronounced mitral valve insufficiency, that is, with grade 3 MVP. Having even a 2 degree defect, the body is more susceptible to various infections and viral diseases. In this case, treatment should be aimed at combating the focus of the spread of infection.

The presence of a defect in the mitral valve leaflets is a non-fatal anatomical violation of the structure of the heart. People with a congenital anomaly can live their entire lives without even knowing they have left valve prolapse. If PMK is diagnosed, then it is worth following the recommendations of doctors in order not to have health problems in the future. The right treatment and preventive approach - and that's it! Important: any appointment in this case is the prerogative of a specialist!

With MVP at the stage of LV systole, the valve leaflets bend into the cavity of the left ventricle.

Normally, at the stage of atrial systole, the leaflets of the mitral valve are in the open state.

When left ventricular systole occurs, the valve halves close, thereby pushing blood out of the ventricle into the aorta.

Due to the fact that the valve leaflets are in a state of prolapse, part of the blood returns back to the atrium.

AT modern medicine Classification of RMC is practiced according to its severity:

• 1 degree - mitral regurgitation 1 tbsp. considered insignificant and is the norm. It can be found in both young and old people. For diagnosis, the simplest method is used - auscultation. As a rule, in this situation, the pathology does not require special treatment. It is enough that the patient will be examined by specialists several times during the year. This is necessary in order to avoid the possibility of developing concomitant diseases or any complications;
• Grade 2 - moderate MR - is characterized by the development of circulatory disorders, as well as heart contraction. It is possible to diagnose the pathology of this severity through the use of examination methods such as an electrocardiogram or an electrophysiological examination of the heart and system. When listening to the contraction of the patient's heart, specialists have the opportunity to hear a specific click that is formed during the stay of the heart in the systole phase;
• Grade 3 - regurgitation of this severity is considered the most difficult and dangerous. Among the symptoms that may occur in patients, one can single out the presence of edema of the upper and lower extremities, an increase in liver volume, and a significant increase in venous pressure. Patients diagnosed with RMK 3 tbsp. receive a disability of 1 group.

I would also like to note that regurgitation of the MC of the 2nd degree is classified due to its development into the following groups:

1. Primary. The main reason for its development is violations of the structure of the connective tissue, which Negative influence on the leaflets of the mitral valve. These disorders develop during the period of intrauterine development of the child. As a result of such violations, the valve becomes more elastic and pliable.
2. Secondary. This defect develops as a result of myocardial dystrophy, which has a rheumatic origin. Often the cause of secondary regurgitation of the 2nd degree is also mechanical damage to the integrity of the chest, which entails a violation of the integrity of the heart.

Maximum precise definition the degree of regurgitation and the causes of its origin will help to choose an effective method of treatment.

Causes and consequences

I would also like to note that it can have a chronic or sharp shape. This is facilitated by the following factors:

• violation of the functioning or structure of the papillary muscles of the myocardium;
• damage to the endoderm of the heart wall caused by the development of infection (endocarditis);
• an increase in the volume of the left ventricle;
• mechanical damage to the mitral valve;
• ischemic disease hearts;
• the development of rheumatism in the patient, which leads to myocardial damage.

Often, grade 2 MK regurgitation can be diagnosed in a newborn. This is due to such reasons:

• development of myocardial inflammation;
• proteins accumulate in the area near the heart valve or on the inside of the shell of the heart;
• congenital heart disease.

In the case of diagnosing RCC of the second degree in patients, the likelihood of complications increases:

This degree of regurgitation is one of the main causes of GM stroke in those patients who are 40 years of age or older.

It is also worth noting that a change in the structure of the mitral valve cusps can become a site for the formation of blood clots (which in turn leads to the development of thromboembolism of the cerebral vessels), an increase in the volume of the left atrial cavity, atrial fibrillation, a change in the structure of blood cells that are responsible for the coagulation process.

With age, the likelihood of complications increases.

Approximately 15 - 40% of patients with age, the intensity and frequency of manifestation of symptoms of pathology increases. In patients, there is a transformation of the RMC of the 2nd degree into a more significant and dangerous disease of cardio-vascular system.

However, regurgitation 2 tbsp. does not always lead to complications. As a rule, this is typical for 60% of cases.

If any symptoms characteristic of mitral valve regurgitation stage 2 are detected, you should immediately contact a specialist for a thorough examination. This is necessary in order to exclude the presence of a more serious concomitant disease or development of complications.

🔻🔻Symptoms and signs of mitral valve regurgitation stage 1 and 2

To define the concept of "applied mitral regurgitation" it is necessary to recall the anatomical features of the valvular apparatus. It consists of two valves and communicates with each other the left-sided sections of the heart muscle.

At the moment of atrial contraction, blood is ejected into the ventricle, after which the valves of the valvular apparatus close tightly. This happens normally, with the development of a pathological deviation, their loose closure is observed, against the background of which there is a reverse reflux of blood into the atrium.

Symptoms and signs of mitral valve regurgitation

Experts divide the disease into two main forms - acute and chronic.

Symptomatic manifestations acute course diseases resemble signs of a developing cardiogenic shock or insufficient functionality of the heart muscle. Mitral valve regurgitation chronic course initially does not have bright signs and is asymptomatic.

Clinical manifestations increase gradually:

• as the volume of the left ventricle increases;
• gradual increase in pulmonary pressure;
• changes in the structure of the left ventricle.

Symptomatic features are detected with a moderate or severe degree of damage:

• rapid fatigue, regardless of the level of physical activity;
• rapid contraction of the heart muscle;
• the occurrence of insufficient air intake - shortness of breath, which appears both during exertion and in a state of absolute rest;
• if the impulse conduction is disturbed, ventricular fibrillation is recorded;
• puffiness;
• feeling of heaviness in the right hypochondrium;
• enlarged liver;
• coughing up blood particles;
• ascites is the accumulation of fluid in abdominal cavity.

Mitral valve regurgitation grade 1

The initial stage of the pathological condition is characterized by a gradual increase symptomatic manifestations or their sudden onset. Typical signs illnesses are:

• a state of persistent physical fatigue;
• frequent, shallow breathing;
• accelerated heartbeat;
• shortness of breath;
• increased urge to empty the bladder;
• occasional cough.

During a physical examination, the cardiologist notes in the patient:

• murmurs in the heart muscle;
• characteristic sounds in the pulmonary region, resembling crackling;
• vibrations in the supracardiac region;
• signs of right-sided insufficiency in the work of the heart muscle - swelling of the veins cervical region, swelling of the lower extremities, an increase in the volume of the liver.

Mitral valve regurgitation of the first degree is characterized by a reverse deflection of the leaflets at a distance of not more than 6 mm. The recurrent blood flow in pathology is insignificant, the general condition of the patient is assessed as "satisfactory".

Mitral valve regurgitation grade 2

This degree of damage is characterized by the reflux of large volumes of blood reaching the middle of the atrium. If the refund amount exceeds one fourth of general indicators, then stagnation develops in pulmonary circle circulatory systems. negative state fixed in the presence of the following symptoms:

• pain in the chest, especially in the region of the heart;
• feeling of insufficient intake of air and tightness in the chest;
• rapid, shallow breathing;
• unstable work of the heart muscle - intermittently;
• persistent fatigue;
• a state of lethargy and apathy;
• periodic short-term loss of consciousness.

Incorrect functionality of the tricuspid valve is recorded in babies even before birth - during the standard ultrasound. A pathological condition can form in the primary stages of pregnancy - up to 13 weeks.

In most cases, the abnormal condition occurs in infants with a variety of chromosomal abnormalities, including Down syndrome. A certain percentage of the disease can be fixed in a fetus with absolute health and standard development.

The average data of pediatric cardiology report a rapidly growing rate of this anomaly in various age periods. The first degree of pathological deviation in modern medicine began to refer to conditional standards.

In the absence of other lesions of the cardiovascular department in babies, there is high probability in spontaneous restoration of the functionality of the valve apparatus. With the transition of the disease to more complex stages, there is a risk of insufficient functionality of the heart muscle and impaired performance of the right ventricle.

Such children are registered with a cardiologist, and must undergo preventive examinations every six months. The main goal of prevention is to prevent the transition of the disease to new levels.

Upon initial contact with medical institution, the patient is directed to diagnostic tests. Examinations are necessary to determine the degree and severity of the development of a pathological deviation and to establish concomitant diseases of the cardiovascular department.

Diagnostics helps to identify the root causes of the development of the disease, the main factors for the appearance of which are:

• functionality or mechanical damage papillary muscles;
• infectious lesions of the inner wall of the heart - endocarditis;
• mitral valve disorders;
• a sharp increase in the cavity of the left ventricle;
• ischemic lesions;
• rheumatoid inflammation.

In newborns, pathology is diagnosed under the influence of:

• processes of inflammation in the heart muscle - myocarditis;
• with the accumulation of protein elements in inner layers the heart membrane and the area next to the valves;
• with congenital malformations of the mitral valve.

Research is carried out using:

1. X-rays of the chest - they will show changes in the size of the left sections of the heart muscle. In advanced variants of the disease, the whole heart undergoes an increase.
2. ECG - refers to uninformative options, practically not prescribed.
3. Echocardiography - to determine exact dimensions valvular gap when the valves close. With the help of the technique, the magnitude of the backflow of blood, the root cause of the formation of a pathological deviation - prolapse, partial ruptures of the muscles of the valvular apparatus, and other destructive changes are determined.
4. Transesophageal echocardiography - is prescribed in especially severe cases. Allows you to determine the presence of calcification, ischemic damage to the myocardium and fibrotic changes in valvular tissue.
5. Dopplerography is a technique designed to assess the magnitude and speed of blood flow. Shows a complete picture of blood circulation in the entire vascular bed.

After receiving all these analyzes, the specialist makes the final diagnosis and prescribes the necessary symptomatic treatment.

Treatment of the disease

The initial forms of the pathological process are detected by chance, at the time of the patient's preventive examinations. specific therapy there are no degrees for these degrees, the patient is prescribed a periodic preventive examination, in order to be able to monitor the dynamics of the development of the disease.

Medical treatment is prescribed in serious cases- to stop negative symptomatic manifestations and suppress the root causes of the formation of the disease. to the main groups medicines relate:

• antibacterial agents - necessary to suppress the further development of the infectious process;
• anticoagulants - prevent the formation of blood clots that occur against the background of failures in the process of hemodynamics;
• diuretics - reduce additional loads from the heart muscle, remove excess accumulated fluid in the body, are used to reduce the level of tissue swelling;
• beta-blockers - help to reduce the frequency of contractions of the heart muscle and myocardial oxygen demand.

Surgical manipulations are used in extreme cases - with advanced forms of pathological deviation. Their main goal is the process of restoration or prosthetics of the damaged valvular apparatus.

The appointment of the operation occurs until the development of the phase of ventricular decompensation. After a successful intervention, the patient's heart functionality stabilizes, hemodynamic disturbances disappear, and negative symptoms are suppressed.

Recovery prognosis

The primary stages of the lesion give a favorable prognosis. With systemic examinations and the implementation of all recommendations of specialists, the general condition of the patient is assessed as stable-satisfactory.

Severe lesions can lead to the development various complications if not promptly detected and treated. In severe cases, valvular insufficiency can lead to disability.

Prevention of pathology

To prevent the development of the disease, experts recommend:

• contact a medical institution in a timely manner when primary symptomatic manifestations appear;
• to the end to cure all existing diseases;
• undergo preventive examinations by a cardiologist at least once every six months.

The pathological condition does not pose a serious danger until it progresses to new levels. Careful attention to your own health will help to avoid illness.

Mitral valve regurgitation grade 2

Features of mitral valve prolapse 2 degrees

The mitral valve of the heart, consisting of anterior and posterior leaflets, separates the left ventricle from the left atrium. When the ventricle contracts, the cusps close completely, preventing backflow of blood. One of the most frequent pathologies mitral valve is a prolapse, or sagging of one of the valves towards the left atrium. The anterior is affected more often than the posterior, but a defect in both is also possible. As a result, part of the blood through the hole formed returns back to the left atrium. Mitral valve prolapse is not a disease, but a clinical and anatomical syndrome.

There are several criteria by which different types anomalies. One of them is the degree of bulging of the valves. If they protrude by 6-9 mm, then this is grade 2 mitral valve prolapse. Its course is most often benign, without progression. The patient's condition often remains stable throughout life.

Usually, grade 2 prolapse is detected during an ultrasound of the heart. In addition to the degree of valve prolapse, it is also necessary to determine the degree of regurgitation (backflow of blood). This indicator is more important because it determines the state of a person. The level of blood return has a separate classification, since it does not always correspond to the level of bulging of the valves. There are three degrees of regurgitation:

1. 1 degree - the jet reaches the valves;
2. Grade 2 - blood reaches the middle of the atrium;
3. Grade 3 - the jet reaches the other side of the atrium.

The level of regurgitation cannot be detected by electrocardiography. Diagnosis is usually made by auscultation of the heart for systolic murmurs and echocardiography. As a rule, disturbances in the work of the heart occur with regurgitation above the second degree.

Prolapse of the 2nd degree is congenital or acquired. It can be isolated or combined with other heart diseases or connective tissue defects.

The causes of congenital anomalies have not been elucidated. It is believed that this is due to the connective tissue that is weak from birth, from which the valvular apparatus is formed. At the same time, the structure of the papillary muscles changes, additional chords appear, their length changes, and their attachment may be incorrect. It is known that MVP is inherited.

As a rule, people with this defect are tall, thin, with long limbs. Congenital prolapse of the 2nd degree is usually not considered a disease, has a favorable course and, in the absence of severe symptoms does not require treatment.

Acquired mitral valve prolapse can develop in diseases such as myocardial infarction, acute rheumatic fever, ischemic heart disease, systemic lupus erythematosus. Another reason is chest trauma.

Mitral valve prolapse is often observed in congenital bone fragility and hyperthyroidism.

Mitral valve prolapse grade 2

Grade 2 prolapse may be asymptomatic with little or no regurgitation. If there is a second degree of regurgitation and above, then the following symptoms are possible:

• Pain in the chest in the region of the heart.
• Inability to take a full breath, feeling of lack of air.
• Frequent heartbeat alternates with rare.
• General weakness.
• Dyspnea.
• Headaches that go away after walking.
• Dizziness, sometimes fainting.

Chest pains are usually short-term, aching, dull. They do not depend on physical work. In some patients with grade 2 regurgitation, not heart pain, but muscle pain predominates. Dyspnea, panic attacks, mood swings are usually associated with nervous diseases. Headaches are like migraines. With dizziness, pre-fainting conditions may appear. With pathologies such as flat feet and scoliosis, symptoms may worsen.

In the absence of symptoms and complaints, special treatment may not be required. Although it is recommended to adhere to the following rules:

• It is necessary to observe the regime of the day. Getting enough sleep is especially important.
• Dosed physical activity, an active lifestyle are shown. Sports with sudden movements should be avoided: jumping, running, boxing.
• It is recommended to visit a cardiologist for examination every 3 years if there are no symptoms and there is no mitral insufficiency.

In the presence of symptoms of vegetative-vascular dystonia, various sedatives are prescribed:

In some cases, for example, with the development of arrhythmia or mitral insufficiency, drug treatment may be required. It should be said that drug therapy will not fix a valve defect, but may relieve symptoms. Beta-blockers and anticoagulants are prescribed. The drugs eliminate chest pain, normalize heart rate, relieve palpitations, and relieve anxiety.

With mitral valve prolapse, physiotherapy and balneological treatment may be indicated. Massage and water procedures have a good effect on the patient.

With prolapse with severe insufficiency mitral valve surgery may be indicated. It consists in replacing the damaged valve with an artificial one or in its reconstruction.

With grade 2 mitral valve prolapse, the heart becomes more vulnerable, for example, it becomes susceptible to infections. Therefore, the development of infective endocarditis is not excluded. Tonsillitis, sinusitis, carious lesions of the teeth should be treated in a timely manner to prevent the spread of infection.

Complications

Prolapse of the second degree rarely gives complications. Most common complication This pathology is mitral valve insufficiency. More often it happens with a significant deformation of the valvular apparatus and severe regurgitation.

Pregnancy with prolapse 2 degrees

With this diagnosis, pregnancy is possible in the absence of symptoms. As a rule, in this case, pregnancy and childbirth pass without any complications. Throughout the entire period of gestation, a woman should be observed by a cardiologist in order to avoid adverse effects on the fetus.

Prolapse 2 degrees in children

Children with congenital bulging mitral valve leaflets may have the following pathologies:

• hip dysplasia;
• scoliosis;
• flat feet;
• strabismus;
• nephroptosis;
• varicocele;
• umbilical and inguinal hernias.

Children with secondary mitral valve prolapse of the second degree in autumn and winter often catch colds in autumn and winter, constantly suffer from tonsillitis. They may experience weakness and dizziness, get tired quickly, have shortness of breath, and sometimes faint. Children become overly vulnerable and irritable, quickly excited, become discouraged. This condition requires the intervention of a cardiologist.

Prolapse 2 degrees and military service

In most cases, this anomaly is not a contraindication for military service. Suitability for service is determined not by the degree of valve deflection, but by the functionality of the valve apparatus, that is, by the amount of blood that it passes back into the left atrium. If a young man has second-degree mitral valve prolapse without blood return or with first-degree regurgitation, then he is not exempt from the army. The usual contraindication is grade 2 prolapse with regurgitation above grade 2. A young person with grade 2 prolapse may be unfit for service in the presence of conditions such as impaired conduction, arrhythmias, and others.

Mitral regurgitation: degrees, causes and treatment

Mitral regurgitation is a dysfunction of the mitral valve leaflets. The mitral valve is located between the left ventricle and the left atrium. When the left atrium contracts, blood enters the ventricle. After that, the left atrium is blocked by the mitral valve, and blood from the left ventricle enters the aorta.

If the mitral valve does not provide complete blockage, its walls do not contract enough and begin to sag, this leads to reverse process- flow of blood from the left ventricle into the left atrium. This process leads to circulatory disorders. The cardiovascular system slows down the process of pumping blood. The pressure begins to fall, which causes a shortage of oxygen supplied to organs and tissues.

Mitral regurgitation can develop against the background of congenital or acquired pathologies.

Causes of birth defects:

• hereditary pathology;
• failure in the formation of the heart during fetal development;
• mitral valve deformity.

Causes of acquired pathology:

• rheumatism;
• systemic lupus erythematosus;
• infective endocarditis;
• myocardial infarction;
• chest trauma.

Classification

Depending on the volume of blood backflow in case of malfunction of the mitral valve, several degrees of pathology are distinguished:

1. Mitral regurgitation of the 1st degree is accompanied by a countercurrent, with a volume of not more than 25%. Pathological deviation in the initial stage, it may not manifest itself in any way, since the patient does not experience any complaints. The ECG does not reveal any abnormalities in the operation of the valve. To identify the pathology of the 1st degree is possible only with the help of dopplerography.
2. Mitral regurgitation of the 2nd degree is a more serious pathology. The backflow volume reaches 50%, which is the cause of the resulting pulmonary hypertension. This condition can lead to secondary changes in the heart muscle. ECG reveals abnormalities due to the expansion of the boundaries of the heart. Medical treatment is needed.
3. With pathology of the 3rd degree, the reverse flow of blood from one chamber to another reaches 90%. Secondary myocardial changes are added in the form of left ventricular hypertrophy. There is a displacement of the boundaries of the heart in left side. Changes are clearly shown on the ECG.
4. Mitral regurgitation of the 4th degree is a severe form that can lead to a complete loss of performance. Treatment with medicines is not effective, surgery is required.

According to the clinical course, mitral valve regurgitation is divided into acute and chronic. In the first case, the changes are sudden. The chronic form is accompanied by a gradual increase in valve regurgitation.

With regurgitation of the 1st degree, the pathology has no pronounced signs. This condition can last up to several years.

For grade 2, the following symptoms are characteristic:

At grade 3, there is:

Grade 4 is characterized by the occurrence of atrial fibrillation and heart failure.

Diagnostics

Mitral regurgitation is diagnosed with an ultrasound of the heart. In some cases, dopplerography is used, with the help of which the degree of pathology is determined.

ECHO-KG is also performed to determine the cause of regurgitation.

Ancillary studies are carried out:

At preoperative preparation ordered coronary angiography. This examination is also carried out in case of suspicion of the ischemic nature of the pathology that has arisen. Treatment is prescribed by a doctor after an appropriate diagnosis.

Medical measures

medical mild treatment asymptomatic forms of pathology are not required.

At 2 stages of defect appoint:

Treatment with indirect anticoagulants is appropriate for the development of atrial fibrillation.

At 3-4 degrees, treatment with medicines is impractical, surgical intervention is required.

Progression of pathology occurs only in 5 - 10 patients out of 100. The minimum risk group has a prognosis of 80% five-year survival and 60% - ten years.

With an ischemic nature, the clinical picture is less favorable: severe violation circulation, which reduces survival and worsens the prognosis.

Patients with mitral regurgitation of any degree should be regularly examined by a cardiologist, cardiac surgeon and rheumatologist to assess the stage of development of the pathology.

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Regurgitation of the heart valves: symptoms, degrees, diagnosis, treatment

The term "regurgitation" is quite often found in the everyday life of doctors of various specialties - cardiologists, therapists, functional diagnosticians. Many patients have heard it more than once, but they have little idea what it means and what it threatens. Should I be afraid of the presence of regurgitation and how to treat it, what consequences to expect and how to identify? We will try to find out these and many other questions.

Regurgitation is nothing more than the reverse flow of blood from one chamber of the heart to another. In other words, during the contraction of the heart muscle, a certain volume of blood various reasons returns to the cavity of the heart from which it came. Regurgitation is not an independent disease and therefore is not considered a diagnosis, but it characterizes other pathological conditions and changes (heart defects, for example).

Since blood is constantly moving from one part of the heart to another, coming from the vessels of the lungs and leaving for the systemic circulation, the term "regurgitation" is applicable to all four valves, on which reverse current may occur. Depending on the volume of blood that comes back, it is customary to distinguish the degrees of regurgitation that determine the clinical manifestations of this phenomenon.

A detailed description of regurgitation, the allocation of its degrees and detection in a large number people became possible with the use of ultrasound examination of the heart (echocardiography), although the concept itself has been known for a long time. Auscultation of the heart provides subjective information, and therefore does not allow judging the severity of blood return, while the presence of regurgitation is beyond doubt, except in severe cases. The use of Doppler ultrasound makes it possible to see in real time the contraction of the heart, how the valve flaps move and where the blood stream rushes.

Briefly about anatomy ...

In order to better understand the essence of regurgitation, it is necessary to recall some moments of the structure of the heart, which most of us have safely forgotten, having once studied at school in biology lessons.

The heart is a hollow muscular organ with four chambers (two atria and two ventricles). Between the chambers of the heart and the vascular bed are valves that act as a "gate" that allows blood to flow in only one direction. This mechanism ensures adequate blood flow from one circle to another due to the rhythmic contraction of the heart muscle, which pushes blood inside the heart and into the vessels.

The mitral valve is located between the left atrium and ventricle and consists of two leaflets. Since the left half of the heart is the most functionally burdened, it works with a heavy load and under high pressure, then often it is here that various failures occur and pathological changes, and the mitral valve is often involved in this process.

The tricuspid or tricuspid valve lies on the path from the right atrium to the right ventricle. It is already clear from its name that anatomically it represents three interlocking valves. Most often, its defeat is secondary in the already existing pathology of the left heart.

The valves of the pulmonary artery and the aorta carry three cusps each and are located at the junctions of these vessels with the cavities of the heart. The aortic valve is located on the path of blood flow from the left ventricle to the aorta, the pulmonary artery - from the right ventricle to the pulmonary trunk.

At normal condition valvular apparatus and myocardium at the moment of contraction of one or another cavity, the valve flaps tightly close, preventing the reverse flow of blood. With a variety of heart lesions, this mechanism can be disturbed.

Sometimes in the literature and in the conclusions of doctors, one can find a mention of the so-called physiological regurgitation, which means a slight change in blood flow in the valve leaflets. In fact, in this case, there is a “swirl” of blood at the valve opening, while the cusps and myocardium are quite healthy. This change does not affect the circulation in general and does not cause clinical manifestations.

Physiological can be considered regurgitation of 0-1 degree on the tricuspid valve, in the mitral cusps, which is often diagnosed in lean tall people, and according to some data, 70% have healthy people. This feature of the blood flow in the heart in no way affects the well-being and can be detected by chance during examination for other diseases.

As a rule, the pathological reverse flow of blood through the valves occurs when their valves do not close tightly at the time of myocardial contraction. The reasons may be not only damage to the leaflets themselves, but also papillary muscles, tendon chords involved in the mechanism of valve movement, stretching of the valve ring, pathology of the myocardium itself.

mitral regurgitation

Mitral regurgitation is clearly observed with valve insufficiency or prolapse. At the moment of contraction of the left ventricular muscle, a certain volume of blood returns to the left atrium through an insufficiently closed mitral valve (MV). At the same moment, the left atrium fills with blood flowing from the lungs through the pulmonary veins. This overfilling of the atrium with excess blood leads to overdistension and increased pressure (volume overload). During atrial contraction, excess blood enters the left ventricle, which is forced to greater strength push out large quantity blood into the aorta, causing it to thicken and then widen (dilation).

For some time, violations of intracardiac hemodynamics may remain invisible to the patient, since the heart, as best it can, compensates for blood flow due to the expansion and hypertrophy of its cavities.

With mitral regurgitation of the 1st degree Clinical signs it's missing long years, and with a significant amount of blood returning to the atrium, it expands, the pulmonary veins overflow with excess blood and signs of pulmonary hypertension appear.

Among the causes of mitral insufficiency, which is the second acquired heart disease in frequency after changes in the aortic valve, one can single out:

• Rheumatism;
• Prolapse;
• Atherosclerosis. deposition of calcium salts on the valves of the MC;
• Some connective tissue diseases, autoimmune processes, metabolic disorders(Marfan syndrome, rheumatoid arthritis, amyloidosis);
• Ischemic heart disease (especially heart attack with damage to the papillary muscles and tendon chords).

With mitral regurgitation of the 1st degree, the only sign may be the presence of noise in the region of the apex of the heart, detected by auscultation, while the patient does not complain, and there are no manifestations of circulatory disorders. Echocardiography (ultrasound) can detect a slight divergence of the valves with minimal disturbances in blood flow.

Mitral valve regurgitation of the 2nd degree accompanies a more pronounced degree of insufficiency. and the stream of blood returning back to the atrium reaches its middle. If the amount of blood return exceeds a quarter of its total amount in the cavity of the left ventricle, then signs of stagnation in a small circle and characteristic symptoms are found.

The degree of regurgitation is said to be when, in the case of significant defects in the mitral valve, the blood flowing back reaches the posterior wall of the left atrium.

When the myocardium cannot cope with the excess volume of contents in the cavities, pulmonary hypertension develops, leading, in turn, to an overload of the right half of the heart, resulting in circulatory failure in a large circle.

With 4 degrees of regurgitation characteristic symptoms pronounced violations blood flow inside the heart and increased pressure in the pulmonary circulation are shortness of breath, arrhythmias, possible occurrence of cardiac asthma, and even pulmonary edema. AT advanced cases heart failure to signs of damage pulmonary blood flow puffiness, cyanosis of the skin, weakness, fatigue, a tendency to arrhythmias (atrial fibrillation), pain in the heart join. In many ways, the manifestations of severe mitral regurgitation are determined by the disease that led to damage to the valve or myocardium.

Separately, it should be said about mitral valve prolapse (MVP), which is often accompanied by regurgitation varying degrees. Prolapse in last years began to appear in diagnoses, although earlier such a concept was quite rare. In many respects, this state of affairs is associated with the advent of imaging methods - ultrasound examination of the heart, which allows you to trace the movement of the valves of the MV during heart contractions. With the use of Doppler, it became possible to establish the exact degree of blood return to the left atrium.

MVP is typical for tall, thin people, often found in adolescents by chance during examination before being drafted into the army or passing other medical examinations. Most often, this phenomenon is not accompanied by any violations and does not affect the lifestyle and well-being in any way, so you should not be scared right away.

Mitral valve prolapse with regurgitation is not always detected, its degree in most cases is limited to the first or even zero, but at the same time, such a feature of the functioning of the heart may be accompanied by extrasystole and conduction disturbances nerve impulses by myocardium.

In case of detection of MVP of small degrees, one can limit oneself to the observation of a cardiologist, and treatment is not required at all.

Aortic regurgitation

Reverse blood flow to aortic valve occurs when it is deficient or damaged initial department aorta, when in the presence inflammatory process its lumen and the diameter of the valve ring expand. Most common causes such changes are considered:

• Rheumatic affection;
• Infective endocarditis with leaflet inflammation, perforation;
• Congenital malformations;
• Inflammatory processes ascending department aorta (syphilis, aortitis in rheumatoid arthritis, ankylosing spondylitis, etc.).

Such common and well-known diseases as arterial hypertension and atherosclerosis can also lead to changes in the valve leaflets, aorta, and left ventricle of the heart.

Aortic regurgitation is accompanied by a return of blood to the left ventricle, which overflows with excess volume, while the amount of blood entering the aorta and further into the systemic circulation may decrease. The heart, trying to compensate for the lack of blood flow and pushing excess blood into the aorta, increases in volume. For a long time, especially with regurgitation 1 tbsp. such an adaptive mechanism allows you to maintain normal hemodynamics, and symptoms of disorders do not occur for many years.

As the mass of the left ventricle increases, so does its need for oxygen and nutrients, which it cannot provide. coronary arteries. In addition, the number arterial blood, pushed into the aorta, becomes less and less, and, therefore, it will not come enough to the vessels of the heart. All this creates the prerequisites for hypoxia and ischemia, resulting in cardiosclerosis (proliferation of connective tissue).

With the progression of aortic regurgitation, the load on the left half of the heart reaches its maximum degree, the myocardial wall cannot hypertrophy indefinitely and it is stretched. In the future, events develop in the same way as with damage to the mitral valve (pulmonary hypertension, stagnation in the small and large circles, heart failure).

Patients may complain of palpitations, shortness of breath, weakness, pallor. A characteristic feature of this defect is the occurrence of angina attacks associated with inadequacy of the coronary circulation.

Tricuspid regurgitation

The defeat of the tricuspid valve (TC) in an isolated form is quite rare. As a rule, its insufficiency with regurgitation is a consequence of pronounced changes in the left half of the heart (relative TC insufficiency), when high pressure in the pulmonary circulation prevents adequate cardiac output into the pulmonary artery, which carries blood for oxygenation to the lungs.

Tricuspid regurgitation leads to a violation of the complete emptying of the right half of the heart, adequate venous return through the vena cava and, accordingly, stagnation appears in the venous part of the systemic circulation.

For insufficiency of the tricuspid valve with regurgitation, the occurrence of atrial fibrillation, cyanosis of the skin, edematous syndrome, swelling of the cervical veins, enlargement of the liver and other signs is quite characteristic. chronic insufficiency circulation.

Pulmonary valve regurgitation

Damage to the cusps of the pulmonary valve may be congenital in nature, manifesting itself in childhood or acquired due to atherosclerosis, syphilitic lesion, valve changes at septic endocarditis. Often, damage to the pulmonary valve with insufficiency and regurgitation occurs with existing pulmonary hypertension, lung diseases, and lesions of other heart valves (mitral stenosis).

Minimal regurgitation on the pulmonary valve does not lead to significant hemodynamic disorders, while a significant return of blood to the right ventricle, and then to the atrium, causes hypertrophy and subsequent dilatation (expansion) of the cavities of the right half of the heart. Such changes are manifested by severe heart failure in a large circle and venous congestion.

Pulmonary regurgitation is manifested by all kinds of arrhythmias, shortness of breath, cyanosis. severe edema, accumulation of fluid in the abdominal cavity, changes in the liver up to cirrhosis and other signs. With congenital valvular pathology, symptoms of circulatory disorders occur already in early childhood and are often irreversible and severe.

Features of regurgitation in children

Very important in childhood proper development and functioning of the heart and circulatory system, but violations, unfortunately, are not uncommon. Most often, valvular defects with insufficiency and blood return in children are due to congenital developmental anomalies (Fallot's tetrad, hypoplasia of the pulmonary valve, defects in the septa between the atria and ventricles, etc.).

Severe regurgitation with an abnormal structure of the heart manifests itself almost immediately after the birth of a child with symptoms respiratory disorders, cyanosis, right ventricular failure. Often significant violations end fatally, so each expectant mother you need not only to take care of your health before the intended pregnancy, but also to visit an ultrasound diagnostic specialist in a timely manner during the gestation of the fetus.

Possibilities of modern diagnostics

Medicine does not stand still, and the diagnosis of diseases is becoming more reliable and of high quality. The use of ultrasound has made significant progress in the detection of a number of diseases. The addition of ultrasound examination of the heart (EchoCG) with Dopplerography makes it possible to assess the nature of blood flow through the vessels and cavities of the heart, the movement of the valve flaps at the time of myocardial contractions, to establish the degree of regurgitation, etc. Perhaps EchoCG is the most reliable and informative method diagnosis of cardiac pathology in real time and at the same time being affordable and inexpensive.

mitral regurgitation on echocardiography

In addition to ultrasound, indirect signs of regurgitation can be detected on the ECG. with careful auscultation of the heart and assessment of symptoms.

It is extremely important to identify violations of the valvular apparatus of the heart with regurgitation not only in adults, but also in the period of intrauterine development. The practice of ultrasound examination of pregnant women on different terms allows you to detect the presence of defects that are not in doubt already during the initial examination, as well as to diagnose regurgitation, which is an indirect sign of possible chromosomal abnormalities or emerging valve defects. Dynamic monitoring of women at risk makes it possible to timely establish the presence of a serious pathology in the fetus and decide whether it is advisable to maintain pregnancy.

The tactics of treating regurgitation is determined by the cause that caused it, the severity, the presence of heart failure and concomitant pathology.

Possible as surgical correction valvular disorders ( different kinds plastics. prosthetics), and medical conservative therapy, aimed at normalizing blood flow in the organs, combating arrhythmia and circulatory failure. Most patients with severe regurgitation and damage to both circulations need constant monitoring by a cardiologist, the appointment of diuretics, beta-blockers, antihypertensive and antiarrhythmic drugs, which will be selected by a specialist.

At mitral prolapse small degree, valvular regurgitation of another localization, dynamic observation by a doctor and timely examination in case of aggravation of the condition are sufficient.

The prognosis of valvular regurgitation depends on many factors: its degree, cause, age of the patient, the presence of diseases of other organs, etc. With a caring attitude to one's health and regular visits to the doctor, minor regurgitation does not threaten with complications, and with pronounced changes their correction, including surgical, allows patients to prolong life.