Often, having had viral diseases, a person does not even know about the appearance of possible heart problems. When he begins to worry about coughing, shortness of breath, pain in the chest area, then a visit to a specialist is inevitable. In about half the cases, mitral valve insufficiency is diagnosed. The article describes this pathology, stages of its development, treatment and gives recommendations for improving the condition.
What is a pathology?
Mitral valve insufficiency is a heart defect, it can be congenital or acquired. Doctors often encounter the disease as a complication after previous pathologies. For example, infectious diseases that affect the respiratory tract.
Mitral insufficiency has several periods of development:
- Compensation. It can last quite a long time - up to several years. Patients complain of fatigue, coldness in the fingers, constantly manifested weakness.
- Subcompensation. Appears noticeable shortness of breath, tachycardia with minimal physical exertion. Also, pain often appears on the left behind the sternum (in the region of the heart) and interruptions and rhythms of the heart are felt.
- Decompensation and subsequent stages (severe decompensation, terminal) manifest themselves as an increase in the described symptoms, regardless of physical activity. Also occur: pulmonary edema, asthma attacks, enlarged liver.
In the case of diagnosis of mitral valve insufficiency, drug treatment is not effective. Medicines are able to stop the symptoms, but often their use does not bring the desired results. The only solution to this problem is surgical intervention.
Modern technologies allow an operation with a minimal risk of complications and reduce the risk of an adverse outcome.
Causes of pathology
The appearance of signs of mitral valve insufficiency in both adults and children is often associated with many processes that are not related to the cardiovascular system.
For instance:
- chest injuries;
- infectious diseases;
- the appearance of tumors in the heart;
- transferred surgical interventions;
- the presence of rheumatism;
- tendon damage in connection with myocardial infarction;
- the presence of systemic diseases.
Depending on the anatomical structure of the valvular apparatus of the heart, the following pathology causes are distinguished:
- Excessive movement of the valve leaf. The apex of closure of normal valve cusps is located in the left ventricle below the plane of the fibrous ring. Excessive movement is indicated when part of the sash is located in the systole above the plane of the fibrous ring of the valve. At the same time, the mitral valve is examined in at least two scanning planes.
- Sash inflammation. Part of the body of the sash is located above the plane of the fibrous ring of the valve into the systole, but the closure point (arrow) is below the fibrous ring.
- Casement prolapse. The body and the top of the sash (arrow) are located above the plane of the fibrous annulus of the valve into the systole; there is no closure. The tops of the cusps are aimed at the left ventricle.
- Classic mitral valve prolapse. Defined as the systolic movement of the tops of one or both valve flaps in the left atrium more than 2 mm from the plane of the fibrous ring.
Classification
Mitral valve insufficiency is usually divided in accordance with its etiology. So the disease can be classified due to its formation:
- Organic form - regurgitation is associated with damage to the bicuspid valve.
- Relative (or functional) form - there is no change in the bicuspid valve, but regurgitation is present.
Since the disease may not bother the person and not manifest in an acute form, then according to the clinical picture, there are:
- Sharp shape. It is manifested by hemodynamic disturbances and symptoms of stagnation in the smaller circle of blood circulation. Moreover, the prognosis is often unfavorable and the condition is life-threatening.
- Chronic form. It can occur without symptoms, but over time, the volume and mass of the left ventricle increases.
A classification is also proposed in accordance with the degree of mitral valve insufficiency, which is now widely used and is based on the type of valve movement: from the first to the Thursday degree.
Mitral insufficiency of 1 and 2 degrees
With lesions of type 1, the movement of the valves is normal. In such cases, acute failure tends to be central or moderately deviate from the central one. The first type is mainly a consequence of dilatation of the fibrous annulus of the valve, but there may be less common mechanisms. With this type, surgical treatment of mitral valve insufficiency of the 1st degree is not performed. The forecast is favorable.
Causes:
- Systemic and autoimmune diseases.
- Injuries.
- Rheumatism.
- Ischemia of the heart.
Symptoms:
- Pain in the left side of the sternum.
- The impossibility of a full breath and a feeling of lack of air.
- Disruptions in the rhythm of the heart.
- The appearance of headaches and dizziness, loss of consciousness is possible.
- Low-grade fever.
With mitral valve insufficiency of the 2nd degree, excessive movement of the valves is noted. The severity can have a wide range. It is possible that only part of the valve leaf protrudes above the line of the fibrous ring into the systole, but the closure point remains below the plane of the fibrous ring.
Causes of pathology:
- Viral endocarditis.
- Rheumatic processes.
- Systemic lupus erythematosus.
- Tendon rupture due to injury.
- Changes in valve flaps.
Symptoms
- The appearance of shortness of breath after physical exertion.
- On the examination notes the displacement of the borders of the heart.
- Ripple in the heart and peritoneum may be observed.
- A slight increase in blood pressure.
Mitral insufficiency 3, 4 degrees
If you ignore the symptoms, mitral valve insufficiency of the 1st and 2nd degree can be aggravated.
Type 3 lesion is recorded when restriction of leaflet movement is noted. This type is divided into subtypes 3a and 3b.
- With subtype 3a, restriction is "structural" (most often a consequence of rheumatism) and the movement of the leaflet is impaired in both systole and diastole.
- With subtype 3b, the restriction of “functional” and full closure of the valves cannot occur, since the mitral valve in the systole is pulled in the direction of the apex of the left ventricle, this may be due to dilatation and / or displacement of the papillary muscles. The etiological factor in the occurrence of subtype 3b is often cardiac ischemia, and in such cases the term "mitral insufficiency of ischemic genesis" is used. With subtype 3b, the movement of the sash into the diastole is normal.
Grade 3 mitral regurgitation has the following symptoms:
- Liver enlargement.
- The appearance of edema.
- Cough.
- Increased venous pressure.
The defeat of type 4 is attributed to severe heart disease. The last degree is manifested by regurgitation to the upper part of the atrium. When setting this degree, the patient becomes surgical and he needs a medical correction.
Determining the severity of the disease
If the patient is planning to perform an intervention on the heart muscle, a preoperative assessment of the degree of mitral valve insufficiency using a transesophageal transducer provides an answer to three key questions:
- How severe is the pathology?
- What is the mechanism of the disease and where exactly does the lesion manifest?
- Is it possible to perform surgical plastic surgery (correction)?
The severity of valve insufficiency is sometimes classified as trivial, mild, moderate and severe. This corresponds to a classification of 1+ to 4+.
A two-dimensional study often makes it possible to suspect that there is an insufficiency of a pronounced degree. Some finds may directly indicate this.
For example, signs may be:
- significant violation of the closing of the valves.
- sash structural anomaly.
- hemodynamic consequences of severe mitral regurgitation (volume overload of the left side of the heart or signs of pulmonary hypertension).
To determine the severity of mitral valve insufficiency, the following methods are used:
- A detailed two-dimensional examination of the heart is extremely important for the exact location of the lesion.
- Color dopplerography remains the easiest and best method for screening for the presence of MN, since this method has high sensitivity and specificity.
- Spectral dopplerography also allows an assessment of the severity of failure.
As soon as the presence of severe insufficiency is established, the next is to determine the mechanism of mitral regurgitation and the exact location of the lesion, so that an appropriate surgical plan can be formulated. Accurate localization of lesions requires a systematic study using a two-dimensional image. The purpose of a systematic study of the mitral valve is to obtain numerous images of all parts of the valve and identify each segment of the valves.
Diagnostic Issues
Patients with mitral valve insufficiency in the heart often have atypical chambers, and cardiac anatomy is distorted. This can make it difficult to perform transesophageal echocardiography, as the appearance of various ultrasound sections from the heart changes.
Changes in preload, afterload, contractility, and myocardial compliance can have a significant effect on the appearance of the regurgitation stream. In addition, in the operating room, all of these factors can be affected by general anesthesia. Several authors have documented that the severity of mitral regurgitation decreases by at least 1 + after induction of anesthesia. These changes are least pronounced in the breakage of valve cusps and most pronounced in patients with a functional form of the disease.
Changing the condition of other valves can also affect mitral regurgitation. For example, in patients with significant aortic stenosis, the severity of mitral regurgitation predominantly decreases after aortic valve replacement, since pressure in the left ventricle decreases. Therefore, a doctor who evaluates the severity of mitral valve insufficiency should have a good knowledge of the clinical conditions available at the time of the examination.
Treatment of mitral regurgitation
The prescription of treatment for mitral valve insufficiency is possible after determining the severity and from which of the five stages the development of the disease is.
The two initial stages - the first degree (compensation) and moderate (subcompensation) - do not require any serious intervention. Symptoms practically do not appear or they can be felt with intense physical exertion. At these steps, preventive measures play an important role.
The third stage - decompensation - is characterized by obvious cardiac abnormalities, especially manifested after physical exertion. When signs of mitral valve insufficiency appear, surgical treatment can be used. At this time, patients are usually prescribed:
- anti-arrhythmia drugs;
- vasodilators that reduce the tone of arterioles and reduce the tension of the walls of the aorta;
- drugs that reduce peripheral vascular resistance;
- antiplatelet agents and anticoagulants to normalize blood coagulation and blood clots;
- nitrates, which reduce blood flow to the right atrium and reduce the load on it;
- antibiotics that prevent repeated rheumatic attacks.
Therapy at this step is aimed at preparing for a possible surgical intervention.
The fourth stage (dystrophic) - implies the performance of mandatory surgical operations. At this stage, the functioning of the heart muscle is disrupted, which leads to a deterioration in blood supply, shortness of breath, edema and impaired functioning of the internal organs are disturbing.
The fifth (terminal) stage, as a rule, is no longer amenable to medical and surgical intervention due to violations. Drugs are prescribed that only alleviate the condition, but do not affect life expectancy.
Surgical treatment of mitral valve insufficiency of the 1st, 2nd degree is not required, in contrast to the 3rd and 4th degrees.
Surgery is divided into two types:
- Valve plastic - allows you to reconstruct your own valve by plastic valves and adjusting the length of the chords. In this case, no drug treatment after plastic surgery is prescribed at all or it lasts up to three months, depending on the indications.
- Prosthetics - replacing your own valve with an analogue of a biological (animal aorta) or artificial material (medical alloys). In the first case, the prosthesis works for up to ten years, it is absolutely silent. Acceptance of drugs aimed at regulating blood coagulation is not prescribed. In the second case, the prosthesis lasts up to twenty years, works with a sound that resembles the ticking of a clockwork. It takes anticoagulants to the end of life.
A categorical limitation to any operation is the presence of serious illnesses that can lead to dangerous complications and death.
Forecast
The prognosis for the treatment of mitral valve insufficiency of degree 1, 2 is favorable, provided that the attending physician constantly monitors and follows the recommendations. In this case, a person retains his ability to work. For women, the diagnosis is not a contraindication to pregnancy and bearing a child.
The examination is enough to conduct once a year using ultrasound. Since stage 1 is very difficult to diagnose, it is recommended that patients arrive at the appointment and follow the doctor's instructions in a timely manner.
The prognosis for mitral valve insufficiency of grade 3 and 4 largely depends on the course of the disease. If there is an infection, then this can lead to disturbances in the circulatory system. Also, a chronic form of pathology has an unfavorable prognosis. The danger at these stages is the appearance of heart failure. Statistics show that almost all patients live more than 5 years, and 4/5 of the total number - more than 10 years.
Prevention
Even in the treatment of mitral valve insufficiency of 1, 2, 3 degrees, a relapse can occur. Therefore, if a person does not show symptoms, then prevention is still necessary.
This ailment is a dangerous pathology, therefore it is extremely important to carry out measures to prevent its occurrence.
Prevention of mitral regurgitation is divided into the following types:
- primary - to prevent the disease;
- secondary, which is used when the disease enters the chronic form.
The rules of primary prevention:
- prevention of the occurrence of the disease by increasing immunity, conducting hardening measures;
- avoidance of stressful situations;
- prevention of infectious endocarditis;
- timely identification of symptoms and the start of treatment at the first clinical signs, so as not to provoke the development of heart disease;
- limited physical activity;
- systematic consultation of a cardiologist and rheumatologist;
- rejection of bad habits;
- mandatory treatment of infectious foci such as caries and tonsil inflammation.
Secondary prevention involves preventing the development of the disease. For this, a specialist (rheumatologist, cardiologist or cardiac surgeon) prescribes medications aimed at such an action:
- improvement of blood supply to heart tissues;
- expansion of blood vessels;
- an increase in the number of contractions of the heart muscle;
- decrease in high blood pressure.
Also, the doctor prescribes glycosides, diuretics and antibiotics according to indications.
The work of the heart largely depends on the presence of congenital and acquired pathologies. Not all people know that simple infectious diseases can trigger heart disease. If a mitral valve insufficiency of 1 degree is diagnosed, then the disease requires subsequent consultation with a specialist and the implementation of all recommendations. We can say that with proper timely treatment, a person’s life can be extended.