Mitral insufficiency is a pathological process that develops most often during the following diseases: rheumatism, infectious endocarditis, much less often as a result of calcification of the mitral ring, damage to the heart valves with systemic scleroderma or systemic lupus erythematosus, as well as aortoarteritis, degenerative diseases of the connective tissue - Eulers-Danlos or Marfan syndromes. As a complication of balloon valvuloplasty, the occurrence of this pathology is also possible.
Mitral insufficiency develops due to rupture of the chord or papillary muscle, for example, with myocardial infarction. In the outcome of infectious endocarditis, the valve cusps can quickly be destroyed or damaged. When performing valve replacement, a complication may develop - periclungal regurgitation.
Relative mitral regurgitation can develop due to the expansion of the chambers of the heart (with myocardial dystrophy, myocarditis, cardiomyopathy, coronary heart disease).
There are two types of mitral regurgitation: acute and chronic.
Characteristic symptoms of acute failure are manifestations of left ventricular failure with the addition of arterial hypotension and pulmonary edema. Atrial fibrillation often occurs , atrial extrasystole develops less often.
Chronic mitral regurgitation can persist for a long time (about 10 years). Then there are complaints characteristic of heart failure: shortness of breath during physical exertion, fatigue. Ortner's symptom may appear: hoarseness appears due to compression by the enlarged heart of the recurrent nerve. Subsequently, cough and hemoptysis, edema due to pronounced stagnation in the small and large circles of blood circulation join.
When examining such a patient, the appearance of cyanosis of the lips is possible. This mitral heart disease is characterized by a pulse of medium filling. Perhaps tachypnea. The displacement of the apical impulse occurs to the left, it becomes diffuse and strengthened; with significant mitral regurgitation, systolic trembling occurs in the region of the apex of the heart.
Auscultation with mitral insufficiency is characterized by the appearance of systolic murmur at the apex, which is well conducted in the axillary region. At the top of the heart, weakening of the I tone is also characteristic.
Mitral heart defects, which include mitral regurgitation, require compulsory treatment, the exception is asymptomatic chronic. First, diuretics (furosemide) and peripheral vasodilators (sodium nitroprusside) are prescribed . In order to maintain normal hemodynamics, intra-aortic balloon counterpulsation is possible .
Surgical treatment is carried out taking into account the patient's condition and the causes of mitral regurgitation. For example, with infectious endocarditis, acute mitral valve insufficiency in the next day requires surgical intervention, and with myocardial infarction, conservative therapy is a priority.
Regardless of the etiology of the defect, it is necessary to prevent infectious endocarditis.
The onset of symptoms is an indication for surgical treatment. The operation of choice is mitral valve plastic surgery. This allows you to achieve great synchronism in the contractions of the left ventricle and does not require constant anticoagulant therapy. In the presence of calcifications, mitral valve replacement is used. Annuloplasty is used in the treatment of relative mitral regurgitation.