Internal illnesses. Mitral valve defects (most important)

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Internal illnesses. Mitral valve defects (most important)

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12. MITRAL VALVE DEFECTS

Mitral valve insufficiency - incomplete closure of the valves during left ventricular systole as a result of damage to the valvular apparatus.

Etiology. 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.

Pathogenesis. As a result of incomplete closure of the mitral valve leaflets, a reverse flow of blood occurs during systole from the left ventricle into the left atrium. Tonogenic dilatation and hypertrophy of the left atrium occurs. The left atrium loses muscle tone and its pressure increases. Passive (venous) pulmonary hypertension occurs.

Clinic. Enlargement of the borders of the heart in all directions.

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.

Diagnostic study. ECG examination, X-ray examination, echoCG examination, Doppler echocardiography examination.

Treatment. Conservative treatment is carried out with the underlying disease and heart failure. Surgical treatment involves mitral valve replacement.

Forecast. With the development of heart failure - unfavorable.

Mitral stenosis is a narrowing of the left atrioventricular orifice, which obstructs the movement of blood from the left atrium to the left ventricle.

Etiology. Organic lesions (rheumatism), congenital malformations (Lutembashe syndrome - mitral).

Pathogenesis. Fusion of the mitral valve leaflets and tendon threads along the free edge. The area of the mitral orifice decreases (normally 4-6 cm2). Hypertrophy and tonogenic dilatation of the left atrium develop, and systole lengthens.

Clinic. Patients have an asthenic build, are infantile, the skin is pale, and there is facial cyanosis (facies mitralis).

Shortness of breath, weakness, palpitations, occasional cough, sometimes hemoptysis, suffocation at night, and occasionally dysphonia and dysphagia appear. The borders of the heart are enlarged upward and to the right, a flapping 1st sound, presystolic murmur, bifurcation of the 2nd tone, “cat purring”, weak, irregular pulse are heard.

Diagnostic study. ECG examination, X-ray examination, echoCG examination.

Complications. Congestion in the pulmonary circulation, hemoptysis, cardiac asthma, high pulmonary hypertension, pulmonary aneurysm, dilatation of the heart cavities, atrial fibrillation and flutter, thromboembolism, spherical thrombus in the left atrium, symptoms of compression (recurrent nerve, subclavian artery).

Treatment. More often performed: mitral comis-surotomy. Symptomatic therapy is carried out with circulatory failure and an active rheumatic process.

Forecast. With timely commissurotomy and subsequent active antirheumatic therapy - favorable.

Author: Myshkina A.K.

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