The human body is unique. However, sometimes there are situations when a certain organ does not fully perform its functions. It is precisely such a violation of the structure - insufficiency of the aortic valve - the topic of this article.
Terminology
Initially, you need to understand the terms that will be used in the presented article. So what is aortic valve insufficiency? This is a violation of the work of this body, as a result of which its valves do not completely close tightly. This leads to such a problem as the reflux of blood from the aorta back into the left heart ventricle. This happens during diastole - the process of filling the heart with blood. What is the risk? So the human body does not receive enough blood volume necessary for normal operation. As a result, the load on the heart increases in order to compensate for this shortage.
Generally speaking, at first, while the body is young and full of strength, aortic valve insufficiency most often does notbrings no problems. The only thing is that the heart can increase slightly in size in order to be able to compensate for the lack of blood. Symptoms are initially completely absent, and the patient may not even be aware of the existence of a problem. Later, shortness of breath, increased fatigue begins to occur. To cope with this disease, the patient may be sent for aortic valve replacement surgery.
The problem is in numbers
Scientists note that it is males who most often suffer from such a problem as aortic valve insufficiency. If we consider the percentages, then the number of deaths from this pathology, in the case of all those who died with various heart problems, is about 14%. If we consider this particular disease, then in about 4% of cases, aortic valve insufficiency is observed in its pure form, and in 10.3% of cases - in combination with other heart diseases.
Reasons
Generally speaking, the cause of the development of this problem in 2/3 of cases is precisely the rheumatic lesion of the valves. Less commonly, the disease causes infective endocarditis. Scientists also distinguish two groups of causes, which are divided into chronic and acute.
Causes of chronic insufficiency
In this case, doctors identify several important reasons that can cause chronic processes:
- Congenital heart defects. Children can be born with only one or two valves, which causes many problems and difficulties.while the heart is pumping blood.
- Aging processes. That is, the aortic valve can wear out over time, wear out.
- Rheumatic fever, which causes scarring of the valve leaflets, preventing them from closing properly.
- Infectious processes in the heart, when vegetations (whole colonies of bacteria) “eat through” the valve leaflets, or, simply accumulating on the valves, prevent them from closing normally.
- Enlargement of the aorta, when its bulb is stretched so much that the valves simply cannot close completely.
- Treat various problems that can cause aortic valve insufficiency. For example, radiation therapy or the use of Phentermine, a weight loss drug that was withdrawn from use at the end of the 20th century. According to scientists, its use could cause various heart problems, including aortic valve insufficiency.
Causes of acute deficiency
Among the causes of aortic valve insufficiency, doctors also distinguish diseases such as endocarditis (infection of the organ), aortic dissection (as a result of which blood flows through the resulting gaps). Occasionally, patients who have undergone aortic valve replacement surgery also develop valve insufficiency. The acute causes of this problem also include chest trauma (for example, during a car collision, when a person hits his chest hard on the dashboard). This often also leads to damage to the aortic valve.
Symptoms of the problem
What are the signs of aortic valve insufficiency, by which you can determine the presence of a problem? As noted above, initially there may not be any symptoms. That is, the patient may not even feel that he has a specific problem. However, the situation has changed over the years. The heart works harder to compensate for the lack of blood. As a result, the left ventricle increases slightly, and the heart itself becomes weaker. This is where aortic valve insufficiency makes itself felt. Symptoms that may occur in this case:
- Permanent fatigue, weakness throughout the body.
- The patient has shortness of breath. It increases during physical activity.
- There are also arrhythmias, that is, heart rhythm disturbances.
- The patient may complain of an accelerated heartbeat.
- Chest pain (angina pectoris) may occur during exercise.
- Very rarely, patients also suffer from loss of consciousness.
If the patient has acute insufficiency, then all the symptoms appear suddenly, their strength is greater, they manifest themselves more clearly. In this case, patients often require emergency ambulance, up to life saving.
About degrees of insufficiency
Also has such a problem as aortic valve insufficiency, degree of development. They differ in the length of the jet that is injected back into the ventricle through poorly closed cusps. Depending on this, they are distinguished by three:first, second and third.
First degree
What is special about grade 1 aortic valve insufficiency? In this case, the jet does not exceed a length of 5 mm from the aortic cusps. So, this problem can still be called insignificant. After all, blood is collected approximately under the very valves, without causing any special problems. Aortic valve insufficiency of the 1st degree does not cause a significant increase in the left ventricle, in this case it can be of full normal size.
Second degree
Aortic valve insufficiency of the 2nd degree is special in that the length of the jet in this case increases to 10 mm. That is, the blood "splashes" at a distance of about 10 mm from the valve leaflets. In this case, the jet can reach the leaflets of the mitral valve, which significantly worsens the situation. Aortic valve insufficiency of the 2nd degree increases the pulsation in the carotid artery and heart, the left ventricle increases. This is all easily seen on an echocardiogram.
Third degree
Aortic valve insufficiency of the 3rd degree is characterized by the fact that blood is injected back to a distance that exceeds 10 mm. In this case, the jet crosses the mitral valve and may reach the apex of the left ventricle. In this case, the borders of the heart increase by more than 2 cm, left ventricular hypertrophy can be “visible” on the ECG.
Child Deficiency
Separately, I would like to consider aortic valve insufficiency in children. Will there be any differencesadult and child? So, the symptoms will be slightly different. In this case, children most often experience pallor of the skin, pulsation of the arteries in the extremities, Musset's symptom may develop (the child will shake his head to the sides, depending on the heart rate). As for the treatment and diagnosis of the problem, this procedure will be the same for both children and adults.
Diagnosis
A preliminary diagnosis of "aortic valve insufficiency" can be made by the doctor after listening (auscultation) of uncharacteristic heart murmurs (there will be an unusual diastolic murmur). However, this is just a guess for now. Next, the doctor will ask about symptoms that may indicate the presence of this problem, collect a complete history. Further, the doctor will send the patient for additional studies that will confirm or disprove the previously formulated diagnosis.
- Palpation. In this case, the specialist can, by feeling, determine the trembling over the base of the heart. This is due to the release of a very large volume of blood. Percussion is also “observed” when the borders of the heart “go” to the left.
- EKG. This procedure makes it possible to determine the increase in the size of the left ventricle of the heart.
- EchoCG. This procedure in two-dimensional mode reveals left ventricular hypertrophy. In one-dimensional - it is able to distinguish the flutter of the leaflet of the mitral valve due to the ingress of a jet into it.
- Dopplerography givesthe ability to determine the degree of aortic valve insufficiency - shows the length of the jet of blood thrown back.
- X-ray. If aortic valve insufficiency is severe, this procedure makes it possible to “see” an increase in the size of the heart, calcification of the leaflets.
- To detect an increase in intracardiac pressure, a cardiac catheterization procedure may be prescribed. In this case, physicians distinguish four degrees of aortic valve insufficiency according to the volume of blood injected back. With the first degree, it is about 15%, with the second - from 15 to 30%, with the third - from 30 to 50%, with the fourth - more than 50%.
If a patient has been previously diagnosed with aortic valve insufficiency, the problem will not necessarily be diagnosed using all of these methods. So, the doctor decides for himself what the patient needs at this stage. It should be noted that, in addition to the above diagnostic methods, sometimes coronary angiography is also used, which can be prescribed for the same indications as for aortic stenosis.
Medical treatment
If a patient is diagnosed with aortic valve insufficiency, treatment will depend on the degree of the patient's disease. Thus, the urgency of the use of certain drugs or procedures is interrelated with the severity of the manifestation of various symptoms. If the form of the disease is chronic, therapeutic treatment is possible.
Medication that the patient may need:
- Diuretics. The main purpose of these drugs in this case is to remove excess fluid from the body, lowering blood pressure.
- Antibiotics. Can be prescribed as a prophylaxis of infectious diseases during surgical or dental procedures.
- Calcium channel blockers are also prescribed (mainly the drug "Nifedipine"), the main purpose of which is to reduce blood leakage. It should be noted that in some cases, the use of these drugs can be an excellent alternative to surgery.
- Other drugs may also be prescribed, such as ACE inhibitors or angiotensin receptor blockers.
It should also be noted that patients with this problem, albeit present in a chronic form, should be registered with a doctor. They will need to visit the doctor periodically. Radical measures in this case are not always shown.
Surgery
If the disease is acute, there is a need for urgent surgical intervention. The sooner a person gets to the doctor, the higher the chance of staying alive. And although the mortality in this case is low, the delay in going to the doctors can even cost the patient his life.
Also, surgery is indicated for patients who have been diagnosed with aortic valve insufficiency quite a long time ago. If the patient already has symptoms, even if initially mild, the left ventricle loses contractility - these are all indications for surgical replacement of the aortic valve.
As a reference, it should be noted that today surgery generally ends positively and brings the desired result to the patient. The first such operation was performed back in 1960 by Dr. Harken, who replaced the aorta with a plastic ball and a metal cage. On the territory of the Soviet Union, such an operation was first carried out in 1964, successfully. Since that time, doctors have developed many techniques and techniques to make this surgical intervention as high-quality and effective as possible.
Patient survival
If the patient has moderate or mild heart failure, the 10-year survival rate is very high, accounting for almost 90% of all patients. If complaints begin to appear, symptoms appear, the situation can worsen dramatically. In this case, if you do not resort to surgical intervention, death can occur in about 2-5 years, depending on the development of other diseases.
If the course of the disease is completely asymptomatic, the prognosis is as favorable as possible. In this case, surgery is required only in 4% of cases. At the same time, complaints can occur in patients during the first five years - in 20% of patients, seven years - in about 25% of patients. If the insufficiency is acute, severe, a fatal outcome is possible in case of ventricular arrhythmia. If the operation is done in time, such a development of events can be avoided.
Prevention
Preventive measures to avoid getting suchsickness, no. In this case, diets or a certain lifestyle will not be able to help. But patients who are at risk can save themselves. So, they regularly need to undergo examinations with a doctor, do the prescribed procedures. The examination schedule may vary, but you should not visit your doctor less than once a year.
