Incorrect closing of mitral valve
The lack of heart, which formed a reverse current Crovie from the left ventricle to the left atrium due to incomplete (incorrect) mitral valve closure. In 10-40% of those with Doppler study recorded a slight protosistolichny reverse flow in the absence of changes in the valve apparatus (ie. N., Physiological regurgitation).
The causes of chronic CVD : rheumatic heart disease, degenerative changes in the valve apparatus (myxomatous degeneration of the mitral valve leaflets [Barlova syndrome], idiopathic rupture chord Marfan syndrome syndrome, Ehlers Danlos, mitral annular calcification and degenerativechanges in the wings), infective endocarditis previously healthy or damaged valve system connective tissue diseases (SLE, antiphospholipid syndrome, systemic scleroderma), diseases of the heart muscle (coronary heart disease, dilated cardiomyopathy, hypertrophic cardiomyopathy), lysosomal storage diseasesand infiltrative disease (amyloidosis, idiopathic eosinophilia, carcinoid endocardial fibrosis), iatrogenic lesions (ergotamine derivatives, drugs that reduce appetite [eg., retired fenfluramine]), congenital heart disease (mitral valve splitting, double mitral valve orifice et al.). .
Causes of acute CVD : the defeat of the leaflets (infective endocarditis, damage the valve leaflets, eg., With balloon valvuloplasty) rupture of the chord (idiopathic myocarditis, miksematozna degeneration , infective endocarditis, acute rheumatic fever, woundin question is to the chord (eg., during balloon valvuloplasty) papillary muscles disease (coronary artery disease-rupture of papillary muscle, left ventricular dysfunction, acute dilatation of the left ventricular injury amyloidosis and sarcoidosis) disease of the mitral ring (infective endocarditis [abscess around the ring], trauma, left atrial myxoma).
Organic CVD occurs during the initial damage to the valve apparatus (leaflets or chordae) functional NMK- by changing the geometry of the left ventricle (more vsego in ischemic tissue damage valve apparata- kb ischemic CVD).
CLINICAL PICTURE TA MODELFOR
In the functional SMC dominated symptoms of the underlying disease.
1. Subjective symptoms: the mild to moderate insufficiency subjective symptoms usually do not appear (if NMC develops slowly, even if severe - symptoms may be neznachitelnymi) over time, there is a feeling of fatigue (its gain is due to a greater extent zgemodinamichnoyu tolerance disadvantages than with the degree of mitral insufficiency), shortness of breath, rapid heartbeat (atrial fibrillation). In acute NMK- sudden shortness of breath, symptoms of hypotension or cardiogenic shock.
2. The objective symptoms holosystolic noise, the volume of which is generally correlated with the degree of regurgitation (except for ischemic CVD) short diastolic murmur (with significant CVD) pozdnesistolichesky noise (appears after systolic schelchka- usually accompanies or papillary muscle dysfunction) attenuation colors (in case of alinicheski significant NMK) split II tone; IRS tone (correlated with the amount of wave regurgitation and left ventricular enlargement). In patients with significant pulmonary SMC and symptoms of right heart gipertenziey- nedostatochnosti- > 244.
3. A typical course of functional SMC depends on the underlying disease. OhStra NMC is very fast and without surgical treatment usually leads to death: among patients with moderate or severe impairment and fresh myocardial infarction 25% die within 30 days, and 50% - during the year; due to rupture of papillary muscle in fresh myocardial infarction during 2 weeks. 95% of patients die. Chronic NMK 10-15 years asymptomatic. In patients without overt symptoms of significant prognostic value is the value of the wave regurgitation. Much NMK can lead to irreversible asymptomatic left ventricular dysfunction.
On the basis of typical clinical symptoms and the results of echocardiography.
1. ECG customary normal, often vsego fibrillation or atrial flutter while maintaining sinus ritme- signs of increased left atrial (aboutoih atria in case of a combination of SMC with tricuspid valve); signs of dilatation and hypertrophy of the left ventricle.
2. Chest X-ray.
3. Echocardiography with Doppler analysis: reveals a wave of regurgitation Ratebe it quantitatively and qualitatively. In the case of inconclusive picture with transthoracic esophageal research study was carried out.
4. Samples with load: need for objective evaluation of exercise capacity. Echocardiography load allows non-invasively assess growth systolicpulmonary artery pressure.
5. Cardiac catheterization and coronary angiography: rarely performed.
6. MRI: more accurately than echocardiography, reflect the structure and activities of the mitral valve.
The differential diagnosis
was conducted among the causes of damage to the valve apparatus, or heart muscle.
Treatment of acute CVD
1. Vasodilators (sodium nitroprusside or nitroglycerin) in the case of simultaneously shoka- catecholamines andIntra kontrapulsatsiya (one of protivopokazaniy- combination of SMC with significant aortic valve insufficiency).
2. Surgical treatment: mandatory, in the case of hemodynamic nestabilnosti- urgently. Depending on the anatomical features, performed plastic mitGeneral valve (eg, resection of the fragment flap suturing ring) or its replacement prosthesis.
Treatment of chronic CVD
1. Sequence of actions with significant chronic mitral regurgitation.
Management of long-bolshoy mitral insufficiency (based on the recommendations of the ESC, modified)
2. Vasodilators (carvedilol, isosorbide mononitrate, ACEI, ARB): the highest performance vazodilatatorov- in patients with left ventricular dilatation, significant impairment of systolic function and an increase in symptoms; epiceneezny from patients with no objective symptoms, and patients with low left ventricular dilatation.
3. Surgical treatment: surgery correction or replacement of the valve. Due to the high risk of surgery in some patients with severe mitral insufficientatochnostyu and contraindications to cardiac surgery treatment - > can be performed implantation procedure cherezkateternoi clip type MitraClip.
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