The main muscle of the human body is the heart. This is a complex mechanism, the components of which are valves. In the right half is a tricuspid valve. He shares the atrium and ventricle. When a failure occurs in his work, the blood flow in this part of the muscle is disrupted. The result is a life-threatening condition. In medical practice, it is also known as "tricuspid valve insufficiency." In today's article, we will consider the main causes, symptoms and methods of treating this disease.
Anatomical reference
The human heart is a muscular organ. Its cavity is divided into 2 atria and 2 ventricles. Communication between these structures occurs through valves. They are responsible for the flow of blood in one direction.
On the right side of the heart, chambers are connected through a tricuspid valve. It consists of the following anatomical formations:
- three wings (septal, anterior and posterior);
- tendon course;
- papillary muscles;
- fibrous ring.
During the contraction of one atrium, the tricuspid valve opens. Gradually, blood fills the ventricle. After this, the myocardium begins to alternately contract, while the valve flaps slam shut under strong pressure. Such a debugged mechanism prevents the return of blood (regurgitation). Under the influence of certain factors, sometimes his work fails. In this case, it is said that the tricuspid valve is experiencing insufficiency. However, he can no longer fully perform his functions.
With this pathology, blood from the right ventricle returns to the atrium. A slight increase in the volume of fluid practically does not affect the functioning of the main muscle of the body. With severe insufficiency, the chambers of the heart undergo deformities, the pressure indicators sharply change in them. It can increase up to 8 times in comparison with natural values.
Brief Description of the Disease
Tricuspid insufficiency is a heart defect that develops due to defective closure of valve flaps, reverse blood flow from the right ventricle to the atrium. Against the background of constant regurgitation, the diastolic volume and pressure in this structure of the heart increase. This entails hypertrophy and dilatation of its walls. As a result of a malfunction of the compensatory mechanisms, the patient develops stagnant phenomena in the body.
Tricuspid insufficiency is often accompanied by other congenital heart defects. For example, an open oval window or an atrial septal defect.
The main causes and forms of pathology
Tricuspid valve insufficiency always has a different course. To make an accurate diagnosis, you must first determine the form of the pathological process. For this purpose, various criteria are used in medical practice: the period of occurrence, the localization of the damaged portion of the valve, the severity of regurgitation.
Depending on the time of development, the disease in question is of two types. As a rule, in all cases it is not acquired, but occurs after the inflammatory process. Congenital malformation is extremely rarely diagnosed and develops in the womb. Its appearance is affected by the action of negative factors on the pregnant woman's body. This may be radiation, an infectious disease, or x-ray exposure.
Based on the part in which the tricuspid valve is damaged, failure can be of two forms. The organic variant is accompanied by a physiological change in the valves. They are gradually deformed, covered with plaque. With the functional form of the disease, the valve does not close completely.
The development of acquired organic tricuspid insufficiency occurs under the influence of the following reasons:
- Rheumatism is an inflammation that spreads to the systems of internal organs.
- Carcinoid syndrome - damage to various organs caused by a small intestinal tumor. Pathogenic elements from the neoplasm enter the bloodstream and begin to attack the endocardium. Then they penetrate into the pulmonary vessels.
- Infectious endocarditis is an inflammatory lesion of the lining of the heart.
- Mitral commissurotomy. This is an operation that is used to treat stenosis.
Acquired functional (relative) insufficiency of the tricuspid valve develops due to damage to the papillary muscles or expansion of the fibrous ring. In the first case, the presented structures are responsible for maintaining the motor ability of the valves. With myocardial infarction, the papillary muscles are damaged. This leads to a violation of the functionality of the tricuspid valve.
Pathologies of the fibrous ring can cause various disorders. These include myocarditis, ruptures of chords, tumors and neoplasms that impede the flow of blood from the ventricle.
Stages of failure
Based on the severity of the regurgitation process, it is customary to distinguish several stages during the disease:
- Grade 1. The reverse blood flow maintains minimal values, is not accompanied by a hemodynamic disorder.
- Degree 2. At this stage, the pathology is accompanied by the advancement of the reverse blood stream to a distance that does not exceed 2 cm.
- Grade 3. Blood flow moves into the atrium at a distance of more than 2 cm from the valve surface.
- Grade 4. At the time of regurgitation, blood enters the upper zone of the atrium, passing throughout the chamber.
What symptoms are accompanied by each of the stages of the development of the disease will be described below.
Signs of tricuspid valve insufficiency
At the initial stage, heart disease does not practically manifest itself. Sometimes after physical exertion, patients note the appearance of a strong pulsation of veins on the neck. A pathological process can be detected only with the help of Doppler ultrasound. Normal ECG does not show significant changes in the work of the heart.
Tricuspid valve insufficiency of the 2nd degree is accompanied by an increase in the volume of reverse blood flow. Right ventricular disorder leads to an increase in heart size. As a result, the clinical picture is supplemented by the following symptoms:
- loss of strength, decreased physical and mental activity;
- frequent urination at night;
- severe swelling of the lower extremities;
- dyspnea;
- a feeling of heaviness under the ribs;
- dyspeptic disorders.
When listening to the heart, pansystolic murmurs and atrial fibrillation are determined.
As a result of the progression of the pathology, the number of symptoms manifested increases. Ignoring their occurrence is not recommended. It is better to seek qualified medical help at the initial stage of the development of the ailment. Tricuspid valve insufficiency 1-2 degrees can still be cured with medication. The transition of the disease to the next stage always requires surgical intervention. Even after the operation, the occurrence of complications is not excluded.
Features of the disease in children
Newborn babies with severe regurgitation and the presence of concomitant cardiac abnormalities are prone to the rapid development of right ventricular failure. Very often, it ends in death.
The acquired form of the disease develops against the background of complications of other diseases. Most often we are talking about an infection of streptococcus, which entails a rheumatic lesion.
Among other causes of childhood deficiency are:
- acute form of hypertension;
- myocardial disease;
- traumatic injuries;
- malignant neoplasms.
At the initial stage, tricuspid valve insufficiency in children is considered as an anatomical feature. The first degree of the pathological process does not require treatment. With age, the disease usually goes away on its own.
Mitral and tricuspid valve insufficiency
Very often, a malfunction of the valve on the right side is combined with a dysfunction of the structures of the left half. In this area, the main load falls on the so-called mitral valve. Symptoms of the disorder add up. The combination of such disorders negatively affects the work of the right ventricle, which is complicated by the occurrence of pulmonary hypertension. Surgery is recommended for patients with a diagnosis of “mitral and tricuspid valve insufficiency of the 1st degree”.
Diagnostic Methods
Early detection of the disease plays a direct role in the success of treatment, and also affects the life expectancy of the patient. Since insufficiency of the tricuspid valve of the 1st degree is almost asymptomatic, pathology is detected only after its transition to the next stage of development.
Diagnosis begins with a survey of the patient, a study of his medical history and physical examination. By asking various questions to the patient, the doctor determines the clinical picture, the time of the onset of the first symptoms. He also needs to know which diseases were preceded by failure. An external examination usually reveals cyanosis of the skin and swelling, and when listening, a violation of the heart rhythm.
As part of the diagnosis, several laboratory tests are mandatory. Among them, the most informative are the blood test and the study of the immunological status of the patient. According to the results of laboratory tests, one can judge the presence of inflammatory processes in the body, parallel ailments.
To clarify the diagnosis, the doctor can use hardware examination methods. These include:
- ECG. It is carried out in order to detect an increase in atrial volumes.
- Phonocardiogram. Demonstrates the presence of systolic murmur.
- Spiral CT. Provides an informative image of the main muscle of the body.
- Roentgenogram. It gives an idea of the size of the heart, reveals congestion.
- Coronocardiography It is used before surgery and allows you to evaluate blood flow.
- Echocardiography. Shows the deformation of the valves, the presence of new formations on them.
Based on the results of a full examination, the doctor gets an idea of what condition the tricuspid valve is in. The insufficiency of this structure lends itself well to treatment only at the initial stage of development. The treatment options for this disease will be discussed in more detail below.
Treatment principles
Tricuspid valve insufficiency of 1 degree does not require therapy. If the disease proceeds to the next stage of development, treatment is prescribed to the patient. It can be both medical and operational. They resort to the help of the latter in especially serious cases, when the use of tablets and injections does not give a result.
For the entire period of treatment, the patient must adhere to the following rules:
- Quit smoking completely.
- Avoid hypothermia and stressful situations.
- Follow a diet to reduce heart stress.
- Reduce the intensity and amount of physical activity.
Compliance with these recommendations increases the effectiveness of the therapy, and is also a kind of prevention of the development of complications.
Drug treatment
Moderate tricuspid valve insufficiency is not considered an indication for surgery. In this case, the treatment is carried out using drugs. The standard treatment regimen involves the use of the following medicines:
- Diuretics (Britomar, Hydrochlorothiazide). Eliminate stagnation in the body, accelerate the process of excretion of fluid.
- Potassium preparations (Panangin, Asparkam). They help the body not accumulate excess fluid.
- Venous dilatators (Corvaton, Nitrosorbide). Reduce the burden on the heart by depositing blood.
- Anticoagulants (Warfarex, Warfarin).
- Cardiac glycosides (Digoxin, Korglikon). Help in the fight against arrhythmia.
- Beta-blockers (Diltiazem, Carvedilol). Reduce the frequency of contractions of the left ventricle.
The dosage regimen and dosage of drugs are determined individually, taking into account the severity of the disease.
Surgical intervention
Grade 3 tricuspid insufficiency is considered the main indication for surgical intervention. Also, surgery is recommended for patients with severe deformations of the cusps or severe malfunctions in their work.
When the valve apparatus is preserved, annuloplasty is used. During the operation, the doctor places U-shaped sutures on the damaged area.
If the intervention is ineffective, there are obvious structural changes, the patient is given an artificial trap. After implantation of the prosthesis, anticoagulant therapy is required. When implanting a biological prosthesis, it is of a short-term nature. If it is made of medical alloys, the treatment of tricuspid valve insufficiency takes a little longer.
Possible complications and prognosis for recovery
The lack of timely treatment can lead to the progression of the disease. The pathological process in this case affects not only the tricuspid valve. Insufficiency gradually leads to the fact that the body begins to look for new compensatory mechanisms. Thus, he tries to cope with the existing violations. Depending on the neglect of the disease, the following disorders may occur:
- pneumonia;
- enlargement of the liver, cirrhosis;
- pulmonary embolism;
- ascites.
According to statistics, these complications develop in 90% of cases.
As for the prognosis for recovery, it depends solely on the degree of development of the disease. Grade 2 tricuspid insufficiency responds well to drug treatment, and the likelihood of complications is almost zero. In the third degree of the pathological process, the five-year survival rate is approximately 60-70%. Such figures are typical for patients who have already undergone surgery. With decompensated forms of failure, accompanied by chronic pulmonary diseases, the prognosis is disappointing.