Internal illnesses. Mitral valve insufficiency (lecture notes)

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Internal illnesses. Mitral valve insufficiency (lecture notes)

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LECTURE No. 9. Mitral valve insufficiency

Incomplete closure of the valves during left ventricular systole as a result of damage to the valvular apparatus. It is rare in isolated form, more often in combination with stenosis of the left atrioventricular orifice.

Etiology. The causes of development may be organic lesions of the valve leaflets or chords in atherosclerosis, rheumatism (up to 75%), infective endocarditis, diffuse connective tissue diseases, less often in visceral forms of rheumatoid arthritis.

Functional lesions are possible: violation of the coordinated function of the muscular apparatus of the valve leaflets, excessive expansion of the left ventricle, annulus fibrosus and circular muscles of the atrioventricular orifice in myocarditis, cardiopathy, myocardial infarction, etc.

Pathogenesis. As a result of incomplete closure of the mitral valve leaflets, blood flows back during systole from the left ventricle to the left atrium. There is a tonogenic dilatation and left atrial hypertrophy (volume overload), an increase in the diastolic volume of the left ventricle, left ventricular hypertrophy. The left atrium loses muscle tone, it increases pressure. Passive (venous) pulmonary hypertension occurs.

The compensatory period is long due to the simultaneous flow of blood into the aorta and pulmonary artery.

Clinic. Clinically, there is an increase in the boundaries of the heart in all directions. An increase in the boundaries of the heart with a decrease in functional activity indicates a relative or muscular insufficiency of the mitral valve.

At the apex, a systolic murmur and a weakening of the I tone are heard, which are more often noted with organic mitral valve insufficiency.

At the first stage, the valve defect is compensated, no complaints are made. With the development of passive (venous) pulmonary hypertension with stagnation in the pulmonary circulation, shortness of breath, attacks of cardiac asthma appear, which ends with the formation of right ventricular failure.

Additional diagnostic study. An ECG study is performed to determine signs of left atrial and left ventricular hypertrophy.

An X-ray examination establishes an increase in the size of the heart, a mitral configuration of the heart, a deviation of the esophagus along a large radius arc, a symptom of a rocker arm.

An echocardiogram is performed to determine the closure of the mitral valve leaflets in systole, a Doppler echocardiogram is performed to determine mitral regurgitation.

Complications. These include pulmonary hypertension, left atrial dilatation.

Treatment. It can be conservative or surgical. Conservative treatment is carried out with the underlying disease and heart failure. Surgical treatment involves mitral valve replacement.

Forecast. Depends on the degree of mitral regurgitation; average life expectancy is about 40 years. With the development of heart failure, the prognosis is unfavorable.

Author: Myshkina A.A.

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