Aortic heart defects are usually acquired in nature and manifest clinically only in old age. Their presence can cause severe hemodynamic disorders. The severity of the pathology lies in the fact that the changes affecting the valves are irreversible.
The structure of the heart: valves
The heart is a hollow organ that consists of 4 chambers. The left and right halves are separated by partitions, in which there are no formations, however, between the atrium and ventricle of each side there is an opening equipped with a valve. These formations allow you to regulate blood circulation, preventing regurgitation, that is, reverse reflux.
On the left there is a mitral valve, consisting of two leaflets, and on the right - a tricuspid valve, it has three leaflets. The valves are equipped with tendon filaments, which ensures that they open only in one direction. This prevents backflow of blood into the atria. There is an aortic valve at the junction of the left ventricle with the aorta.valve. Its function is to ensure the one-way movement of blood into the aorta. There is also a pulmonary valve on the right side. Both formations are called "lunate", they have three valves. Any pathology, for example, calcification of the aortic valve leaflets, leads to impaired blood flow. Acquired defects are usually associated with some disease. Therefore, people with so-called risk factors should have regular check-ups: mainly an echocardiogram.
Aortic valve mechanism
The aortic valve plays an essential role in blood circulation. The valves are compacted or shortened - this is one of the main pathologies. It causes hemodynamic disturbances. The function of this part of the organ is to ensure the movement of blood from the left atrium into the ventricle, preventing regurgitation. The leaflets are open during atrial systole, at which time blood is directed through the aortic valve into the ventricle. Next, the doors close to prevent backcasting.
Heart defects: classification
By the time of occurrence, congenital heart defects (of the aortic valve and other formations) and acquired ones can be distinguished. Changes affect not only the valves, but also the septa of the heart. Congenital pathologies are often combined, which makes diagnosis and treatment difficult.
Aortic valve stenosis
Pathology implies a narrowing of the transition of the left ventricle to the aorta -valve leaflets and surrounding tissues are affected. This disease, according to statistical indicators, is more common in men. Thickening of the walls of the aorta and aortic valve cusps is usually associated with rheumatic and degenerative lesions. Also, endocarditis, rheumatoid arthritis can act as an etiological factor. These diseases lead to fusion of the valves, as a result of which their mobility decreases, and the valve cannot fully open during left ventricular systole. In the elderly, the cause of the lesion is often atherosclerosis and calcification of the aortic valve leaflets.
As a result of the narrowing of the aortic orifice, significant changes in hemodynamics occur. They are observed when the stenosis has a pronounced degree - a decrease in the tract by more than 50%. This leads to the fact that the pressure gradient of the aortic valve changes - in the aorta, the pressure remains normal, and in the left ventricle it increases. An increased effect on the wall of the left ventricle leads to the development of compensatory hypertrophy, that is, to its thickening. Subsequently, diastolic function is also disturbed, which causes an increase in pressure in the left atrium. Hypertrophy leads to an increase in oxygen demand, however, the increased mass of the myocardium accounts for the same blood supply, and with concomitant pathologies, even reduced. This leads to the development of heart failure.
Clinic
In the early stages, the affected aortic valve may not manifest itself in any way. Clinical changes occur when the hole is narrowed by 2/3 of the norm. When expressedphysical activity of patients begin to disturb the pain localized behind the sternum. Pain syndrome in rare cases can be combined with loss of consciousness due to systemic vasodilation. The formation of pulmonary hypertension leads to shortness of breath, which at first worries only during exercise, but then appears at rest. The protracted course of the disease becomes the cause of chronic heart failure. Pathology requires surgical treatment, as there is a risk of deterioration and sudden cardiac death.
Diagnosis
When examining patients, there is a characteristic pallor associated with reduced cardiac output. The pulse on the radial arteries is palpable with difficulty - it is rare and weak. On auscultation, there is a weakening of the 2nd tone or its splitting. The ECG is not informative enough - signs of hypertrophy are determined only with a severe degree of stenosis. The most revealing echocardiography, which allows to evaluate the aortic valve. The valves are compacted and thickened, the opening is narrowed - these are the main diagnostic criteria that this study helps to detect. The degree of stenosis and pressure gradient effectively allows you to determine the catheterization of the cavities.
Treatment
With mild and moderate stenosis, only a lifestyle correction is required - avoidance of excessive physical exertion, treatment of comorbidities. With an increased frequency of contractions, adrenoblockers are prescribed, and for heart failure, diuretics and cardiac glycosides are effective. Pronounced compactionthe walls of the aorta and the cusps of the aortic valve requires surgical treatment. As a rule, prosthetics or balloon dilatation is performed.
Aortic valve insufficiency
This is the name given to a pathology characterized by non-closure of the valves. This phenomenon leads to the backflow of blood into the left ventricle, which occurs during diastole. The defect is usually a complication of infective endocarditis and rheumatic lesions. Less often, syphilis, aortic aneurysm, aortitis, arterial hypertension, Marfan's syndrome, systemic lupus erythematosus lead to it.
The aortic valve plays an important role in blood circulation. Incomplete closure of its valves causes regurgitation, that is, the backflow of blood into the left ventricle. As a result, there is an excessive volume of blood in its cavity, which leads to overload and stretching. Systolic function is impaired, and increased pressure leads to the development of hypertrophy. Retrograde pressure rises in the small circle - pulmonary hypertension is formed.
Clinic
As with stenosis, pathology makes itself felt only with a pronounced degree of insufficiency. Shortness of breath occurs on exertion and is associated with pulmonary hypertension. Pain disturbs only in 20% of cases. At the same time, auscultatory and external manifestations of pathology are expressed:
- Pulsation of the carotid arteries.
- Durozier's symptom or the occurrence of systolic murmur on the femoral artery. It occurs when it is clamped closer to the listening position.
- Quincke's symptom - a change in the color of the lips and nails in accordance with the pulsation of arterioles.
- Double Traube tones, loud, cannonball-like sounds that occur over the femoral artery.
- De Musset sign of head shaking.
- Diastolic murmur after the 2nd tone, which occurs during auscultation of the heart, as well as the weakening of the 1st tone.
Diagnosis
Echocardiography and cavity catheterization are informative methods. They allow you to evaluate the aortic valve, as well as track the volume of regurgitant blood. Based on these studies, the severity of the defect is determined and the question of the need for surgical intervention is decided.
Treatment
Severe insufficiency with a large amount of regurgitation, intense clinical manifestations requires surgical treatment. The optimal solution is artificial aortic valves, which allow you to restore the work of the heart. If necessary, symptomatic drug therapy is prescribed.
Stenosis and insufficiency of the aortic valve are the most common heart defects, which, as a rule, are the outcome of any local or systemic disease. Pathology progresses slowly enough, which allows it to be diagnosed in time. Modern methods of treatment help restore valve function and improve the patient's condition.
