The mitral valve is located between the leftatrium and the left ventricle. It opens during diastole (during the holiday) and through the atrioventricular hole into the left ventricle through the mitral valve freely enters the arterial blood of the right atrium. In systole (the phase in the rest) is closed by the valve when the blood pressure of the left ventricle and prevents reducing backflow of blood from the left ventricle into the left atrium. The valve consists of two flaps.
The mechanism of mitral valve
When infectious and other diseases of the heartleaflet can be deformed to thicken. Then the valve does not completely close, opening remains between the flaps and thus the valve can not completely prevent the reverse flow of blood from the left atrium into the left ventricle. Part of the blood from the left ventricle flows back into the left atrium. First hypertrophied left atrium, but due to the fact that its muscle layer is thin and is not designed for heavy loads and decompensation occurs soon left atrium stretches and increases in size. Because all the blood from the lungs do not have time to be pumped out, there is an increase in pressure in the lung vessels. At the same time due to the large blood flow in diastole phase of the left ventricle of the heart, it is as hypertrophy, but over time its compensatory potential as drying up, and there is a lack of left ventricular function. Ultimately, it increases the load on the right heart, and there is congestion in the systemic circulation.
Symptoms of mitral valve insufficiency
As long as the heart compensates for the lack of workmitral valve, the patient has no complaints, even at high physical exertion. Over time, there are shortness of breath with exertion, later at rest, cardiac asthma symptoms (dry cough with little sputum, sometimes coughing up blood). Pain in the diverse nature of the heart and does not always depend on the physical exertion. Swells the veins in the neck, nails and toes become bluish in color, there are swelling in the legs. Very often mitral insufficiency complicated by atrial fibrillation.
Diagnosis of the disease
When listening to detect systolic murmuron the apex of the heart. On the electrocardiographic finding an increase in the left atrium and the left ventricle. On the X-ray there is an increase of the left heart. Often, to clarify the diagnosis produced radiographic study with contrast esophagus. Echocardiography revealed deformed mitral valve regurgitation from the left ventricle into the left atrium, the left atrium increase in size and the left ventricle.
The treatment of mitral insufficiency
Surgical treatment of mitral insufficiencyValve is the main treatment option. The basic operation to restore the function of the mitral heart valve is a prosthetic valve. Recently produce plastic valve. Sometimes it gives better results, but plastic surgery on the mitral valve is almost impossible for rheumatic defects. There are many techniques as prosthetic valve and plastics. Their use depends on the extent and type of mitral valve. Results of surgical treatment showed an advantage of plastic correction of the mitral valve.
Mitral stenosis - a narrowing of the leftatrioventricular opening. The cause of mitral valve stenosis, as well as the majority of acquired heart defects, rheumatic fever is transferred earlier in 80% of cases. In the remaining 20% are other infectious diseases inner lining of the heart, atherosclerosis, heart injury, syphilis and others. The narrowing of the entrance from the left atrium into the left ventricle causes an increase in pressure in the left atrium, the blood from the pulmonary circulation does not manage to be pumped, the pressure in the lung vessels . Because of the increased pressure in the pulmonary vascular spasm occurs and all this leads to an increase in pressure in the pulmonary artery, which leaves the right ventricle, and carries the blood into the lungs. Right ventricle hypertrophy due to the increased load. Gradually his compensatory reserve is depleted, it expands, the contractile ability of the heart muscle of the right ventricle is reduced. The right ventricle can no longer be completely pumped blood from the systemic circulation. There is heart failure.
The appearance of a patient with mitral stenosis longtime is not changed. Gradually, there is shortness of breath, palpitations. The patient does not tolerate exercise. Over time, with an increase of stenosis it appears the so-called "mitral blush" - blue-pink hue of the lips and cheeks. If you attach the arm to the chest in the area of the patient's heart, you can feel the tremor, the so-called "cat purring."
Methods of diagnosis of mitral valve stenosis
When listening to the heart is determineddiastolic murmur. The noise is produced when the blood in diastole through the narrowed mitral orifice flows into the ventricle. Noise increases after exercise. On the electrocardiographic finding an increase in the left atrium and the right ventricle. Radiologically determined changes in the lungs. On the echocardiogram can see thickening of the leaflets of the mitral valve, a violation of their movement, reducing the size of the atrioventricular openings, deposition of calcium on the valve flaps. Sometimes the enlarged right atrium thrombus found.
Treatment of the disease
Treatment of mitral valve stenosis in mostsurgical cases. for the treatment of stenosis, mitral valve operations were one of the first heart surgery. It produces a closed mitral commissurotomy. Conjoined mitral valve are cut or torn. This is done now. Only in the present conditions it is produced in the so-called "dry" in a heart-lung machine. This allows you to examine in detail the mitral valve, to assess his condition. If necessary, the valve can be made of plastic.
If the valve is damaged significantly, and correctit is impossible to produce this valve prosthesis using an artificial mechanical heart valve. Young patients, especially women, the possibility of sparing surgery. This is a closed mitral commissurotomy (cutting joints), or balloon dilation (widening) of the stenotic opening. The operation is performed through the subclavian artery or another. The chest is not opened, the heart-lung machine is not used. Results of surgical treatment of mitral valve stenosis good.