Aortic valve insufficiency
aortic valve deficiency is a pathological movement of aortic valve structures, the result of which is the development of severe regurgitation of the blood flow into the left ventricular cavity from the aortic lumen during diastole. Insufficiency of the aortic valve as an isolated acquired cardiac defect develops quite rarely and is no more than 14% in the overall structure of the incidence of all malformations. Significantly more patients develop a combined damage to the valvular heart apparatus in the form of aortic estuary insufficiency and stenosis, with the male half of humanity accounting for more than 75% of such cases.
Aortic valve insufficiency in children as an isolated organic heart lesion occurs in no more than 3% of cases and is verified only at the stage of development of severe cardiohemodynamics disorders.
reasons aortic
valve Until recently, the only etiopathogenetic mechanism of aortic valve of varying severity was syphilitic or rheumatic heart failure, and for each of these specific pathologies characterized difference in pathological manifestations( rheumatism mostly leaflet suffer a deformation, Fracture and even rupture, and with syphilis - valve ring, which sharply expands).
In connection with the successful use of preventive treatment of Diseases, now aortic valve regurgitation of rheumatic and syphilitic origin is extremely rare, and in the forefront in the etiology of this vice are the congenital disorders of connective tissue with a primary lesion of the ascending aorta. With the Marfan syndrome, idiopathic necrosis of the mediators of the ascending aorta and Takayasu syndrome, the so-called chronic variant of the aortic valve failure progresses.
acute severe regurgitation on aortic valve is rare and develops against the background of infective endocarditis, acute aortic dissection, rupture of an aortic aneurysm or aortic valve subjected myxomatous changes.
Congenital insufficiency of the aortic valve in an isolated variant is practically not found and is diagnosed exclusively in combination with other cardiac defects.
Symptoms of aortic valve
moderate aortic valve regurgitation is characterized slowly progressive course and a long asymptomatic period during which the patient has absolutely no complaints about the change in health status, while valvular already changing. The most common complaint of patients, long suffering from aortic valve insufficiency, is the appearance of an unpleasant sensation in the area of the heart, which has a clear connection with its contraction. A characteristic feature is an increase in the feeling of palpitations when the body is in a horizontal position on the left side, and also after pronounced physical activity.
During the period of the expanded clinical symptom complex, symptoms of heart failure appear in the foreground in the form of increasing respiratory disorders, swelling of the extremities and severe weakness.
specific clinical criteria aortic valve regurgitation is the appearance of a syphilitic nature of the patient's pain in an "anginal attacks" during the night, due to an increase in the voltage of left ventricular myocardium in a physiological bradycardia.
Some patients experience a sharp dizziness, up to a brief loss of consciousness of an orthostatic nature( their appearance is associated with a sharp change in the position of the body in space).This symptom is a consequence of the acute development of ischemic damage to the structures of the brain due to the fall of the intraluminal pressure gradient in the aorta during diastole.
The course of aortic valve insufficiency of rheumatic genesis has some features, consisting in the long-term formation of hemodynamic disorders( at least seven years after acute rheumatism).
Due to the lack of severity of clinical manifestations in this cardiac defect, the objective verification data of the patient and the results of instrumental examination are of primary importance in the correct verification of the diagnosis. There are absolute visual criteria that allow the diagnosis to be correctly established at the stage of unfolded hemodynamic disorders, and include: increased pulsation in the projection of the jugular notch and anterior abdominal wall, which corresponds to the projection of the arch of the aorta and its abdominal region, marked pulsation at the neck at the site of carotid artery localization, A sign of Mueller, consisting of a pronounced pulsation of the tonsils and the tongue, a sign of Landolphi, consisting in systolic constriction and diastolic dilatation of the pupils.
With palpation of the pulse, tachycardia is noted, but the pulse becomes not only fast, but also high and short. The pronounced insufficiency of the aortic valve is accompanied by changes in the pulse pressure, consisting in an increase in the systolic pressure and a decrease in the diastolic index.
In a situation where the patient has a pronounced progressive regurgitation, when performing palpation of the apical impulse, not only his displacement to the left half of the thorax is noted, but also the appearance of the so-called "cardiac shock".However, the most significant for the implementation of the primary diagnosis of aortic valve insufficiency, as a cardiac defect, is the detection of auscultatory changes in the form of the appearance of specific cardiac murmurs.
Thus, the proto-diastolic murmur for this viral is heard in the projection of the third-fourth intercostal space along the left parasternal line and is carried to the apex of the heart. With a small degree of regurgitation, one should perform auscultation of the heart in the position of the patient sitting at the height of the maximum expiration. In addition, with isolated aortic valve insufficiency, both the first and second heart tone is weakened, and in the development of signs of left ventricular failure, an additional third tone is auscultated. A specific auscultatory criterion of aortic valve insufficiency is the appearance of a loud clapping systolic tone( Traube tone) over the femoral artery.
Degrees of aortic valve insufficiency
The development of aortic valve insufficiency, like that of any other cardiac defect, is gradual, regardless of the etiology of the disease. Each of the pathogenetic stages is characterized by some or other cardiogeodynamic changes, which is reflected in the patient's state of health. The division of aortic defect in severity is used by cardiologists, and to a greater extent by cardiosurgeons in daily practice, since for each degree the use of a certain volume of therapeutic measures is indicated. The classification is based on both clinical criteria and indicators of instrumental research methods, therefore, every patient with a suspicious or previously established diagnosis of "aortic valve insufficiency" needs to undergo a full range of clinical and instrumental examinations.
According to the worldwide cardiological classification, aortic valve insufficiency is divided into four degrees.
The earliest, 1 degree of aortic valve insufficiency is characterized by asymptomatic flow and complete compensation of hemodynamic disorders. The only criterion that allows to establish the correct diagnosis at this stage of the disease is the detection of a small amount of blood( no more than 15%) regurgitating on the valve flaps, which in the Doppler study of the heart is manifested as a "blue stream" with a length of no more than 5 mm from the valves of the aortic valve. Detection of aortic valve failure grade 1 is not a basis for surgical correction of the defect.
2 The degree of aortic valve failure, or the period of "latent heart failure" is characterized by the appearance of complaints of a non-specific nature, appearing only after excessive physical activity. When registering electrocardiography, there are signs in this category of patients that allow to suspect changes in the left ventricle of a hypertrophic nature. The volume of the reverse blood flow in the Doppler study does not exceed 30%, and the length of the "blue blood flow" reaches 10 mm.
3 the degree of aortic valve insufficiency, or the period of unfolded clinical symptoms, is characterized by a marked decrease in efficiency, the appearance of a typical anginal pain syndrome, changes in blood pressure indicators. In the electrocardiographic study, in addition to signs of hypertrophic changes in the left ventricle, the criteria for ischemic myocardial damage are found. Echocardiographic criteria are the detection of a "blue stream" on the aortic valve with a length of more than 10 mm, which corresponds to a blood volume of up to 50%.
The fourth or terminal degree of aortic valve insufficiency is accompanied by severe hemodynamic disorders in the form of the development of a powerful regurgitant flow, in excess of 50%.At this stage, there is a marked dilatation of all cavitary structures of the heart and the development of relative mitral insufficiency.
Treatment of aortic valve insufficiency
Cardiologic and cardiosurgical specialists all over the world adhere to the position of expediency of used medical or surgical treatment. Thus, patients with initial aortic valve failure are not shown to use any type of treatment, other than compliance with the rules of the regime( a slight restriction on physical activity).
The volume of drug therapy is limited to the use of medicines, whose action is aimed at eliminating manifestations of heart failure, in particular diuretics( Furosemide 40 mg once a day), ACE inhibitors( Enap in a minimum dose of 5 mg once a day), cardiac glycosides(Digoxin 0.25 mg once a day).
And yet the only effective method of treating aortic valve insufficiency, like most cardiac defects, is surgical correction of the defect. Absolute indications for the use of any surgical benefit in case of aortic valve insufficiency is development of signs of left ventricular failure, severe regurgitation on the aortic valve and expansion of the size of the left ventricular cavity. Acute insufficiency of the aortic valve in any situation is an urgent condition and requires immediate surgical removal.
In a situation where the cause of this condition is the damage to the valves of the valvular heart apparatus themselves, the operational benefit consists in excision of the damaged biological material and its replacement with a biological or mechanical prosthesis. With an aortic sinus aneurysm, plastic is produced with the valve retained. The mortality rate in the late and early postoperative period does not exceed 4%.
Insufficiency of the aortic valve - which doctor will help ?If there is or suspected development of aortic valve insufficiency, you should immediately seek advice from such doctors as a cardiologist and cardiac surgeon.
