One of the most common heart defects( along with the tetralogy of Fallot, defects of the interatrial and interventricular septum) is the stenosis of the pulmonary artery. About eleven percent of all patients with various heart defects have precisely this ailment. Stenosis of the pulmonary artery is characterized by the presence of an obstruction to the flow of blood in the region of the valve of the pulmonary trunk. The cause for the obstruction is the joint valve flaps. Most often they form a solid membrane with a hole in the center. For the most part, such congenital heart disease as a stenosis of the pulmonary artery in a newborn baby is a valvular stenosis, but sometimes it is found in conjunction with other heart defects.
Features of the disease
The size of the hole for stenosis of the pulmonary artery can be varied and directly affect the patient's condition.
- At a hole size of one millimeter, a newborn requires urgent surgical intervention, otherwise death will occur.
- But with the normal size of the hole, the vice can be detected after a couple of years of life, and then accidentally. After all, the characteristic manifestations are not very symptomatic: the pressure in the right part is lower than in the left one, and the tremor above the heart can not be an accurate sign.
With stenosis of the pulmonary artery, the right ventricle of the heart works with constant overload. This always leads to a thickening of its wall and an expansion of the internal cavity. Therefore, a child with a suspicion of such a defect must constantly be observed. The best development of the disease will show the level of pressure on the heart valve. When the difference between the pulmonary artery and the right ventricle is fifty millimeters of mercury, it is necessary to do the operation. Basically, it happens at the age of nine.
Therefore, in adulthood, there may be a question of replacing the heart valve with a prosthesis. But it is, rather, the consequences. And now let's consider the degree of stenosis of the pulmonary artery.
Type of heart with pulmonary artery stenosis
Staging of pulmonary artery stasis
There are four stages of pulmonary artery stenosis:
- mild stenosis - stage I.There are no complaints from the patient, the ECG shows a slight overload of the right ventricle of the cardiac muscle. Systolic pressure up to sixty millimeters of mercury;
- marked stenosis - II stage. Characterized by a clear manifestation of symptoms. The systolic pressure of the heart muscle in the right ventricle is from sixty to one hundred millimeters of mercury;
- sharp stenosis - III stage. Severe stage of the disease, signs of circulatory disturbances, pressure on the valve of the pulmonary artery and right ventricle over a hundred millimeters of mercury;
- decompensation - IV stage. Obvious signs of myocardial dystrophy, very violent blood flow disturbance. Develops contractility of the right ventricle, so systolic pressure may be low.
By the level of blood flow, it is possible to distinguish valvular( the most common), subvalvular and supra-valued stenosis of the pulmonary artery in a newborn child. Very rare and a combined form of the disease.
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The opinion of doctors. .. & gt; & gt;
- With valve stenosis, the valve flaps grow together and it has a domed shape with a hole in the middle.
- The subvalvular degree of the disease looks like a funnel-shaped narrowing of the outflowing part of the right ventricle as a result of abnormal growth of fibrous and muscular tissue.
- Supra-valued stenosis may be represented by an incomplete or full membrane, localized narrowing, multiple peripheral stenoses of the pulmonary artery, diffuse hypoplasia.
Causes of
Pulmonary artery stenosis can be:
- congenital. Poor heredity, rubella, borne by the expectant mother during pregnancy, chemical and drug intoxication and many other factors;
- purchased. As a result of various diseases, the vegetation of the valve and, consequently, stenosis may develop. Sometimes it arises as a consequence of compression of the pulmonary artery by enlarged lymph nodes or its sclerosis.
Schematic diagram of pulmonary artery stenosis
Symptoms of pulmonary artery stenosis
Symptoms of pulmonary artery stenosis depend on its stage. At a systolic pressure from fifty to seventy millimeters of a mercury column - they are absent.
The most common symptoms:
- increased fatigue during exercise;
- shortness of breath;
- auscultation( cardiac noise);
- dizziness;
- weakness;
- drowsiness;
- pain in the region of the heart;
- syncope;
- angina;
- swelling and pulsation of the cervical veins;
- heart hump.
Diagnosis
Diagnosis of pulmonary artery stenosis includes a set of various instrumental studies and physical data.
- In the second intercostal space, to the left of the sternum there is a gross systolic murmur. It is conducted in the direction of the collarbone and is perfectly auditioned in the interscapular department. The second tone in the first and second stages of the illness is listened to practically unchanged, but with a pronounced stenosis it can disappear completely.
- With slight stenosis, the electrocardiogram does not show any deviations. In all other stages of the disease, there are signs of hypertrophy of the right ventricle of the cardiac muscle. Supraventricular arrhythmias may occur.
- Echocardiography shows dilatation of the right ventricle of the cardiac muscle and poststenotic enlargement of the pulmonary artery. Dopplerography can detect and determine the pressure difference between the pulmonary trunk and the right ventricle.
- Radiographic studies show depletion of the pulmonary pattern and poststenotic expansion of the pulmonary artery trunk.
Next we will tell you about the features of treatment of pulmonary artery stenosis in children.
Treatment of
Therapeutic and medicamentous methods of
Used to prepare for surgery or to alleviate a patient's condition in an inoperable IV stage.
Patient monitoring includes:
- regular echocardiography;
- prophylaxis of infective endocarditis;
- preventive antibiotic therapy;
- detection of carriers of streptococcal infection with sanation of chronic foci.
Operation
The only effective method of treating this heart defect is a surgical operation. Cardiac surgeons have successfully performed it since 1948 and since then the methods have progressed significantly. It is desirable to operate the patient in the second or third stage of the development of the disease. Patients with moderate stenosis are observed, but the operation is not prepared.
Eliminate defect with several types of operations:
- closed pulmonary valvuloplasty. Previously used to eliminate many vices, but is currently most commonly used to treat pulmonary artery stenosis. The operation is performed through the left anterolateral approach to the heart in the fourth intercostal space. With the help of a special tool, valvulot, the spliced walls of the valves are dissected, with the help of special holders, the bleeding decreases. After dissecting the membrane, the opening is expanded with a Fogarty probe or dilator;
- pulmonary valvulotomy. An operation that is performed by catheterization. The probe is injected by a prognostic route and is equipped with special knives or a balloon;
- open valvulotomy. It is performed by connecting the artificial circulation and opening the chest to gain access to the heart. The incision is made at the lumen of the pulmonary trunk and through it the structure of the spliced valves is studied. Then they are cut strictly according to the position of the commissure, from the middle hole to the base of the valves. The valve opening and the valvular space are monitored visually or with the help of a cardiac surgeon's finger. This method of eliminating vice is considered the most effective.
The following video will tell you about the operation of pulmonary artery stenosis:
Prevention of
Disease prevention of intrauterine malformation involves limiting the impact on the future mother of harmful factors and ensuring a normal course of pregnancy. All patients with suspected pulmonary artery stenosis are required to be observed regularly at the cardiologist and to carry out measures for the prevention of infective endocarditis.
And then we'll talk about how dangerous it is not to fight such a disease as a stenosis of the pulmonary artery.
Complications of
With stenosis of the pulmonary artery, myocardial dystrophy, frequent inflammatory diseases of the respiratory tract and an increased predisposition of patients to them may develop, septic endocarditis may appear. For particularly advanced cases:
- stroke;
- right ventricular failure;
- myocardial infarction.
And finally, we will talk about the average life expectancy and prognosis for stenosis of the pulmonary artery.
Forecast
In modern medicine, cardiologists do not allow the development of the disease, making surgery in early childhood. But with the refusal of some parents from the operation for religious or other reasons, the probability of a lethal outcome increases several hundred times. In the absence of treatment, the patient dies within five years.
The main thing, remember, even if the doctor diagnosed the stenosis of the pulmonary artery in the fetus, everything is fixable, do not despair!
One more kind of operation for valve stenosis of the pulmonary artery will be described by the video below: