Often, disorders of the pulmonary valve ( pulmonary valve ) develop against a background of cardiac rheumatism or thrombosis.
But in most cases, defects in the right side of the heart develop already against the background of defects in the valve system of the left ventricle. And even less, according to statistics, is a congenital malformation.
Pulmonary valve anatomy
The pulmonary valve opens in the systole stage to let the blood flow through itself and closes into the diastole. Consists of 3 half-moon cusps: the right cusp, the left and the front.
Sashes attached to the fibrous ring. The valve separates the pulmonary trunk from the right ventricle of the heart.
What does the heart valve mean normal?
During normal operation, the pulmonary valve is completely closed during diastole, that is, during relaxation of the heart muscles. If the valve flaps synchronously and tightly close and open, then the pulmonary valve is normal.
The pulmonary artery is an artery that carries venous blood from the lungs to the heart, into its right ventricle. It is in the right ventricle that a small circle of blood circulation begins.
Valve insufficiency. Causes
When in the medical community they talk about the insufficiency of a valve, it means a “breakdown” of the valve, due to which it closes poorly or opens poorly (stenosis). In the heart there are 4 chambers and, accordingly, 4 valves that control the flow of blood from one chamber to another. When one valve fails, the others also become damaged over time.
Pulmonary valve insufficiency occurs when its flaps do not close tightly.
Reasons for failure:
- Congenital failure
- Acquired pathology.
Acquired valve failure develops in adults due to such health problems:
- Infectious endocarditis is an inflammation of the inner lining of the heart.
- Carcinoid syndrome. With the syndrome, a small tumor in the intestine releases harmful substances that gradually destroy the right side of the heart and lungs. But this is a very rare disease.
- Rheumatism. With this inflammatory disease, the valves of the heart muscle are often damaged.
- Syphilis.
- Serious chest injury that leads to valve rupture.
- Drug use.
- Mitral stenosis.
- The presence of blood clots in the pulmonary trunk.
- Pickwick's syndrome, its main symptom, is lung problems.
- Dilation of the right ventricle due to regurgitation of the tricuspid valve.
Another important reason is the long-term current lung disease in smokers.
Here the reverse process is triggered - pulmonary hypertension begins first, and then, as a result, the pulmonary artery valve is disrupted.
Such a pathology as insufficiency can manifest itself to a mild and severe degree, when surgical intervention is already needed.
The degree of regurgitation of the pulmonary valve
The term "regurgitation" means in medicine that the heart valve is not completely closed, as a result of which the blood goes in the opposite direction. For example, when a pulmonary valve is damaged, blood moves from an artery to the right ventricle, which causes it to overflow with blood. This defect at the 1st stage does not significantly impair heart function. In this case, hemodynamics are not disturbed, the thickness of the heart muscle of the right ventricle remains within normal limits.
But when regurgitation on the valve of the pulmonary artery of the 2nd degree is detected, a person already has some complaints about health. His right ventricle is already beginning to feel an increased load.
With pulmonary regurgitation of the 2nd degree, the heart becomes more and more damaged over time, for example, the system does not already have the same synchronism, the whole "mechanism" gradually becomes disordered.
Valve stenosis
With a valve abnormality such as stenosis, the valve for some reason does not open enough to let a portion of blood pass into another heart chamber.
Symptoms of stenosis are somewhat different from the symptoms of insufficiency. Due to obstructed blood flow, a person feels dizzy, tired, often faints due to poor circulation in the vessels of the brain. But with stenosis of the pulmonary artery valve of the 1st degree, a person still does not feel such serious symptoms, he only more often feels fatigue.
The valve works worse if stenosis is not treated and the advice of a cardiologist is not followed. First comes the compensation stage, when the heart works at a double rhythm to provide blood flow. And then the situation worsens. The stage of decompensation sets in, the right ventricle expands, since too much blood is in it. And its muscle walls are not able to push this mass of blood through the narrowed walls of the valve.
Severe pulmonary valve stenosis is treated mainly with xenopericardial prosthetics. That is, exclusively operational. The operation is indicated for those people who have severe right ventricular failure and are at risk of death.
Isolated stenosis in the pulmonary trunk in the neonatal period
Isolated stenosis, that is, stenosis that is not associated with other heart diseases, is formed in the prenatal (neonatal) period of fetal development in such cases:
- the mother was ill with rubella during gestation;
- has diabetes of the 1st or 2nd degree;
- the woman drank alcohol;
- genomic damage;
- such substances in the mother's body as isotretinoin, which is used to treat seborrhea, also lead to a defect; or hydantoin - a substance used in drugs against convulsions.
The clinical manifestations of pulmonary valve stenosis in newborns proceeds differently. In mild cases, the defect does not make itself felt, is asymptomatic. And in severe cases, from the first days of life, there is a strong lack of blood supply in the tissues and cyanosis.
Diagnostics
How does the doctor diagnose what tests and procedures will require? A cardiologist, in fact, uses the standard program for examining the heart and its defects. He cannot make a diagnosis based on patient complaints alone. He needs to objectify, then specify the problem, find out at what stage the disease is.
Research is carried out as follows:
- chest x-ray;
- ECG and echo ECG;
- catheterization of cavities;
- laboratory tests;
- angiopulmonography using a contrast agent.
In addition, the doctor looks at other signs, such as swelling of the cervical veins. During auscultation, noise is sometimes heard; the doctor can determine the duration of these noises and can make an assumption about their nature. However, his assumption still needs to be confirmed using the above procedures. If the pulmonary valve is functioning properly and no extraneous noise is heard, no procedure is required.
An ultrasound is performed on pregnant women to find out if there is a risk of heart disease in the fetus.
Medical preparations
Acquired heart defects, including valve defects of the pulmonary artery, in the compensation stage can be treated with some drugs:
- Anticoagulants.
- Cardioprotectors.
- Cardiac glycosides.
- Beta blockers.
If the cause of insufficiency of the valve of the pulmonary artery of the 2nd degree is infectious endocarditis, anti-inflammatory drugs are used.
How is a prosthetics operation?
The operation is prescribed to those individuals who are diagnosed with subcompensated or decompensated pulmonary valve disease. Judging by the situation, the doctor decides whether to save the valve or put a new one. Artificial valves exist both mechanical and biological. However, the biological lifespan is only 15 years, then an operation is required again. Therefore, young people immediately put mechanical.
Those people who have suffered a stroke or myocardial infarction, surgery is contraindicated. It is also forbidden to carry out such a serious operation for diabetics.
Before surgery, for 12 hours the patient is prohibited from eating food and canceling all medications. The day before, a person is offered to drink a sedative so that he does not set himself up for bad thoughts and is not afraid. After all, the operation is performed on an open heart, and at this time, its function is performed by the heart-lung machine. But the risk, thanks to the honed skill and joint work of specialists, is minimal.
After the operation, the patient must undergo a rehabilitation course. The program of the course usually has physiotherapy exercises and special breathing exercises.
Prevention of malformation
The best prevention of valve dysfunction at all times is to maintain a healthy lifestyle. No vitamin supplements or "golden formulas" of youth will help to maintain health if a person smokes from a young age and does not observe sleep and wakefulness.
The human heart is a very vulnerable organ. Smoking and alcohol do irreparable harm to him. And another factor in heart health - a person is designed to move. At any age, he should play sports, but moderate. Heavy loads for the sake of the result are also harmful.
Women during pregnancy should avoid various mutagenic factors and not take medications without consulting their doctor. Many intrauterine drugs can cause pulmonary valve defects.
Output
More common are defects of the mitral and aortic valves than the valves of the pulmonary trunk. The insufficiency of the valves of the left side of the heart usually follows after the left side does not cope at the stage of decompensation; and then the right side of the heart “breaks” already.
Infectious endocarditis is also considered a common cause of pulmonary valve defects. Older people are advised to engage in the prevention of endocarditis and more often consult a cardiologist for a routine examination.
However, if he is nevertheless diagnosed after a detailed examination, the patient needs to completely review his life.