The heart valve itself will close large people. Stones in the vessels of the human heart. How do heart valves work normally?

Heart valves are one of the components of the human heart. Their correct work ensures not only the functioning of the cardiovascular system, but also the whole organism as a whole. For this reason, it is very important to know how many valves a person has, how they work, and how to recognize signs of valve disease.

human heart

The human heart is a hollow muscle. It is formed by four chambers: the right and left atrium, the right and the atria with the ventricles connect the cusp valves. The heart beats rhythmically, and blood flows in portions from the atria to the ventricles. connect the ventricles to the vessels, through them the blood is pushed out of the heart into the aorta and pulmonary artery.

Thus, blood with a high content of carbon dioxide passes through the right chambers and enters the lungs to be enriched with oxygen. And from the lungs, blood is sent back to the bloodstream through the left side of the heart. Ensuring a constant pumping of blood through the vessels is the main function that the heart performs.

Heart valves

The valve apparatus is necessary in the process of pumping blood. Heart valves ensure that blood flows in the right direction and in the right amount. Valves are the folds of the inner lining of the heart muscle. These are kind of “doors” that allow blood to flow in one direction and prevent it from moving back. The valves open at the moment of rhythmic contraction of the heart muscle. In total, there are four valves in the human heart: two valves and two semilunar:

1. Bicuspid mitral valve.
2. Semilunar valve Another name for it is the pulmonary valve.
3. Aortic semilunar valve or aortic valve.

The heart valves open and close according to the successive contraction of the atria and ventricles. The blood flow of blood vessels depends on their synchronous work, therefore, oxygen saturation of all cells of the human body.

Functions of the valve apparatus

Blood, acting through the vessels in the heart, accumulates in the right atrium. Its further progress is delayed tricuspid valve. When it opens, blood enters the right ventricle, from where it is expelled through the pulmonic valve.

Further, the blood flow enters the lungs for oxygen saturation, and from there it is sent to the left atrium through the aortic valve. The mitral valve connects the left chambers and restricts blood flow between them, allowing blood to pool. After blood enters the left ventricle and accumulates in the right amount, the blood is pushed into the aorta through the aortic valve. From the aorta, the renewed blood continues its movement through the vessels, enriching the body with oxygen.

Pathologies of the heart valves

The function of the valves is to regulate the flow of blood through the human heart. If the rhythm of opening and closing of the valve apparatus is disturbed, the heart valves close or do not open completely, this can cause many serious diseases. It is noted that the mitral and aortic valves are most often affected by pathologies.

Heart defects are most common in people over the age of sixty. In addition, heart valve disease can become a complication of certain infectious diseases. Children are also prone to valvular diseases. As a rule, these are congenital defects.

The most common diseases are heart failure and stenosis. In case of insufficiency, the valve does not close tightly, and part of the blood returns back. Valve stenosis is called narrowing of the valve, that is, the valve does not open completely. With this pathology, the heart experiences constant overload, since more effort is required to push the blood.

valve prolapse

Heart valve prolapse - the most common diagnosis that a doctor establishes when a patient complains of malfunctions in the cardiovascular system. The mitral valve of the heart is most often affected by this pathology. Prolapse occurs due to a defect in the connective tissue that forms the valve. As a result of such defects, the valve does not close completely and blood flows in the opposite direction.

Separate primary and secondary valve prolapse. Primary prolapse refers to congenital diseases when connective tissue defects are a genetic predisposition. Secondary prolapse occurs due to trauma to the chest, rheumatism or myocardial infarction.

As a rule, valve prolapse does not have serious consequences for human health and is easily treated. But in some cases, complications may occur, such as arrhythmia (violation of the rhythm of contractions of the heart muscle), insufficiency and others. In such cases, medical or surgical treatment is required.

Valve insufficiency and stenosis

The main cause of insufficiency and stenosis is beta-hemolytic streptococcus - the cause of the inflammatory process in rheumatism, reaching the heart, changes its morphological structure. As a result of these changes, the heart valves begin to work differently. The walls of the valves may become shorter, causing insufficiency, or narrowing of the valve opening (stenosis).

Due to rheumatism, it most often occurs in adults. Stenosis on the background of rheumatism is susceptible to the aortic or mitral heart valve in children.

There is such a thing as "relative insufficiency". Such a pathology occurs if the structure of the valve remains unchanged, but its function is disturbed, that is, the blood has a reverse outflow. This is due to a violation of the ability of the heart to contract, expansion of the cavity of the heart chamber, and so on. Heart failure is also formed as a complication of myocardial infarction, cardiosclerosis, tumors of the heart muscle.

The lack of qualified treatment of insufficiency and stenosis can lead to insufficient blood flow, dystrophy of internal organs, arterial hypertension.

Symptoms of valve disease

Symptoms of heart disease directly depend on the severity and extent of the disease. As the pathology develops, the load on the heart muscle increases. As long as the heart copes with this load, the disease will be asymptomatic. The first signs of the disease can be:

• dyspnea;
• failure of the heart rhythm;
• frequent bronchitis;
• pain in the chest.

Shortness of breath and dizziness often indicate heart failure. The patient experiences weakness and fatigue. Congenital mitral valve prolapse is manifested in children by episodic pain in the sternum during stress or overexertion. Acquired prolapse is accompanied by palpitations, dizziness, shortness of breath, weakness.

These symptoms may also indicate vegetative-vascular dystonia, aortic aneurysm, arterial hypertension and other heart pathologies. In this regard, it is important to make an accurate diagnosis, which will reveal that it is the heart valve that causes malfunctions. Treatment of the disease depends entirely on the correct diagnosis.

Diagnosis of diseases

When the first signs of heart valve disease appear, you should consult a doctor as soon as possible. The appointment is carried out by a general practitioner, the final diagnosis and treatment is prescribed by a narrow specialist - a cardiologist. The therapist listens to the work of the heart to identify noises, study the medical history. Further examination is carried out by a cardiologist.

Diagnosis of heart defects is carried out using instrumental research methods. An echocardiogram is the main test for valvular disease. It allows you to measure the size of the heart and its departments, to identify violations in the valves. An electrocardiogram records the heart rate, revealing arrhythmia, ischemia, and cardiac hypertrophy. shows a change in the contour of the heart muscle and its size. In diagnosing valve defects, catheterization is important. A catheter is inserted into a vein and advanced through it to the heart, where it measures blood pressure.

Possibility of treatment

The drug treatment method includes the appointment of drugs aimed at relieving symptoms and improving heart function. Surgery is aimed at changing the shape of the valve or replacing it. Correction surgery is generally better tolerated by patients than replacement surgery. In addition, after a heart valve replacement, the patient is prescribed anticoagulants, which will need to be used throughout life.

However, if the valve defect cannot be eliminated, it becomes necessary to replace it. A mechanical or biological heart valve is used as a prosthesis. The price of the prosthesis largely depends on the country of manufacture. Russian prostheses are much cheaper than foreign ones.

Several factors influence the choice of artificial valve type. This is the age of the patient, the presence of other diseases of the cardiovascular system, and which valve is to be replaced.

Mechanical implants last longer, but require lifelong coagulation. This causes difficulties in installing them for young women who plan to have children in the future, since taking such drugs is a contraindication during pregnancy. In the case of a tricuspid valve replacement, a biological implant is placed, due to the location of the valve in the bloodstream. In other cases, if there are no other contraindications, it is recommended to install a mechanical valve.

Among the serious diseases that deprive a person of the opportunity to live a full life, not the last place is occupied by heart disease.

Statistics show that every third person who seeks help from doctors has problems in the sphere of cardiac activity. Experts say that not all heart diseases lead to serious consequences.

But there are diseases that can only be cured by competent surgical intervention: a complete transplant of the heart or its parts. Among the methods of treating heart diseases that are popular in professional circles, the method of implanting an artificial valve is called popular.

The life limit of a person whose heart was equipped with an artificial valve is a question that worries those who are recommended for surgery. The life expectancy of people who have undergone implantation of an artificial valve in the heart reaches 20 years. However, expert assessments prove the possibility of the implant functioning for 300 years. This fact allows them to argue that the installation of the valve does not affect life expectancy in any way. The cause of death of people who underwent an operation to install an artificial valve 20 years ago is by no means the problems of the functioning of the cardiovascular system.

Reasons for installing an artificial valve

A heart valve is compared in medical circles to a door that needs to be repaired if it loses its original functionality. In the case of a heart valve, doctors use the same approach. Damage to the heart valve, requiring cardinal approaches and choices of treatment methods, is classified into three types.

The first involves the processes of narrowing or sticking, which causes a slowdown in blood flow, which adversely affects the nutrition of the heart, leading to oxygen starvation. The second is due to the processes of expansion or overstretching, leading to a violation of the indicators of the tightness of the heart and increased stress. The third is a combined version of the two previous types.

Diagnosis of heart failure is not a cause for panic. Implantation is not always shown. Doctors perform other operations, for example, they reconstruct an organ.

Implants and their types

Valves of artificial origin at the present stage are represented by two options: the first is mechanical, the second is biological. Both have both positive and negative characteristics.

A mechanical type implant is a prosthesis that is installed in place of a natural heart valve. The task of the prosthesis is actions aimed at conducting blood flow through the heart. The use of a mechanical prosthesis is due to dysfunction of the native organ.

Tests carried out on prototypes of artificial prostheses indicate the possibility of their operation for 50 thousand years. And this is when conditions of forced wear are created. Therefore, if the installed mechanical valve takes root in the human body, then it will perform its functions uninterruptedly for as long as the person lives.

The main precaution required for execution concerns the need for additional support for the functioning of the prostheses, as well as the regular intake of anticoagulants, the action of which is aimed at diluting the blood flow. This technique helps to avoid the formation of heart clots. A prerequisite is the regularity of collection and verification of analyzes.

Biological type valves also appear to be prostheses, but animal tissues are used to create them. Consumables can be valves borrowed from pigs. An indispensable condition for the use of such material is its pre-treatment. Otherwise, the implant is not suitable. Biological valves, when compared with mechanical ones, are much less durable.

Heart valve transplantation and possible complications

According to experts, a patient who comes to a medical consultation in a timely manner practically reduces the risk of complications to zero. All other variants of the development of the event testify to the minimal risk of the operation itself and the danger of non-compliance with the recommendations of doctors in the period after implantation.

Careful attitude to one's own health is a principle that the operated person must adhere to. The patient must follow the doctor's recommendations regarding: daily routine, nutrition, medication. Only in this way can a person with an artificial implant ensure a long life.

Moscow 2015

Heart (Latin cor, Greek καρδιά)- a fibromuscular hollow organ that provides blood flow through the blood vessels through repeated rhythmic contractions. It is present in all living organisms with a developed circulatory system, including all representatives of vertebrates, including humans. The heart of vertebrates consists mainly of cardiac, endothelial and connective tissue. In this case, the heart muscle is a special type of striated muscle tissue found exclusively in the heart. The human heart, contracting an average of 72 times per minute, will complete about 2.5 billion cardiac cycles over 66 years. The mass of the human heart depends on gender and usually reaches 250-300 grams (9-11 ounces) in women and 300-350 grams (11-12 ounces) in men.

The human heart is four-chambered. There are right and left atrium, right and left ventricle; Between the atria and ventricles are fibromuscular inlet valves - on the right tricuspid, on the left bicuspid (mitral). At the outlet of the ventricles, there are outlet tricuspid valves similar in structure (pulmonary on the right and aortic on the left).

What is a heart valve?

Valve - part of the heart, formed by the folds of its inner shell, provides unidirectional blood flow by blocking the venous and arterial passages.

The heart is a kind of pump that makes blood circulate throughout the body. This is made possible by maintaining pressure in the cavities (chambers) of the heart. The human heart has 4 chambers: 2 ventricles and 2 atria. Valves are special flaps located between the chambers of the heart that regulate the pressure in the chambers of the heart and keep the blood moving in the right direction.

There are 4 valves in the heart:

The mitral valve is located between the left atrium and the left ventricle. This valve consists of two flaps: anterior and posterior. Prolapse (bulging) of the anterior leaflet of the mitral valve is more common than prolapse of the posterior leaflet. Attached to each leaflet of the valve are thin threads called chords. These threads, in turn, are attached to small muscles (papillary, papillary muscles). For the normal functioning of the valve, the joint work of the valves, chords and papillary muscles is necessary. During the contraction of the heart, the pressure in it rises greatly. Under the action of this pressure, the mitral valve opens the leaflets, which are held by chordae and papillary muscles.

The tricuspid (tricuspid) valve consists of 3 valves and is located between the right atrium and the right ventricle of the heart.

The aortic valve is located between the left ventricle and the aorta and prevents blood from returning back to the ventricle.

How do heart valves work normally?

The left ventricle has 2 openings: one communicates with the left atrium (the mitral valve is located here), the second communicates with the aorta (the aortic valve is located here). Blood moves through the heart in the following direction: from the atrium through the open mitral valve to the ventricle and then from the ventricle through the open aortic valve to the aorta. In order to prevent the blood from returning back to the atrium during the contraction of the left ventricle, but to move into the aorta, the mitral valve closes tightly. During relaxation of the ventricle, the aortic valve closes and blood cannot return to the heart.

The tricuspid (tricuspid) valve and the pulmonary valve operate on the same principle. Thus, due to the normal functioning of the heart valves, the movement of blood through the heart departments and the maintenance of blood circulation throughout the body is carried out.

Valve diseaseSymptoms of the disease and its treatmentSurgical treatmentsValve replacement surgeryMechanical and allografts

The valves of the heart ensure the movement of blood in the right direction, preventing its backflow. Therefore, it is very important to maintain the correct rhythm of their work and, in case of its violation, carry out strengthening procedures.

valve disease

Most often, heart valves begin to hurt when a person's age exceeds 60-70 years. At this age, the wear and tear of the body increases, as a result of which the work of the cardiac apparatus will be complicated. But heart defects can also occur as a result of infectious diseases that affect the cardiovascular system. At the same time, the spread of infectious bacteria occurs quite rapidly and takes from 2 to 5 days.

The human heart muscle has 4 cavities, which include 2 atria and 2 ventricles. It is into them that blood from the veins enters, and from there it is distributed through the arteries of the body. The valves of the heart are located at the junction of the atria with the ventricles. Their structure helps to maintain the direction of blood flow.

The heart valve has characteristic features that determine changes in its work, which are divided into 2 main groups. In the first case, the valvular apparatus of the heart does not close completely, which leads to the return of blood mass (regurgitation). The second group of disorders includes incomplete opening of the valves (stenosis). This greatly impedes the flow of blood fluid, which greatly burdens the heart and causes premature fatigue.

Valvular defects are a fairly common disease. They make up 25-30% of all diseases of the cardiovascular system. In this case, most often there is a defect of the mitral and aortic valve. Similar diagnoses can also be made in children, as they may be of a viral nature. Infectious diseases that worsen the functioning of the heart muscle include endocarditis, myocarditis, and cardiomyopathy.

Most often, doctors establish a diagnosis of mitral valve prolapse, in which the work of the heart will be accompanied by extraneous noises or clicks. A similar violation occurs due to the fact that at the time of ventricular contraction, its opening does not close tightly. This causes a deflection of the atrial cavity, which leads to the outflow of blood in the opposite direction.

Prolapse is primary and secondary. Primary is a congenital disease that develops due to a genetic defect in the connective tissues. Secondary prolapse may occur due to mechanical damage to the chest, myocardial infarction or rheumatism.

Back to index

Symptoms of the disease and its treatment

If a person has a heart valve that does not work well, then he will experience the following symptoms of the disease:

severe fatigue; swelling of the legs and ankles; pain and shortness of breath when walking and lifting weights; dizziness accompanied by fainting.

If such symptoms appear, you should immediately seek the advice of a qualified specialist. It will help to understand why the valvular apparatus of the heart does not work, and will develop the required course of treatment. Initially, patients are prescribed conservative methods of treatment. They are aimed at relieving pain, adjusting the heart rate and preventing possible complications. Similar methods are prescribed after undergoing operations of the cardiovascular system, they help prevent the occurrence of relapses.

To determine a more effective method of treatment, the doctor must take into account the severity of the disease, the age of the patient and all individual contraindications. Patients are prescribed medications that will increase the intensity of the work of the heart muscle, while there should be an improvement in its functionality. In the case when medicinal methods of treatment do not help, then surgical intervention is prescribed.

Back to index

Surgical treatments

Diseases of the valvular apparatus of the heart are physical diseases, so surgery may be prescribed to completely restore the functioning of the heart. Most often, during such operations, damaged valves are replaced.

Before the operation, a diagnostic examination of patients is prescribed, which will help determine the damaged valves and determine the severity of the disease. In addition, during such examinations, doctors should obtain information about the structure of the heart and underlying diseases of the body.

To increase the effectiveness of surgical intervention, such a procedure is combined with simultaneous shunting, with the treatment of an aortic aneurysm, or with atrial fibrillation.

Currently, there are two main types of surgical intervention for the treatment of the cardiovascular apparatus. The first kind is gentle. It provides for the restoration of damaged valves. The second type of operation is more complex: during its implementation, a complete replacement of the damaged organ is performed.

If cardiologists prescribe surgical recovery, then in this case the use of individual parts is not provided. The mitral valve lends itself best to such restoration. Sometimes reconstructive surgery helps to improve the functioning of the tricuspid and aortic system.

During reconstructive surgery, the degree of possible infection of the body is reduced, since there will be no rejection of foreign materials. In addition, patients will not need to take anticoagulants to help thin the blood throughout their lives.

Back to index

valve replacement surgery

A complete replacement of the heart valves is prescribed when the recovery procedure is not possible. Most often, a complete replacement is performed when the aortic valves fail.

During such a surgical intervention, a complete replacement of the damaged organ is performed. During this process, the valve is changed, which is sewn to the native ring. For this, biocompatible materials with body tissues are used to prevent their rejection.

After the complete replacement of the internal valves, all patients are prescribed the mandatory intake of tablets that can thin the blood. Among these drugs can be listed Coumadin, Marevan or Warfarin. They will help to significantly reduce the formation of large blood clots and delay their clotting. This quality will help prevent the occurrence of strokes or heart attacks. In addition, all patients after surgery must be sure to take blood tests that will help track and evaluate the performance of the heart and the effectiveness of the drugs taken.

Cardiac prostheses can have a different structure: biological and mechanical.

Biological ones are made from bioprosthetic tissue based on the internal organs of cows or pigs. Less commonly, human donor material may be used. To facilitate their installation, several artificial components are used that will help to place and attach the implanted organ in a quality manner.

Biological prostheses work for a long time without causing disruptions in the heart rhythm. The duration of their work can reach 15-20 years, while patients do not need to take anticoagulants daily.

Back to index

Mechanical and allografts

Allografts are living donor tissue that is transplanted into a sick person after the sudden death of the donor. Such operations correspond to the Ross technique, which makes it possible not only to easily carry out the operation, but also to postpone a further recovery period.

Engraftment of tissues takes place quite quickly, and there are no cases of rejection of the donor organ. Most patients operated on by the Ross method recover quickly without the need for constant follow-up with their physicians and maintenance medications.

Mechanical shutters are made from artificial elements. The material from which they are made takes root quite well in the human body. For this, a medical alloy with carbon parts is best suited. Such a design is quite reliable and can work without fail for 10-12 years.

The most common mechanical design is the butterfly valve, which is made from a metal ring and carbon leaflets. The upper part of such a valve is covered with a polyester fabric. The disadvantage of such a mechanical damper is that mechanical clicks will be observed during its operation. In addition, patients are advised to take regular medications.

The recovery period after surgery is from 60 to 90 days. After 8-10 months, a person can already drive without worrying about losing consciousness. During the recovery period, patients are contraindicated in smoking and drinking alcohol. Nutrition should be dietary, it excludes hard-to-digest foods and requires a reduced level of cholesterol intake.

Any heart disease is associated with an anomaly of the valves. Aortic valve defects are especially dangerous, since the aorta is the largest and most important artery in the body. And when the work of the apparatus that supplies oxygen to all parts of the body and the brain is disrupted, a person is practically inoperable.

The aortic valve is sometimes formed in utero already with defects. And sometimes heart defects are acquired with age. But whatever the reason for the violation of the activity of this valve, medicine has already found a treatment in such cases - aortic valve replacement.

Anatomy of the left side of the heart. Functions of the aortic valve

The four-chambered structure of the heart must work in perfect harmony to fulfill its primary function of supplying the body with nutrients and air carried by the blood. Our main organ consists of two atria and two ventricles.

The right and left parts are separated by an interventricular septum. Also in the heart there are 4 valves that regulate blood flow. They open in one direction and close tightly so that the blood moves in only one direction.

The heart muscle has three layers: endocardium, myocardium (thick muscle layer) and endocardium (outer). What is happening in the heart? The depleted blood, which has given up all the oxygen, returns to the right ventricle. Arterial blood passes through the left ventricle. We will consider in detail only the left ventricle and the work of its main valve - the aortic one.

The left ventricle is cone-shaped. It is thinner and narrower than the right one. The ventricle connects to the left atrium through the atrioventricular orifice. The leaflets of the mitral valve are attached directly to the edges of the hole. The mitral valve is bicuspid.

The aortic valve (valve aortae) consists of 3 cusps. Three flaps are named: right, left and posterior semilunar (valvulae semilunares dextra, sinistra, posterior). The leaflets are formed by a well-developed duplication of the endocardium.

The muscles of the atria from the ventricular muscles are isolated by a plate of the right and left fibrous rings. The left fibrous ring (anulus fibrosus sinister) surrounds the atrioventricular orifice, but not completely. The anterior sections of the ring are attached to the aortic root.

How does the left side of the heart work? Blood enters, the mitral valve closes, and there is a push - a contraction. The contraction of the walls of the heart pushes blood through the aortic valve into the widest artery - the aorta.

With each contraction of the ventricle, the valves are pressed against the walls of the vessel, giving a free flow of oxygenated blood. When the left ventricle relaxes for a fraction of a second to fill the cavity with blood again, the aortic valve of the heart closes. This is one cardiac cycle.

Congenital and acquired defects of the aortic valve

If there are problems with the aortic valve during the intrauterine development of the baby, it is difficult to notice. Usually, the defect is noticed after birth, since the child's blood goes around the valve, immediately into the aorta through the open ductus arteriosus. It is possible to notice deviations in the development of the heart only thanks to echocardiography, and only from 6 months.

The most common valve anomaly is the development of 2 leaflets instead of 3. This heart disease is called bicuspid aortic valve. The anomaly does not threaten the child. But 2 sashes wear out faster. And by adulthood, supportive therapy or surgery is sometimes needed. Less commonly, a defect such as a one-leaf valve occurs. Then the valve wears out even faster.

Another anomaly is congenital aortic valve stenosis. The semilunar cusps either fuse, or the valvular fibrous ring itself, to which they are attached, is excessively narrow. Then the pressure between the aorta and the ventricle is different. Over time, the stenosis increases. And interruptions in the work of the heart prevent the child from fully developing, it is difficult for him to do sports even in the school gym. A serious disruption of blood flow through the aorta at some point can lead to the sudden death of a child.

Acquired vices - a consequence of smoking, immoderate nutrition, sedentary and stressful lifestyle. Since everything is connected in the body, after 45–50 years, all minor ailments usually develop into diseases. The aortic valve of the heart wears out a little with old age, as it works constantly. Exploitation of the resources of your body, lack of sleep wear out these important parts of the heart faster.

aortic stenosis

What is stenosis in medicine? Stenosis means a narrowing of the lumen of a vessel. Aortic stenosis is a narrowing of the valve that separates the left ventricle of the heart from the aorta. Distinguish minor, moderate and severe. This defect can affect the mitral and aortic valves.

With a slight valve defect, a person does not feel any pain or other signal symptoms, because the increased work of the left ventricle will be able to compensate for the poor valve performance for some time. Then, when the compensatory possibilities of the left ventricle are gradually exhausted, weakness and poor health begin.

The aorta is the main blood "highway". If the valve is broken, all vital organs will suffer from a lack of blood supply.

The causes of stenosis of the heart valves are:

Congenital valve disease: fibrous film, bicuspid valve, narrow ring. Scar formed by the connective tissue directly under the valve. Infective endocarditis. Bacteria that have fallen on the tissues of the heart change the tissue. Due to a colony of bacteria, connective tissue grows on tissues and valves. Osteitis deformans. Autoimmune problems: rheumatoid arthritis, lupus erythematosus. Due to these diseases, connective tissue grows in the place where the valve is attached. Growths are formed on which calcium is deposited more. There is calcinosis, which we will remember later. Atherosclerosis.

Unfortunately, in most cases, aortic stenosis is fatal if valve replacement is not done on time.

Stages and symptoms of stenosis

Doctors distinguish 4 stages of stenosis. At first, there is practically no pain or discomfort. Each stage has a set of symptoms. And the more serious the stage of development of stenosis, the faster the operation is needed.

The first stage is called the compensation stage. The heart is still coping with the load. A deviation is considered insignificant when the valve clearance is 1.2 cm2 or more. And the pressure is 10–35 mm. rt. Art. Symptoms at this stage of the disease are not manifested. Subcompensation. The first symptoms appear immediately after exercise (shortness of breath, weakness, palpitations). Decompensation. It is characterized by the fact that the symptoms appear not only after the load, but also in a calm state. The last stage is called the terminal. This is the stage when there have already been strong changes in the anatomical structure of the heart.

Symptoms of severe stenosis are:

pulmonary edema; shortness of breath; sometimes asthma attacks, especially at night; pleurisy; heart cough; pain in the chest.

On examination, the cardiologist detects usually moist rales in the lungs during listening. The pulse is weak. Noises are heard in the heart, a vibration is felt created by the turbulence of blood flows.

Stenosis becomes critical when the lumen is only 0.7 cm2. The pressure is more than 80 mm. rt. Art. At this time, the risk of death is high. And even an operation to eliminate the defect is unlikely to change the situation. Therefore, it is better to consult a doctor in the subcompensatory period.

Development of calcification

This defect develops as a result of a degenerative process in the tissue of the aortic valve. Calcification can lead to severe heart failure, stroke, generalized atherosclerosis. Gradually, the leaflets of the aortic valve become covered with a calcareous growth. And the valve is calcified. That is, the valve flaps cease to close completely, and also open weakly. When a bicuspid aortic valve forms at birth, calcification renders it inoperative more quickly.

And also calcification develops as a consequence of disruption of the endocrine system. Calcium salts, when they do not dissolve in the blood, accumulate on the walls of blood vessels and on the valves of the heart. Or a kidney problem. Polycystic or kidney nephritis also lead to calcification.

The main symptoms will be:

aortic insufficiency; enlargement of the left ventricle (hypertrophy); interruptions in the work of the heart.

A person should take care of his health. Pain in the chest area and the increasing frequency of periodic attacks of angina pectoris should be a signal to undergo a cardiac examination. Without surgery for calcification, in most cases a person dies within 5-6 years.

Aortic regurgitation

During diastole, blood from the left ventricle flows into the aorta under pressure. This is how the systemic circulation begins. But with regurgitation, the valve "gives" blood back into the ventricle.

Valve regurgitation, or aortic valve insufficiency, in other words, has the same stages as valve stenosis. The causes of this condition of the valves are either an aneurysm, or syphilis, or the mentioned acute rheumatism.

Deficiency symptoms are:

low blood pressure; dizziness; frequent fainting; swelling of the legs; broken heart rate.

Severe failure leads to angina pectoris and ventricular enlargement, as in stenosis. And such a patient also needs an operation to replace the valve in the near future.

valve seal

Stenosis can be formed due to the fact that endogenous factors cause the appearance of various growths on the valve leaflets. The aortic valve seals and begins to malfunction. The causes that led to the sealing of the aortic valve can be many untreated diseases. For example:

Autoimmune diseases. Infectious lesions (brucellosis, tuberculosis, sepsis). Hypertension. As a result of prolonged hypertension, tissues become thicker and coarser. Therefore, over time, the lumen narrows. Atherosclerosis is the clogging of tissues with lipid plaques.

Thickening of tissues is also a common sign of aging. Consolidation will inevitably result in stenosis and regurgitation.

Diagnostics

Initially, the patient must provide the doctor with all the necessary information for making a diagnosis in the form of an accurate description of the ailments. Based on the patient's medical history, the cardiologist prescribes diagnostic procedures in order to know additional medical information.

Required to be assigned:

X-ray. The shadow of the left ventricle is enlarged. This can be seen from the arc of the contour of the heart. Signs of pulmonary hypertension are also visible. ECG. Examination reveals an increase in the ventricle and arrhythmia. Echocardiography. On it, the doctor notices whether or not there is a seal of the valve flaps and a thickening of the walls of the ventricle. Sounding of the cavities. The cardiologist must know the exact value: how much the pressure in the aortic cavity differs from the pressure on the other side of the valve. Phonocardiography. Noises are recorded during the work of the heart (systolic and diastolic murmur). Ventriculography. It is prescribed to detect mitral valve insufficiency.

With stenosis, the electrocardiogram shows disturbances in the rhythm and conduction of biocurrents. On the x-ray, you can clearly see signs of darkening. This indicates congestion in the lungs. It is clearly seen how dilated the aorta and left ventricle are. And coronary angiography shows that the amount of blood ejected from the aorta is less. It is also an indirect sign of stenosis. But angiography is done only for people over 35 years old.

The cardiologist also pays attention to symptoms that are visible even without devices. Pallor of the skin, Musset's symptom, Muller's symptom - such signs indicate that the patient most likely has aortic valve insufficiency. Moreover, the bicuspid aortic valve is more prone to insufficiency. The doctor must take into account congenital features.

What other signs can suggest a diagnosis to a cardiologist? If, when measuring pressure, the doctor notices that the upper one is much higher than normal, and the lower one (diastolic) is too low - this is a reason to refer the patient to echocardiography and radiographs. Extra noise during diastole, heard through a stethoscope, also does not bode well. This is also a sign of failure.

Treatment with drugs

For the treatment of insufficiency at the initial stage, drugs of the following classes can be prescribed:

peripheral vasodilators, which include nitroglycerin and its analogues; diuretics are prescribed only for certain indications; calcium channel blockers, such as Diltiazem.

If the pressure is very low, nitroglycerin preparations are combined with Dopamine. But beta-blockers are contraindicated in case of aortic valve insufficiency.

Aortic valve replacement

Aortic valve replacement operations are now being carried out quite successfully. And with minimal risk.

During the operation, the heart is connected to a heart-lung machine. The patient is also given full anesthesia. How can a surgeon perform this minimally invasive operation? There are 2 ways:

The catheter is inserted directly into the femoral vein and ascends to the aorta against the flow of blood. The valve is secured and the tube is removed. A new valve is inserted through the left chest incision. An artificial valve is inserted, and it snaps into place, passing through the apical part of the heart, and is easily excreted from the body.

Minimally invasive surgery is suitable for those patients who have concomitant diseases, and it is impossible to open the chest. And after such an operation, the person immediately feels relief, as the defects are eliminated. And if there are no complaints about well-being, it can be discharged in a day.

It should be noted that artificial valves require constant intake of anticoagulants. Mechanical can cause blood clotting. Therefore, after the operation, Warfarin is immediately prescribed. But there are valves made of biological materials that are more suitable for humans. If a valve from the porcine pericardium is installed, then the drug is prescribed only for a few weeks after the operation, and then canceled, since the tissue takes root well.

Aortic balloon valvuloplasty

Sometimes aortic balloon valvuloplasty is prescribed. This is a painless operation according to the latest developments. The doctor controls all the actions taking place through special x-ray equipment. A catheter with a balloon is passed to the aortic orifice, then the balloon is placed in place of the valve and expanded. This eliminates the problem of valve stenosis.

To whom is the operation indicated? First of all, such an operation is performed on children with a congenital defect, when a unicuspid or bicuspid aortic valve is formed instead of a tricuspid one. It is indicated for pregnant women and people before another heart valve transplant.

After this operation, the recovery period is only from 2 days to 2 weeks. Moreover, it is transferred very easily and is suitable for people with poor health, and even children.

Heart valves
The heart is a muscle that constantly contracts and delivers blood to the rest of the body. Inside the heart, there are four valves that open and close in a strict sequence, and help move blood in a certain direction. Among the valves, there are: tricuspid valve, pulmonary valve, mitral valve and aortic valve.

What is a heartbeat?

Two heart valves control blood flow from the upper chambers of the heart, or atria, to the lower chambers of the heart, the ventricles. The other two valves are responsible for moving blood from the ventricles to the lungs and other human organs. When the valves open or close, they make two different sounds, which is what we call a heartbeat.

How does oxygen-poor blood pass through the heart?

When the heart beats normally, oxygen-depleted blood returns from the body and fills the right atrium, which contracts to push blood through the tricuspid valve into the right ventricle. The right ventricle then contracts and pushes blood through the pulmonary valve into the pulmonary artery. The pulmonary artery carries blood to the lungs where it is enriched with oxygen.

How does oxygenated blood pass through the heart?

At the same time, oxygen-enriched blood flows from the lungs into the left atrium, which, contracting, pushes it through the mitral valve into the left ventricle. The left ventricle contracts and blood enters the aorta through the aortic valve, and from there it travels to the rest of the body.

How do the atria and ventricles work?

Blood moves through the heart through valves. When the atrium contracts, the valves in these upper chambers—the tricuspid valve and the mitral valve—open, allowing blood to flow into the ventricles. When they contract, the tricuspid and mitral valves close, and at this time, under pressure, the ventricular valves - pulmonary and aortic - open. The blood leaving the ventricles does not get back into them due to the tight closure of the cusps of the aortic and pulmonary valves.

Heart valve disorders

There are disorders associated with the functioning of the heart valves, such as valvular regurgitation (backflow of blood) and valvular stenosis (narrowing of the valve lumen).

Why does the heart need valves?

The human heart is a hollow muscular organ, which is also called the "pump" in the human body. After all, the way it is, the heart has to pump blood every minute, thereby providing our body with nutrients and oxygen. Moreover, the entire cardiovascular system is also involved in the removal (elimination) of harmful substances and metabolic products from our body, thereby ensuring its full development.

The laying of the valvular apparatus begins at the stage of formation of a two-chamber heart. Even then, a tubercle is formed, which will then become the site of the development of heart valves. At the time when the four-chambered heart is being formed, the valves are also being formed. In the final version, the heart acquires four chambers, which form the right venous and left arterial heart. In fact, a person has one heart, but due to the fact that blood of different gas composition moves through the right and left sections, it is customary to divide it in this way.

There are four chambers in the heart, and the exit of each of them is equipped with a kind of "pass" - a valve apparatus. If a portion of blood has entered from one chamber to another, the valve does not allow it to return to its original place. Thus, the correct direction of blood flow and the functioning of two circles of blood circulation - small and large circles of blood circulation, working simultaneously are ensured.

Such names accurately reflect their characteristics. The small circle provides blood flow in the vessels of the lungs, enriching the blood with oxygen. A large circle of blood circulation, starting from the left ventricle, provides oxygen enrichment of all other organs and tissues. If the valves of the heart did not work properly, not at all fulfilling the role of a "passport", the work of the small and large circles of blood circulation would not be possible.

2 Where are the valves located?

Each of these "permits" appeared at the right time and in the right place. And such a wonderful harmony allows the cardiovascular system to work clearly and correctly. Moreover, each of them has already managed to get its own name. The exit from the left atrium is provided with a left atrioventrular valve. Another name for it is bicuspid or mitral. It is called mitral because it resembles a Greek headdress - a mitre. The exit from the left ventricle, the ancestor of the systemic circulation, is the location of the aortic valve.

It is also called crescent in another way, because its three wings resemble crescents. The opening between the right atrium and the right ventricle is the location of the right atrioventricular valve. Its other name is tricuspid or tricuspid. The exit from the right ventricle into the pulmonary trunk is controlled by the pulmonary valve, also called the pulmonary valve. The pulmonary valve or pulmonary valve also has three leaflets, which also resemble crescents.

3 How valves work

Heart valves work in different ways. Mitral and tricuspid work in active mode. Aortic and pulmonary are passive, since their opening and closing is not supported by chords, as in the two above, but depends on pressure and blood flow. Therefore, the mechanism of operation of the leaflet and semilunar valves is different. When the blood pressure in the atria becomes equal to or exceeds that in the ventricles, the valve leaflets open into the cavity of the ventricles.

Being in a relaxed state, they do not interfere with the filling of the ventricles. Then the pressure in the ventricles begins to rise. Their walls tense up, and the contraction of the papillary muscles present in the wall of the ventricles pulls the tendon filaments - the chords. Thus, stretching like sails, the valves are protected from sagging into the atrial cavity, and blood is not thrown back. The semilunar valves are closed at this moment, as they need to perform an important function - to prevent blood from returning back from large vessels to the ventricles.

When the increasing pressure in the ventricle begins to exceed that in the efferent vessels, they open, and blood is expelled from the ventricles into the aorta and pulmonary trunk. In this case, the blood, seeking to get back into the chambers of the heart, first enters the pockets of the semilunar valves, which entails the slamming of the valves and an obstacle to retrograde blood reflux. This is how the human “pump” works thanks to the valve apparatus in response to received impulses from the conducting system. Filled with blood, the atria contract and push the blood into the ventricles, and the latter into the large vessels. And this work goes on twenty-four hours a day.

In the literature, one can find interesting data that the human heart is capable of pumping 40 liters of blood in one minute with a maximum load with its high activity. Despite the fact that the human body consists of several tens of trillions of cells, the entire cardiac cycle takes only 23 seconds. That is, the large and small circles of blood circulation do their job in less than half a minute.

An amazing organ is our heart. Each component of it is important and necessary, including the valve apparatus. Without their proper functioning, the cells of the body would not be able to receive oxygen and nutrients. Therefore, it is worth protecting the heart and taking care of it.

What are heart defects?

Heart defects are congenital or acquired lesions of the heart valves. Humans and mammals have 4 heart valves: tricuspid, bicuspid, or mitral, and 2 semilunar. The bicuspid (mitral) valve is formed by two leaflets that are attached to the edges of the left atrioventricular orifice. Through it, blood passes from the atrium to the ventricle, but the valve prevents its reverse flow.

Aortic valve - located between the left ventricle and the aorta, consists of 3 semilunar valves, they prevent the return of blood from the aorta to the ventricle.

The tricuspid valve has three leaflets that separate the right atrium and right ventricle. It prevents the return of blood from the ventricle to the atrium. The semilunar valve is one of the two heart valves, located at the exit of the aorta and pulmonary artery. Each valve has three leaflets that allow blood to flow in one direction - from the ventricles to the pulmonary trunk and aorta.

Due to various reasons, the functions of the heart valves can be disturbed. These defects may be congenital or acquired.

Symptoms of heart defects

• Dyspnea.
• Edema.
• Catarrhal bronchitis.
• Decreased performance.
• Irregular pulse.
• Dizziness and fainting.

Stenosis

One of heart defects- stenosis - narrowing of the valve opening. Due to stenosis of the tricuspid or bicuspid valve, blood flow in the affected half of the atrium slows down. With stenosis of the valves of the aorta or pulmonary trunk, due to a large overload of the heart, the corresponding ventricles are also affected. With incomplete closure, the heart works with overload. At the same time, blood flows through the openings of the valves not only in the right direction, but also in the opposite direction, so the heart has to eject blood again. If the damaged valves do not close enough during the contraction of the heart muscle, then acquired heart defects develop - insufficiency of the bicuspid or tricuspid valve. If the edges of the valves become scarred, their openings narrow and the movement of blood through them becomes difficult, then stenosis develops. Most often, stenosis of the valves of the left half of the heart (bicuspid and aorta) is manifested.

mitral valve stenosis

The disease progresses rather slowly. Symptoms: shortness of breath on exertion, cold extremities, irregular pulse. In addition, the disease is usually accompanied by cough, fatigue, heart palpitations. pain on the right side, swelling of the lower extremities. The skin of the lips and cheeks of the patient acquires a bluish tint. With radiography and other research methods, an enlarged left ventricle is visible, which is caused by a large overload of the heart.

Aortic valve stenosis

The valve does not fully open due to the narrowing of the gap between the movable flaps of the valve. For some time, the left ventricle is able to compensate for impaired blood flow. However, if malfunctions in the work of the ventricle begin, then the following symptoms appear: shortness of breath, dizziness, fainting, pain in the region of the heart. When performing heavy physical work, this heart disease especially dangerous due to the threat of sudden death.

Causes of valve stenosis

Most often heart defects are innate. They can be caused by rheumatic inflammation, bacterial endocarditis, septic endocarditis. Stenosis can occur with scarlet fever, less often as a result of injuries, atherosclerosis, syphilis. In all cases, the valve leaflets are soldered and narrowed. At the same time, the opening through which blood flows also narrows. Of course, valvular stenosis is possible due to scarring of the valve leaflets or tendon cords that remain after endocarditis - inflammation of the inner lining of the heart and its valves.

Stenosis of the right atrioventricular orifice

With stenosis of the right atrioventricular orifice due to damage to the tricuspid valve, blood flow in the vena cava slows down, while less blood is ejected into the right ventricle. The heart tries to compensate for this defect by a stronger contraction of the right atrium. However, blood quickly begins to accumulate even in the neck veins and liver. Severe edema appears and the patient begins to suffocate.

What is heart valve insufficiency?

Incomplete closure of the heart valve leads to the fact that during heart contractions the direction of blood flow changes. This dysfunction of the valve is called heart valve insufficiency. Any valve can fail, but the valves of the left heart are most commonly affected. An increase in the load leads to the fact that the heart does not cope with its task, as a result of which the heart muscle thickens, the patient develops heart failure and shortness of breath.

Sometimes a doctor diagnoses the insufficiency of one or another heart valve in a newborn. In many cases, small holes are found in the valve leaflets or pockets of the semilunar valves, or damage to these formations. However, among congenital heart defects, valvular stenosis is the most common. Holes in the valves or their damage can also be observed in adults. Valve insufficiency in them is more often manifested due to shortening of the ligaments that fix the valve in the heart cavity. Usually these changes are caused by rheumatism, bacterial infection, less often associated with atherosclerosis.

Another specific case is the so-called aneurysm of the heart valve, characterized by protrusion of the valve leaflets due to inflammation, congenital anomalies or degeneration. Sometimes a heart valve aneurysm leads to valve failure.

Treatment of heart defects

Treatment of heart disease start as soon as it is discovered. If heart disease is a complication of rheumatism or any other disease, then these diseases are treated first of all.

With the help of drugs, it is almost impossible to cure heart valve damage, surgery is necessary. Operations are of two types. The first type includes operations during which the heart valve is only tried to be cured, the second type includes operations to replace the natural heart valve with an artificial one. In some cases, the expansion of the affected valve allows you to remove or reduce the effects of stenosis. Often, the holes located on the walls of the valves are sutured.

Sometimes the only way out of the situation is the implantation of an artificial heart valve. Artificial valves are divided into: autologous, homologous and heterologous. Autologous prostheses are made from a person's own tissue, homologous prostheses are made from another person's tissue, heterologous prostheses are made from other materials, e.g. animal tissue or plastic. Artificial heart valves are devices equipped with a locking element.

Are heart defects dangerous?

The danger is connected, first of all, with the fact that the patient's heart is subjected to a greater load than the heart of a healthy person. In order to cope with this load, the heart muscle increases in size. However, subsequently, despite hypertrophy, the work of the heart weakens, and it pumps blood poorly. As a result, the patient develops total heart failure, characterized by a violation of the activity of the left and right heart. Thus, heart defects need urgent treatment.

Due to the fact that the heart pushes out an insufficient amount of blood, the blood supply to the tissues is disrupted, they receive less nutrients and oxygen. With the accumulation of blood in the heart and blood vessels, the danger increases: edema occurs, the functions of the lungs and other vital organs are impaired (venous pressure increases, the liver increases, fluid collects in the abdominal cavity). With absence treatment of heart defects lead to heart failure. which can lead to the death of the patient.

Etiology of aortic insufficiency

The most common causes of organic aortic valve insufficiency are:

• Rheumatism (about 70% of cases);
• infective endocarditis;
• Rarer causes of this defect include atherosclerosis, syphilis, systemic lupus erythematosus (Libman-Sachs lupus endocarditis), rheumatoid arthritis, etc.

In rheumatic endocarditis, thickening, deformity, and wrinkling of the semilunar valve leaflets occur. As a result, their tight closure during diastole becomes impossible, and a valve defect is formed.

Infective endocarditis often affects previously altered valves (rheumatic disease, atherosclerosis, congenital anomalies, etc.), causing deformation, erosion or perforation of the valves.

It should be borne in mind the possibility of relative insufficiency of the aortic valve as a result of a sharp expansion of the aorta and the annulus of the valve in the following diseases:

• arterial hypertension;
• aortic aneurysms of any origin;
• ankylosing rheumatoid spondylitis.

In these cases, as a result of the expansion of the aorta, the cusps of the aortic valve diverge (separate) and they also do not close during diastole.

Finally, one should be aware of the possibility of a congenital aortic valve defect, for example, the formation of a congenital bicuspid aortic valve or aortic dilation in Marfan syndrome, etc.

Aortic valve insufficiency in congenital defects is rare and often associated with other congenital defects.

Aortic valve insufficiency causes a significant amount of blood (regurgitation) ejected into the aorta to return back into the left ventricle during diastole. The volume of blood returning to the left ventricle may exceed half of the total cardiac output.

Thus, with aortic valve insufficiency, during diastole, the left ventricle is filled as a result of both blood flow from the left atrium and aortic reflux, which leads to an increase in end-diastolic volume and diastolic pressure in the cavity of the left ventricle.

As a result, the left ventricle increases and significantly hypertrophies (the final diastolic volume of the left ventricle can reach 440 ml, at a rate of 60-130 ml).

Hemodynamic changes

Loose closure of the aortic valve leaflets leads to regurgitation of blood from the aorta into the left ventricle during diastole. The reverse flow of blood begins immediately after the closing of the semilunar valves, i.e. immediately after the II tone, and can continue throughout the diastole.

Its intensity is determined by the changing pressure gradient between the aorta and the LV cavity, as well as by the size of the valvular defect.

Mitralization of vice- the possibility of "mitralization" of aortic insufficiency, i.e. the occurrence of relative insufficiency of the mitral valve with significant dilatation of the left ventricle, dysfunction of the papillary muscles and expansion of the fibrous ring of the mitral valve.

At the same time, the valve leaflets are not changed, but they do not completely close during ventricular systole. Usually, these changes develop in the late stages of the disease, with the occurrence of LV systolic dysfunction and pronounced myogenic dilatation of the ventricle.

"Mitralization" of aortic valve insufficiency leads to regurgitation of blood from the LV to the LA, expansion of the latter and a significant aggravation of stagnation in the pulmonary circulation.

The main hemodynamic consequences of aortic valve insufficiency are:

Compensatory eccentric LV hypertrophy (hypertrophy + dilatation), which occurs at the very beginning of the formation of the defect. Signs of left ventricular systolic insufficiency, stagnation of blood in the pulmonary circulation and pulmonary hypertension, developing with decompensation of the defect. Some features of the blood filling of the arterial vascular system of the systemic circulation:

- increased systolic blood pressure;

- low diastolic blood pressure;

- increased pulsation of the aorta, large arterial vessels, and in severe cases - muscle-type arteries (arterioles), due to an increase in the filling of arteries in systole and a rapid decrease in filling in diastole;

- impaired perfusion of peripheral organs and tissues due to a relative decrease in effective cardiac output and a tendency to peripheral vasoconstriction.

Relative insufficiency of coronary blood flow.

1. Eccentric hypertrophy of the left ventricle

An increase in diastolic filling of the left ventricle with blood leads to a volume overload of this part of the heart and an increase in the EDV of the ventricle.

As a result, a pronounced eccentric LV hypertrophy develops (myocardial hypertrophy + dilatation of the ventricular cavity) - the main mechanism for compensating for this defect. For a long time, an increase in the force of contraction of the left ventricle, which is due to the increased muscle mass of the ventricle and the activation of the Starling mechanism, ensures the expulsion of the increased blood volume.

Another peculiar compensatory mechanism is tachycardia characteristic of aortic insufficiency, leading to a shortening of diastole and some limitation of blood regurgitation from the aorta.

2. Cardiac decompensation

Over time, there is a decrease in LV systolic function and, despite the continued increase in EDV of the ventricle, its stroke volume no longer increases or even decreases. As a result, blood pressure in the LV, filling pressure and, accordingly, pressure in the LA and veins of the pulmonary circulation increase. Thus, pulmonary congestion in the event of LV systolic dysfunction (left ventricular failure) is the second hemodynamic consequence of aortic valve insufficiency.

In the future, with the progression of violations of LV contractility, persistent pulmonary hypertension and hypertrophy develop, and in rare cases, pancreatic insufficiency. In this regard, it should be noted that in decompensated aortic valve insufficiency, as well as in decompensated aortic stenosis, clinical manifestations of left ventricular failure and blood stasis in the pulmonary circulation always predominate, while signs of right ventricular failure are mild or (more often) absent altogether.

The third hemodynamic consequence of aortic valve insufficiency is the significant features of filling the arterial bed of the systemic circulation with blood, which are often detected even in the stage of defect compensation, i.e. before the development of left ventricular failure. The most significant of them are:

- decrease in diastolic pressure in the aorta, which is explained by regurgitation of part of the blood (sometimes significant) in the left ventricle

- a pronounced increase in pulse pressure in the aorta, large arterial vessels, and in severe aortic valve insufficiency - even in muscle-type arteries (arterioles). This diagnostically important phenomenon occurs as a result of a significant increase in left ventricular velocity (increase in systolic blood pressure) and a rapid return of part of the blood to the left ventricle (“emptying” of the arterial system), accompanied by a drop in diastolic blood pressure. It should be noted that an increase in the pulse fluctuations of the aorta and large arteries and the appearance of arteriole pulsations unusual for resistive vessels underlie numerous clinical symptoms detected in aortic valve insufficiency.

4. "Fixed" cardiac output

It was shown above that in aortic insufficiency at rest for a long time, the LV can provide ejection of an increased systolic blood volume into the aorta, which fully compensates for the excess diastolic filling of the LV.

However, during physical activity, i.e. under conditions of even greater intensification of blood circulation, the compensatory increased pumping function of the left ventricle is not enough to "cope" with an even more increased volume overload of the ventricle, and a relative decrease in cardiac output occurs.

5. Impaired perfusion of peripheral organs and tissues

With prolonged existence of aortic valve insufficiency, a peculiar paradoxical situation arises: despite a sharp increase in cardiac output (more precisely, its absolute values), a decrease in perfusion of peripheral organs and tissues is observed.

This is primarily due to the inability of the LV to further increase stroke volume during physical and other types of exercise (fixed VR). With decompensation of the defect, a decrease in LV systolic function (both at rest and during exercise) is also of great importance. Finally, activation of the SAS, RAAS, and tissue neurohormonal systems, including endothelial vasoconstrictor factors, also plays a certain role in peripheral blood flow disorders.

With severe aortic regurgitation, perfusion disorders of peripheral organs and tissues can also be caused by the described features of the blood filling of the arterial vascular system, namely: a rapid outflow of blood from the arterial system or, at least, a stop or slowdown in the movement of blood through the peripheral vessels during diastole.

6. Insufficiency of coronary circulation

Of particular note is another important consequence of aortic valve insufficiency - the occurrence of coronary circulation insufficiency, which is explained by two main reasons associated with the peculiarities of intracardiac hemodynamics in this defect:

- low diastolic pressure in the aorta.

As is known, the filling of the coronary vascular bed of the left ventricle occurs during diastole, when the intramyocardial tension and diastolic pressure in the LV cavity decreases and, accordingly, the pressure gradient between the aorta (about 70–80 mm Hg) and the LV cavity (5– 10 mm Hg), which determines the coronary blood flow. It is clear that a decrease in diastolic pressure in the aorta leads to a decrease in the aortic-left ventricular gradient, and coronary blood flow drops significantly.

- the second factor leading to the occurrence of relative coronary insufficiency is a high intramyocardial tension of the LV wall during ventricular systole, which, according to Laplace's law, depends on the level of intracavitary systolic pressure and LV radius. Pronounced dilatation of the ventricle is naturally accompanied by an increase in the intramyocardial tension of its wall. As a result, the work of the left ventricle and myocardial oxygen demand sharply increase, which is not fully provided by the coronary vessels, which function in unfavorable conditions from a hemodynamic point of view.

Clinical manifestations

Formed aortic valve insufficiency for a long time (10–15 years) may not be accompanied by subjective clinical manifestations and may not attract the attention of the patient and the doctor. The exception is cases of acute aortic valve insufficiency in patients with infective endocarditis, dissecting aortic aneurysm, etc.

One of the first clinical manifestations of the disease is unpleasant sensation of increased pulsation in the neck, in the head, as well as increased heart beats (patients "feel their heart"), especially when lying down. These symptoms are associated with high cardiac output and pulse pressure in the arterial system, described above.

These feelings are often accompanied by cardiopalmus. associated with sinus tachycardia characteristic of aortic valve insufficiency.

With a significant aortic valve defect, the patient may develop dizziness. a sudden feeling of faintness and even a tendency to faint, especially with exertion or a rapid change in body position. This indicates cerebrovascular insufficiency caused by the inability of the left ventricle to adequately change cardiac output (fixed stroke volume) and impaired cerebral perfusion.

Heartache(angina pectoris) - can also occur in patients with a severe aortic valve defect, and long before the onset of signs of LV decompensation. Pain is usually localized behind the sternum, but often differ in character from typical angina pectoris.

They are not as often associated with certain external provoking factors (for example, physical activity or emotional stress) as angina attacks in patients with coronary artery disease. Pain often occurs at rest and is of a pressing or compressive nature, usually continues for a long time and is not always well stopped by nitroglycerin. The attacks of nocturnal angina, accompanied by profuse sweating, are especially difficult for patients to tolerate.

Typical anginal attacks in patients with aortic valve insufficiency, as a rule, indicate the presence of concomitant coronary artery disease and atherosclerotic narrowing of the coronary vessels.

The period of decompensation is characterized by the appearance of signs of left ventricular failure.

Dyspnea first appears during exercise, and then at rest. With a progressive decline in LV systolic function, shortness of breath becomes orthopnea.

Then asthma attacks (cardiac asthma and pulmonary edema) join it. Characterized by the appearance of fatigue during exercise, general weakness. For obvious reasons, all symptoms associated with insufficiency of cerebral and coronary circulation are exacerbated by the occurrence of left ventricular failure. Finally, in more rare cases, when for a long time persists and progresses pulmonary hypertension. and patients do not die from left ventricular failure, individual signs of blood stagnation in the venous bed of the systemic circulation (edema, heaviness in the right hypochondrium, dyspeptic disorders) associated with a drop in the systolic function of the hypertrophied pancreas can be detected.

However, this does not happen more often, and the above-described symptoms predominate in the clinical picture, due to damage to the left heart, features of the blood filling of the arterial vascular system of the large circle, and signs of blood stagnation in the veins of the pulmonary circulation.

Inspection

During a general examination of patients with aortic insufficiency, first of all, the pallor of the skin, indicating insufficient perfusion of peripheral organs and tissues, attracts attention.

With a pronounced aortic valve defect, numerous external signs of systolic-diastolic pressure drops in the arterial system, as well as increased pulsation of large and smaller arteries, can be detected:

• increased pulsation of the carotid arteries(“Dance of the carotid”), as well as a pulsation visible to the eye in the area of ​​​​all superficially located large arteries (brachial, radial, temporal, femoral, arteries of the rear of the foot, etc.);
• de Musset's sign- rhythmic shaking of the head forward and backward in accordance with the phases of the cardiac cycle (in systole and diastole);
• Quincke's symptom("capillary pulse", "precapillary pulse") - alternating redness (in systole) and blanching (in diastole) of the nail bed at the base of the nail with sufficiently intense pressure on its top. In a healthy person, with such pressure, both in systole and in diastole, a pale color of the nail bed is preserved. A similar variant of Quincke's "precapillary pulse" is detected when pressing on the lips with a glass slide;
• Landolfi's symptom- pulsation of the pupils in the form of their narrowing and expansion;
• Muller's sign- pulsation of the soft palate.

Palpation and percussion of the heart

The apex beat is significantly enhanced due to LV hypertrophy, diffuse ("domed") and shifted to the left and down (LV dilatation). With a pronounced aortic valve defect, the apex beat can be determined in the VI intercostal space along the anterior axillary line.

Systolic trembling is often detected at the base of the heart - along the left and right edges of the sternum, in the jugular notch, and even on the carotid arteries. In most cases, it does not indicate concomitant aortic stenosis of the aortic orifice, but is associated with the rapid ejection of an increased volume of blood through the aortic valve. In this case, the opening of the aortic valve becomes relatively "narrow" for a sharply increased volume of blood ejected during the period of expulsion into the aorta. This contributes to the occurrence of turbulence in the region of the aortic valve, the clinical manifestation of which is low-frequency systolic tremor, detected by palpation, and functional systolic murmur at the base of the heart, determined by auscultation.

Diastolic trembling in the precordial region with aortic valve insufficiency is extremely rare.

Percussion in all patients with aortic insufficiency is determined by a sharp shift of the left border of the relative dullness of the heart to the left. The so-called aortic configuration with an emphasized "waist" of the heart is characteristic.

Only when dilatation of the LA occurs, due to the “mitralization” of the defect, can smoothing of the “waist” of the heart occur.

Auscultation of the heart

Typical auscultatory signs of aortic insufficiency are diastolic murmur on the aorta and at the Botkin point, weakening of II and I heart sounds, as well as the so-called "accompanying" systolic murmur on the aorta of a functional nature.

I tone changes. Usually, the 1st tone at the apex is weakened as a result of a sharp LV volume overload and a slowdown in the isovolumic contraction of the ventricle. Sometimes I tone is split.

II tone changes. Depending on the etiology of the defect, the II tone can either increase or decrease until it disappears. Deformation and shortening of the valve leaflets due to rheumatism or infective endocarditis contributes to the weakening of the II tone on the aorta or its disappearance. Syphilitic damage to the aorta is characterized by an increased II tone with a metallic tinge (“ringing” II tone).

Pathological III tone auscultated in aortic insufficiency quite often. The appearance of the third tone indicates a pronounced volume overload of the left ventricle, as well as a decrease in its contractility and diastolic tone.

diastolic murmur on the aorta is the most characteristic auscultatory sign of aortic insufficiency. Noise is best heard in the II intercostal space to the right of the sternum and in the III-IV intercostal space at the left edge of the sternum and is carried out to the apex of the heart.

Diastolic murmur in aortic insufficiency begins in the proto-diastolic period, i.e. immediately after the second tone, gradually weakening throughout the diastole. Depending on the degree of regurgitation, the frequency response of diastolic murmur changes: slight regurgitation is accompanied by a soft blowing, predominantly high-frequency murmur; with severe regurgitation, a mixed frequency composition of the noise is determined, severe regurgitation leads to the appearance of coarser low- and mid-frequency noise. This nature of the noise is observed, for example, in syphilitic lesions of the aorta.

It should be remembered that with decompensation of the defect, tachycardia, as well as with combined aortic heart disease, the intensity of the diastolic murmur of aortic insufficiency decreases.

Functional noises

Functional diastolic Flint murmur- this is a presystolic murmur of relative (functional) stenosis of the left atrioventricular orifice, which is occasionally heard in patients with organic aortic valve insufficiency.

It occurs as a result of the displacement of the anterior leaflet of the mitral valve by the regurgitant blood stream from the aorta, which creates an obstacle to the diastolic blood flow from the LA to the LV during active atrial systole.

In the genesis of this noise, the vibration of the leaflets and chords of the mitral valve, which occurs as a result of the “collision” of turbulent blood flows entering the LV cavity from the aorta and LA, is probably also important.

At the same time, at the apex of the heart, in addition to the wired organic diastolic murmur of aortic insufficiency, there is also a presystolic amplification of the murmur - Flint's murmur.

Functional systolic murmur relative stenosis of the aortic orifice is often heard in patients with organic aortic valve insufficiency.

Noise arises due to a significant increase in the systolic volume of blood ejected into the LV aorta during the period of exile, for which the normal unchanged opening of the aortic valve becomes relatively narrow - a relative (functional) stenosis of the aortic orifice is formed with turbulent blood flow from the LV to the aorta.

At the same time, on the aorta and at the Botkin point, in addition to the organic diastolic murmur of aortic insufficiency, during the expulsion of blood, a functional systolic murmur is heard, which can be carried out to the entire region of the sternum, the apex of the heart and spread to the region of the jugular notch and along the carotid arteries.

When examining the vascular system in patients with aortic valve insufficiency, it is necessary to pay attention to the existence of two more vascular auscultatory phenomena:

1. Symptom of Durozier (double noise of Durozier). This unusual auscultatory phenomenon is heard over the femoral artery in the groin, just below the pupart ligament.

With a simple application of a stethoscope in this area (without pressure), the tone of the femoral artery can be determined - a sound synchronous with the local arterial pulse. With gradual pressure with the head of the stethoscope in this area, an artificial occlusion of the femoral artery is created and a quiet and short, and then more intense systolic murmur begins to be heard at first.

Subsequent compression of the femoral artery sometimes results in a diastolic murmur. This second murmur is quieter and shorter than the systolic murmur. The phenomenon of Durozier's double noise is usually explained by a greater than normal volumetric blood flow velocity or retrograde (towards the heart) blood flow in large arteries.

2. Double tone Traube- a rather rare sound phenomenon, when two tones are heard (without compression of the vessel) on a large artery (for example, the femoral one). The second tone is usually associated with the reverse flow of blood in the arterial system, due to severe regurgitation of blood from the aorta to the left ventricle.

Arterial pressure

In aortic insufficiency, there is an increase in systolic and a decrease in diastolic blood pressure, resulting in an increase in pulse blood pressure.

The decrease in diastolic pressure in aortic valve insufficiency requires comment. With direct invasive measurement of blood pressure in the aorta, diastolic pressure never drops below 30 mm Hg. Art. However, when measuring blood pressure by the Korotkov method in patients with severe aortic valve insufficiency, diastolic pressure is often reduced to zero. This means that during the measurement of blood pressure, when the pressure in the cuff decreases below the true diastolic pressure in the aorta above the artery, Korotkoff sounds continue to be heard.

The reason for this discrepancy between direct and indirect BP measurements lies in the mechanisms by which Korotkoff sounds appear during BP measurements. One way or another, Korotkoff sounds are determined by auscultation as long as intermittent blood flow persists in a large artery. In a healthy person, such a “pulsating” blood flow is artificially created by squeezing the brachial artery with a cuff. When the pressure in the cuff reaches diastolic blood pressure, the difference between the blood flow velocity in the brachial artery in systole and diastole decreases, and Korotkoff sounds sharply weaken (phase IV of Korotkoff sounds) and disappear completely (phase V).

Severe aortic valve insufficiency is characterized by the constant existence of a large circle of "pulsating" blood flow in the arterial system. Therefore, if you listen to the area of ​​​​a large artery (even without squeezing it with a cuff), sometimes (with severe aortic insufficiency) you can listen to sounds resembling Korotkov's tones. It should be remembered that "infinite tone" on a large artery (or diastolic blood pressure = 0) can also be determined with a pronounced decrease in the tone of the arterial wall, for example, in patients with neurocirculatory dystonia.

In most cases, the pulse on the radial artery has characteristic features: a rapid rise (growth) of the pulse wave is determined and its equally sharp and rapid decline.

The arterial pulse becomes fast, high, large and fast (pulsus celer, altus, magnus et frequens). Such a pulse, creating an alternation of fast and strong tension in the walls of the arteries, can lead to the fact that on the arteries, where sounds are not normally heard, tones begin to be determined. Moreover, the severity of pulsus celer et magnus can be reflected in the appearance of the so-called "palm tone", determined on the inner surface of the patient's hand, applied to the doctor's ear.

Instrumental diagnostics

ECG

An electrocardiographic study reveals a turn of the electrical axis of the heart to the left, an increase in the R wave in the left chest leads, and, in the future, a downward shift of the ST segment and inversion of the T wave in the standard and left chest leads.

With aortic valve insufficiency on the ECG are determined:

With aortic valve insufficiency, in most cases, signs of severe LV hypertrophy are detected without its systolic overload, i.e. without changing the end part of the ventricular complex. Depression of the RS-T segment and smoothness or inversion of T are observed only during the period of decompensation of the defect and the development of heart failure. With "mitralization" of aortic insufficiency, in addition to signs of LV hypertrophy, signs of left atrial hypertrophy (P-mitrale) may appear on the ECG.

X-ray examination

In aortic valve insufficiency, as a rule, distinct radiological signs of LV dilatation are detected. In direct projection, already at the earliest stages of the development of the disease, a significant elongation of the lower arc of the left contour of the heart and a displacement of the apex of the heart to the left and down are determined.

In this case, the angle between the vascular bundle and the LV contour becomes less obtuse, and the “waist” of the heart becomes more emphasized (“aortic” configuration of the heart). In the left anterior oblique projection, there is a narrowing of the retrocardial space.

echocardiography

An echocardiographic study reveals a number of characteristic symptoms. The end diastolic size of the left ventricle is increased. Hyperkinesia of the posterior wall of the left ventricle and interventricular septum is determined. High-frequency flutter (trembling) of the anterior leaflet of the mitral valve, interventricular septum, and sometimes the posterior leaflet during diastole is recorded. The mitral valve closes prematurely, and during the period of its opening, the amplitude of movement of the valves is reduced.

Cardiac catheterization

When catheterizing the heart and conducting appropriate invasive studies in patients with aortic insufficiency, an increase in cardiac output, KDD in the LV and the volume of regurgitation are determined. The latter indicator is calculated as a percentage in relation to stroke volume. The volume of regurgitation quite well characterizes the degree of aortic valve insufficiency.

Diagnosis and differential diagnosis

Recognition of aortic valve insufficiency usually does not cause difficulties with diastolic murmur at the Botkin point or on the aorta, an increase in the left ventricle and certain peripheral symptoms of this defect (large pulse pressure, an increase in the pressure difference between the femoral and brachial arteries up to 60-100 mm Hg. .characteristic changes in pulse).

However, diastolic murmur on the aorta and at the V point can also be functional, for example, with uremia. With combined heart defects and small aortic insufficiency, the recognition of the defect can be difficult. In these cases, Echocardiographic examination helps, especially in combination with Doppler cardiography.

The greatest difficulties arise in establishing the etiology of this defect. Other rare causes are possible: myxomatous valve disease, mucopolysaccharidosis, osteogenesis imperfecta.

Rheumatic origin heart disease can be confirmed by history data: approximately half of these patients have indications of typical rheumatic fever. Convincing signs of mitral or aortic stenosis also speak in favor of a rheumatic etiology of the defect. Identification of aortic stenosis can be difficult. Systolic murmur over the aorta, as already mentioned above, is also heard with pure aortic insufficiency, and systolic trembling over the aorta occurs only with its sharp stenosis. In this regard, echocardiography is of great importance.

The appearance of aortic insufficiency in a patient with rheumatic mitral heart disease is always suspicious for the development infective endocarditis. although it may be due to recurrence of rheumatism. In this regard, in such cases, it is always necessary to conduct a thorough examination of the patient with repeated blood cultures. Insufficiency of the aortic valve of syphilitic origin in recent years is much less common. Diagnosis is facilitated by identifying signs of late syphilis in other organs, such as damage to the central nervous system. In this case, the diastolic murmur is heard better not at the Botkin-Erb point, but above the aorta - in the second intercostal space on the right and spreads widely down, on both sides of the sternum. The ascending aorta is dilated. In a significant number of cases, positive serological reactions are detected, and the immobilization reaction of pale treponema is of particular importance.

Aortic insufficiency may be due to atherosclerosis. With atheromatosis of the aortic arch, the valve ring expands with the occurrence of slight regurgitation, atheromatous lesions of the valve leaflets are less common. With rheumatoid arthritis (seropositive), aortic insufficiency is observed in approximately 2-3% of cases, and with a long course (25 years) of Bechterew's disease, even in 10% of patients. Cases of rheumatoid aortic insufficiency are described long before the appearance of signs of damage to the spine or joints. Even less often, this defect is observed in systemic lupus erythematosus (according to V.S. Moiseev, I.E. Tareeva, 1980, in 0.5% of cases).

Prevalence Marfan syndrome in expressed form, according to various sources, from 1 to 46 per 100,000 population.

Cardiovascular pathology, along with typical changes in the skeleton and eyes, is part of this syndrome, but is found with difficulty in almost half of these patients only with the help of echocardiography. In addition to the typical damage to the aorta with the development of its aneurysm and aortic insufficiency, damage to the aortic and mitral valves is possible. With a clear family predisposition and pronounced extracardiac signs of cardiovascular pathology, the syndrome is detected in childhood. If the anomalies of the skeleton are not very pronounced, as in the patient described above, then heart damage can be detected at any age, however, usually in the third, fourth and even sixth decades of life. Changes in the aorta relate primarily to the muscle layer; necroses with cysts are found in the wall, fibromic-somatous changes in valves are possible. Aortic regurgitation often progresses gradually, but it may appear or worsen suddenly.

Cystic necrosis without other features of Marfan's syndrome is called Erdheim syndrome. It is believed that similar changes can simultaneously or independently occur in the pulmonary arteries, causing them, the so-called congenital idiopathic expansion. An important differential diagnostic feature that makes it possible to distinguish aortic lesions in Marfan syndrome from syphilitic ones is the absence of its calcification. Damage to the mitral valve and chords with their break occurs only in some patients, usually accompanies damage to the aorta and leads to prolapse of the mitral valve leaflets with mitral insufficiency.

A rare cause of aortic regurgitation may be Takayasu's disease- nonspecific aortoarteritis, which occurs mainly in young women in the second - third decade of life and is associated with immune disorders. The disease usually begins with general symptoms: fever, weight loss, joint pain. In the future, the clinical picture is dominated by signs of damage to large arteries extending from the aorta, more often from its arch. Due to impaired patency in the arteries, the pulse often disappears, sometimes only on one arm. Damage to the large arteries of the aortic arch can lead to cerebrovascular insufficiency and visual impairment. Damage to the renal arteries is accompanied by the development of arterial hypertension. Insufficiency of valves, aorta may be due to the expansion of the aortic arch in patients with giant cell arteritis. This disease develops in the elderly, manifested by damage to the temporal arteries, which, in typical cases, are palpable in the form of a dense, painful, nodular cord. Possible damage to the intracardiac arteries.

Aortic insufficiency is often combined with a variety of extracardiac manifestations, a careful analysis of which allows us to establish the nature of heart disease.

Forecast

The life expectancy of patients, even with severe aortic insufficiency, is usually more than 5 years from the moment of diagnosis, and in half - even more than 10 years.

The prognosis worsens with the addition of coronary insufficiency (angina attacks) and heart failure. Drug therapy in these cases is usually ineffective. The life expectancy of patients after the onset of heart failure is about 2 years. Timely surgical treatment significantly improves the prognosis.

Heart valve insufficiency

Incomplete closure of the heart valves causes some of the blood to flow back, from a cavity with high pressure to a cavity with less pressure.

This is heart valve insufficiency, which leads to an additional load on the heart, an increase in direct blood flow through the valve.

There is a fatigue of the heart, stretching of the cavities of the heart and large vessels at the valve.

Valve failure and causes

When there is insufficiency of the heart valve, then the ventricle adjacent to it should increase in size in proportion to the flowing volume of blood. The left ventricle is conical in shape and experiences higher pressure and is therefore more likely to be affected by valvular insufficiency than the sickle right ventricle, which is subjected to markedly less pressure. That is why heart failure is more often observed with valve insufficiency of the left side of the heart.

Diagnostics

Valve insufficiency is diagnosed in three stages. At the first stage, the very fact of insufficiency is established, which is determined by the characteristic regurgitation noise, and it is also recognized which particular valve is affected. The noise of regurgitation always captures the relaxation phase. Auscultation (listening) is carried out over the aorta at the upper right edge of the sternum, the pulmonary trunk located at the upper left edge of the sternum, the mitral valve, and the tricuspid valve at the lower left edge of the sternum. In these places, the noises characteristic of valve insufficiency are best heard. Listening is enough to make a diagnosis.

The second stage should show the severity of valve insufficiency. Refinement is done using:

• physical research,
• radiography,
• the patient's complaints are also taken into account.

The third stage is to determine the origin of this pathology, since such knowledge determines the treatment regimen.

Venous insufficiency of the heart

Physical inactivity, characteristic of modern life, which manifests itself in prolonged sitting or standing in one place, and sometimes the existing congenital features of the hormonal status and vascular system often end in problems with venous outflow of blood.

Venous insufficiency is defined as insufficiency of deep vein valves. This is a very common pathology, which, unfortunately, is often not paid due attention. Scientists argue that this is a payment of man to nature for walking upright.

Venous valves occur in both deep and superficial veins. With deep vein thrombosis of the lower extremities, their lumen is clogged, and when it is restored, the valves remain affected. Veins lose and their fibrosis begins, as a result, the valves of the veins are destroyed and that prevents normal blood flow.

Valves are needed by the body to counteract the reverse flow of blood through the veins of the legs, and if they are insufficient, venous insufficiency appears. Pain and heaviness in the legs begin, in the evenings, swelling is observed that disappears by morning, night cramps come, a noticeable change in the color of the skin in the lower part of the leg, loss of skin elasticity, and the appearance of varicose veins. In a later stage, dermatitis, eczema and trophic ulcers are possible, mostly in the ankle area.

Treatment of valve insufficiency

Deep vein valve insufficiency is treated with compression therapy, for which elastic bandages are used, but it is better to use special compression stockings.

Treatment with sclerotherapy consists in the introduction into the vein of certain substances that irritate the inner wall of the veins, which causes its chemical burn. In this case, the walls of the veins stick together and their infection occurs. These drugs include:

ethoxysclerol, fibrovein and thrombovar. The compression of the veins is continued for three months.

Surgical methods of treatment are also used, for example, removal of a conglomerate of varicose veins or ligation of the confluence of the saphenous vein of the thigh into the femoral vein.