The human body is unique. However, sometimes there are situations when a certain body does not fully fulfill its functions. It is such a violation of the structure - aortic valve insufficiency - the topic of this article.
Terminology
Initially, you need to deal with the terms that will be used in the present article. So what exactly is aortic valve insufficiency? This is a violation of the work of this body, as a result of which its flaps do not completely close tightly. This leads to a problem such as refluxing blood from the aorta back to the left heart ventricle. This happens during diastole - the process of filling the heart with blood. What is this fraught with? So the human body does not receive the necessary amount of blood for normal work. As a result, the load on the heart rises in order to compensate for this shortage.
Generally speaking, at first, while the body is young and full of strength, aortic valve insufficiency most often does not bring any problems. The only thing is that the heart can slightly increase in size in order to be able to compensate for the lack of blood. Symptoms are initially completely absent, and the patient may not even be aware of the existence of a problem. Later shortness of breath, increased fatigue begins to occur. To cope with this disease, the patient can be sent for surgery to replace the aortic valve.
The problem is in numbers
Scientists note that it is the males who most often suffer from such a problem as aortic valve insufficiency. If we consider the percentage, the number of deaths from this pathology, in the case of all deaths with various heart problems, is about 14%. If this disease is considered, then in about 4% of cases, aortic valve insufficiency is observed in its pure form, and in 10.3% of cases - in combination with other heart diseases.
Causes
Generally speaking, the cause of the development of this problem in 2/3 cases is just rheumatic lesion of the valves. Less commonly, the disease causes infectious endocarditis. Scientists also distinguish two groups of causes, which are divided into chronic and acute.
Causes of Chronic Failure
In this case, doctors identify several important reasons that can cause chronic processes:
- Congenital heart defects. Children can be born with only one or two wings, which causes many problems and difficulties during the pumping of blood by the heart.
- Aging processes. That is, the aortic valve can wear out and wear out over time.
- Rheumatic fever , which causes scarring of the valve cusps, which prevents them from fully closing.
- Infectious processes in the heart when vegetation (entire colonies of bacteria) “eat up” the valve flaps, or, simply accumulating on the valves, prevent them from closing normally.
- Aortic enlargement , when her bulb is stretched so that the valves simply cannot completely close.
- Treating various problems that can cause aortic valve insufficiency. For example, radiation therapy or the use of "Phentermine" - a drug for weight loss, which was withdrawn from use in the late 20th century. According to scientists, its use could cause various heart problems, including aortic valve insufficiency.
Causes of Acute Failure
Among the causes of aortic valve insufficiency, doctors also distinguish diseases such as endocarditis (an infectious organ lesion), aortic dissection (as a result of which the blood flows through the resulting gaps). Sometimes patients after undergoing surgery to replace the aortic valve also develop its insufficiency. The acute causes of this problem also include trauma to the chest (for example, during a car collision, when a person strikes the dashboard with his chest). This often also causes damage to the aortic valve.
Symptomatology problems
What are the signs of aortic valve insufficiency by which to determine the presence of a problem? As already noted above, initially there may not be any symptoms. That is, the patient may not even feel that he has a certain problem. However, the situation has changed over the years. The heart works more actively to compensate for the lack of blood. As a result, the left ventricle is slightly enlarged, and the heart itself becomes weaker. This is where aortic valve insufficiency makes itself felt. Symptoms that may occur in this case:
- Constant fatigue, weakness throughout the body.
- The patient has shortness of breath. It intensifies during physical activity.
- Arrhythmias, i.e. heart rhythm disturbances, are also observed.
- The patient may complain of an accelerated heartbeat.
- During exertion, chest pain (angina pectoris) may occur.
- Very rarely, patients also suffer from loss of consciousness.
If the patient has acute failure, then all the symptoms appear suddenly, their strength is greater, they manifest themselves more clearly. In this case, patients often need an emergency ambulance, up to saving a life.
About degrees of insufficiency
Also has such a problem as aortic valve insufficiency, the degree of development. They differ in the length of the stream, which is injected back into the ventricle through poorly closed valves. Depending on this, they are distinguished by three: the first, second and third.
First degree
What is the peculiarity of aortic valve insufficiency of 1 degree? In this case, the stream does not exceed a length of 5 mm from the valves of the aorta. So, this problem can also be called insignificant. After all, blood is collected approximately under the valves, without causing any problems. Aortic valve insufficiency of the 1st degree does not cause a significant increase in the left ventricle, in this case it can be of full normal size.
Second degree
Deficiency of the aortic valve of the 2nd degree is special in that the stream length in this case increases to 10 mm. That is, the blood "sprays" at a distance of about 10 mm from the valve cusps. In this case, the jet can reach the mitral valve cusps, which significantly worsens the situation. Grade 2 aortic valve insufficiency increases pulsation in the carotid artery and heart, the left ventricle increases. This is all easily visible on the echocardiogram.
Third degree
Grade 3 aortic valve insufficiency is characterized by the fact that blood is injected back to a distance that exceeds 10 mm. In this case, the jet crosses the mitral valve and can reach the top of the left ventricle. In this case, the borders of the heart increase by more than 2 cm, left ventricular hypertrophy can be “seen” on the ECG.
Deficiency in children
I would also like to consider aortic valve insufficiency in children. Will there be any differences between an adult and a child? So, the symptoms will be slightly different. In this case, pallor of the skin, pulsation of arteries in the extremities are most often observed in children, a Musset symptom may develop (the child will shake his head to the sides, depending on the rhythm of the heart contractions). As for the treatment and diagnosis of the problem, this procedure will be the same for both children and adults.
Diagnostics
A preliminary diagnosis of “aortic valve insufficiency” can be made by the doctor after listening to (auscultation) abnormal heart murmurs (there will be an unusual diastolic murmur). However, this will only be an assumption. Next, the doctor will ask about symptoms that may indicate the presence of this problem, will collect a complete medical history. Further, the doctor will send the patient to additional studies that confirm or refute the previously formulated diagnosis.
- Palpation . In this case, the specialist can feel by feeling the trembling above the base of the heart. This occurs due to the release of a very large amount of blood. Percussion is also "observed" when the borders of the heart "go" to the left.
- ECG This procedure makes it possible to determine the increase in the size of the left ventricle of the heart.
- Echocardiography . This procedure in two-dimensional mode reveals left ventricular hypertrophy. In one-dimensional, it is able to distinguish between the flutter of the mitral valve leaf due to a jet entering it.
- Dopplerography makes it possible to determine the degree of insufficiency of the aortic valve - shows the length of the jet of blood being thrown back.
- X-ray If aortic valve insufficiency is expressed, this procedure makes it possible to "see" an increase in heart size, calcification of the valves.
- To detect an increase in intracardiac pressure, a cardiac catheterization procedure may be prescribed. In this case, doctors distinguish four degrees of aortic valve insufficiency according to the volume of blood injected back. In the first degree this is about 15%, in the second - from 15 to 30%, in the third - from 30 to 50%, in the fourth - more than 50%.
If the patient is previously diagnosed with aortic valve insufficiency, the diagnosis of the problem will not necessarily be carried out using all of these methods. So, the doctor decides for himself what the patient needs at this stage. It should be noted that, in addition to the above diagnostic methods, sometimes coronary angiography is also used, which can be prescribed according to the same indications as with stenosis of the aortic orifice.
Medical treatment
If the patient is diagnosed with aortic valve insufficiency, treatment will depend on the degree of the patient’s disease. So, the urgency of using certain drugs or procedures is interconnected with the severity of the manifestation of various symptoms. If the form of the disease is chronic, therapeutic treatment is possible.
Medication that the patient may need:
- Diuretics . The main goal of these drugs in this case is to remove excess fluid from the body, lowering blood pressure.
- Antibiotics . They can be prescribed as a prophylaxis of infectious diseases during surgical or dental procedures.
- Calcium channel blockers are also prescribed (mainly Nifedipine), the main purpose of which is to reduce blood leakage. It should be noted that in some cases, the use of these drugs can be an excellent alternative to surgery.
- Other drugs, such as ACE inhibitors or angiotensin receptor blockers, may also be prescribed .
It should also be noted that patients with this problem, even if present in a chronic form, must be registered with a doctor. They will periodically have to visit a doctor. Radical measures in this case are not always shown.
Surgical intervention
If the disease proceeds in an acute form, there is a need for urgent surgical intervention. The sooner a person gets to the doctor, the higher the chance to stay alive. And although mortality in this case is small, the delay in visiting doctors can even cost the patient life.
Surgery is also indicated for patients who have been diagnosed with aortic valve insufficiency for quite some time. If the patient already has symptoms, even if initially weak, the left ventricle loses contractility - these are all indications for surgical replacement of the aortic valve.
As a reference, it should be noted that today the surgical intervention basically ends positively and brings the desired result to the patient. The first such operation was performed back in 1960 by Dr. Harken, who prosthetized the aorta with a plastic ball and a metal cage. On the territory of the Soviet Union, such an operation was first performed in 1964, successfully. Since that time, doctors have developed many techniques and techniques to make this surgical intervention as high-quality and effective as possible.
Patient survival
If the patient has moderate or mild heart failure, 10-year survival is very high and makes up almost 90% of all patients. If complaints begin to appear, symptoms occur, the situation can worsen dramatically. In this case, if you do not resort to surgical intervention, a fatal outcome can occur in about 2-5 years, depending on the development of other diseases.
If the course of the disease is completely asymptomatic, the prognosis is as favorable as possible. In this case, surgery is required only in 4% of cases. In this case, complaints can occur in patients during the first five years - in 20% of patients, seven years - in approximately 25% of patients. If the failure is acute, severe, a fatal outcome is possible in case of ventricular arrhythmia. If the operation is done on time, this development of events can be avoided.
Prevention
There are no preventive measures in order not to acquire such a disease. In this case, diets or a certain lifestyle can not help. But here patients who are at risk can protect themselves. So, they regularly need to undergo examinations at the doctor, do the prescribed procedures. The schedule of the examination may be different, however, it is impossible to visit the attending physician less than 1 time per year.