Mitral stenosis is a heart disease in which the left atrioventricular aperture narrows, thereby disrupting the work of the muscle. At the initial stages, vice does not cause inconvenience to the patient, however, subsequently it can lead to serious complications.
The most common mitral stenosis is found in women 40-60 years of age. In children, the congenital form of vice is extremely rare: about 0.2% of all vices. The symptomatology is the same for all ages.
Often, the disease does not cause any discomfort to the patient, however, it is possible to become pregnant with it only if the aperture of the mitral valve is larger than 1.6 cm2. In the opposite case, the patient is shown an abortion.
Now let's talk about what are the types and degrees of stenosis of the mitral valve.
The following video will be very detailed about the features of mitral stenosis:
Forms and degrees
Mitral stenosis is distinguished by the anatomical shape of the affected valve, degree and stage. The form can be:
- looped( doctors call it "jacket loop";
- funnel-shaped( fish mouth);
- in the form of a double constriction;
. In the doctor's practice, 4 degrees of disease are distinguished, depending on the area of narrowing of the atrioventricular aperture:
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- First or minor when the area is less than 3 cm2
- Second or moderate,when the area varies between 2.3 and 2.9 cm2
- The third or pronounced area varies between 1.7 and 2.2 cm2.
- The fourth, critical. The hole narrows to 1-1.6 cm2.
There are several classifications of the defect in stages, however, in Russia, the most popular among A. N. Bakuleva, distributing the defect in 5 stages:
- Complete compensation of blood circulation. There is no symptomatology, the disease is revealed during the study. The mitral opening is 3-4 cm2 in area.
- Relative circulatory failure. Symptomatology is poorly expressed, the patient complains of shortness of breath, hypertension, slightly elevated venous pressure. The mitral opening is 2 cm2, and the left atrium increases in size to 5 cm.
- Severe insufficiency. The symptomatology is expressed clearly, the size of the heart and liver is significantly increased. The mitral orifice is 1-1.5 cm2, and the left atrium & gt;5 cm in size.
- Acute insufficiency with stagnation in a large circle. It is expressed by a strong increase in the liver and heart, high venous pressure and other signs. The mitral orifice narrows, becomes less than 1 cm2, the left atrium becomes even greater.
- The fifth stage corresponds to the third, terminal, stage of insufficiency according to the classification of V. Kh. Vasilenko. The heart and liver are significantly enlarged, ascites and swelling appear. The mitral orifice dangerously narrows, and the left atrium increases.
Scheme of mitral stenosis
The most common cause of mitral stenosis is rheumatism. In children, vice appears due to congenital pathologies. Other causes of the disease include:
- oncological diseases;
- blood clots;
- excrescence, partially narrowing the mitral orifice;
- autoimmune diseases;
Rarely, the appearance of stenosis may be influenced by external factors, for example, uncontrolled intake of medications. Let's now consider the main signs and symptoms of mitral valve stenosis.
Symptomatic of mitral stenosis does not appear at all in the first stage. With the course of the disease, patients note:
- is dyspnea, which at late stages occurs even at rest;
- cough with blood streaks;
- cardiac asthma;
- pain in the region of the heart;
- cyanosis of the lips, tip of the nose;
- mitral blush;
- heart hump( protrusion from the left of the sternum);
Now consider the methods for diagnosing mitral stenosis.
In more detail with the symptoms of mitral valve stenosis, the following video will be narrated:
The primary diagnosis is the collection of anamnesis of complaints and palpation that detects presystolic jitter. This and auscultation help to detect mitral stenosis in more than half of the patients.
Auscultation, usually, detects an attenuation of I tone at the tip and systolic murmur after I tone, which has a decreasing or permanent character. The localization of listening to this noise extends into the armpits and rarely into the subscapular space, sometimes it can be carried towards the sternum. The noise volume can be different, for example, severe deficiency it is mild.
After setting the preliminary diagnosis, the doctor prescribes:
- Phonocardiography, which allows to track how the detected noise relates to the phase of the heart cycle.
- ECG, which reveals the hypertrophy of the heart, the disturbance of its rhythm, the blockade of the bundle of the Guiss in the zone of the right leg.
- Echocardiography, which detects the area of the mitral orifice, increases the size of the left atrium. Transesophageal echocardiography helps to exclude vegetation and calcification of the valve, to reveal thrombi.
- X-ray is necessary for detecting the bulging of the pulmonary artery, atria and ventricles, widening of the veins and other signs of the disease.
- Probing of the heart cavities, which is rarely used, helps to detect an increase in pressure in the right heart.
If the patient is subsequently referred for a valve prosthesis, he will need to undergo left ventriculography, atriography and coronary angiography. Also, additional consultation is possible with specialists, for example, a therapist or rheumatologist.
Stenosis of the mitral valve involves treatment, about the methods of which we will talk later.
The main treatment for mitral stenosis is surgical, since the rest of the measures help to only stabilize the patient's condition.
Operation does not require for the first and fifth stages. In the first case, it is not necessary, because the disease does not interfere with the patient, and in the second - it can be dangerous for his life.
This technique is based on monitoring the patient's condition. Because the disease can develop, the patient should undergo a full examination and consultation with a cardiac surgeon every 6 months. Also, patients are shown minimal heart loads, including avoiding stress, a diet low in cholesterol.
Drug therapy is aimed at preventing the causes of stenosis. The patient is prescribed:
- Antibiotics for the prevention of infectious endocarditis.
- Diuretics and cardiac glycosides for the alleviation of heart failure.
- Beta-blocker to eliminate arrhythmia.
If a patient has thromboembolism, he is prescribed antiplatelet agents and heparin subcutaneously.
If the heart is severely damaged, then patients are prescribed prosthetics with a biological or artificial prosthesis or an open mitral commissurotomy. The last operation is that commissures and subclavian fusion are dissected, at this time the patient is connected to the artificial circulation.
For young patients, especially important is the sparing performance of this operation, which calls open mitral commissurotomy. The mitral orifice during the operation is expanded by a finger or instruments by splitting the fusion.
Patients sometimes receive a percutaneous balloon dilatation. The operation is performed under an x-ray or ultrasound. A balloon is inserted into the aperture of the mitral valve, which inflates, thereby separating the valves and eliminating stenosis.
Prevention of the disease
Preventive measures are reduced to the treatment and prevention of recurrence of rheumatism, focal sanitation of streptococcus. Patients should be observed at the cardiologist and rheumatologist, once every 6-12 months, to exclude the progression of mitral stenosis.
It will not be superfluous to follow the principles of a healthy lifestyle. Moderate and proper nutrition can help improve the body's immune capacity, the state of the heart muscle.
Mitral stenosis and mitral insufficiency
Statistically, mitral insufficiency appears less frequently than mitral stenosis. The ratio of these pathologies in adults is approximately 1:10.According to Jonas's research, conducted in 1960, the ratio reached 1:20.Children suffer from mitral stenosis more often than adults.
Mitral insufficiency studies in patients who underwent commissurotomy showed that the disorder occurs in about 35% of cases. Let's consider possible complications of mitral stenosis.
If mitral stenosis is not treated or late diagnosed, the disease can lead to:
- Heart failure. With this disease, the heart can not normally pump blood.
- Extension of the heart muscle. The condition develops due to the fact that with mitral stenosis the left atrium is full of blood. Over time, this leads to overflow and right-wing branches.
- Atrial fibrillation. Because of the disease, the heart shrinks chaotically.
- Thrombosis. To the fact that in the right atrium are formed clots, leads to fibrillation.
- Swelling of the lungs, when plasma will accumulate in the alveoli.
Because mitral stenosis affects hemodynamics, blood does not flow to organs in normal volume, which can affect their functioning.
More details about hemodynamics with mitral stenosis will be described by the following video:
Mitral stenosis is prone to progress, so the five-year survival rate is 50%.If the patient underwent surgery, the percentage of his five-year survival rate rises to 90-95%. The probability of postoperative stenosis is 30%, so patients should be constantly monitored by a cardiac surgeon.