Often, malfunctions of the pulmonary valve (pulmonary artery valve) develop against the background of cardiac rheumatism or thrombosis.
But in most cases, defects in the right side of the heart develop already against the background of defects in the valvular system of the left ventricle. And even less often, according to statistics, it is a congenital defect.
Pulmonary valve anatomy
The pulmonic valve opens during systole to allow blood to pass through and closes during diastole. Consists of 3 semilunar valves: right leaf, left and front.
The leaflets are attached to the annulus fibrosus. The valve separates the pulmonary trunk from the right ventricle of the heart.
What does a normal heart valve mean?
During normal operation, the pulmonic valve is completely closed during diastole, that is, during relaxation of the heart muscles. If the valve leaflets close and open simultaneously and tightly, then the pulmonary valve is normal.
The pulmonary artery is the artery that carries venous blood from the lungs to the heart, into its right ventricle. It is in the right ventricle that the pulmonary circulation begins.
Valve failure. Reasons
When people in the medical community talk about the insufficiency of a valve, they mean a "breakage" of the valve, due to which it does not close or open well (stenosis). There are 4 chambers in the heart and, accordingly, 4 valves that control the flow of blood from one chamber to another. When one valve fails, the others will also fail over time.
Pulmonary valve insufficiency occurs when the valves do not close tightly.
Reason for failure:
- Congenital deficiency.
- Acquired pathology.
Acquired valve insufficiency develops in adults due to these he alth problems:
- Infective endocarditis - inflammation of the inner lining of the heart.
- Carcinoid syndrome. In the syndrome, a small tumor in the intestine releases harmful substances that gradually destroy the right side of the heart and lungs. But it is a very rare disease.
- Rheumatism. This inflammatory disease often damages the valves of the heart muscle.
- Syphilis.
- Serious chest injury resulting in valve rupture.
- Drug use.
- Mitral stenosis.
- Presence of blood clots in the pulmonary trunk.
- Pickwick's syndrome, its main symptom islung problems.
- Right ventricular dilatation due to tricuspid valve regurgitation.
Another important reason is long-term lung disease in smokers.
Here, the reverse process is triggered - first, pulmonary hypertension begins, and then, as a result, the functioning of the pulmonary artery valve is disrupted.
Such a pathology as insufficiency can manifest itself mildly and severely, when surgery is needed.
Degrees of pulmonary valve regurgitation
The term "regurgitation" means in medicine that the valve of the heart does not close completely, as a result of which the blood flows in the opposite direction. For example, if the pulmonary valve is damaged, blood moves from the artery into the right ventricle, causing it to overflow with blood. This defect at the 1st stage does not greatly impair the work of the heart. At the same time, hemodynamics is not disturbed, the thickness of the heart muscle of the right ventricle remains within the normal range.
But when regurgitation on the pulmonary valve of the 2nd degree is detected, the person already has some he alth complaints. His right ventricle is already beginning to feel the increased load.
With pulmonary regurgitation of the 2nd degree, the heart is more and more damaged over time, so, in the work of the system there is no longer the former synchronism, the whole "mechanism" is gradually deteriorating.
Valve stenosis
With such a valve anomaly,like a stenosis, for some reason the valve doesn't open enough to allow blood to pass into another heart chamber.
The symptoms of stenosis are somewhat different from those of insufficiency. Due to obstructed blood flow, a person feels dizzy, fatigued, often faints due to poor circulation in the vessels of the brain. But with grade 1 pulmonary valve stenosis, a person does not yet feel such serious symptoms, he only feels fatigue more often.
The valve works worse if the stenosis is not treated and the advice of the cardiologist is not followed. First comes the compensation stage, when the heart doubles its pace to provide blood flow. And then the situation gets even worse. The stage of decompensation sets in, the right ventricle expands, as it contains too much blood. And his muscular walls are not able to push this mass of blood through the narrowed walls of the valve.
Severe pulmonic stenosis is treated mainly with xenopericardial prosthetics. That is, extremely efficient. The operation is indicated for those people who have severe right ventricular failure and are at risk of death.
Isolated pulmonary stenosis in the neonatal period
Isolated stenosis, that is, stenosis not associated with other heart diseases, is formed even in the prenatal (neonatal) period of fetal development in such cases:
- mother had rubella during gestation;
- has diabetes 1stor 2nd degree;
- woman drank alcohol;
- genomic breakdown;
- Substances in the mother's body, such as isotretinoin, which is used to treat seborrhea, also lead to malformation; or hydantoin, a substance used in drugs against convulsions.
Clinical manifestations of pulmonary valve stenosis in newborns proceed in different ways. In mild cases, the defect does not make itself felt, it is asymptomatic. And in severe cases, from the first days of life, there is a strong lack of blood supply in the tissues and cyanosis.
Diagnosis
How does a doctor make a diagnosis, what tests and procedures will require? The cardiologist, in fact, uses the standard program for examining the heart and its defects. He cannot make a diagnosis based on the patient's complaints alone. He needs to objectify, then specify the problem, find out at what stage the disease is.
The following studies are being carried out:
- chest X-ray;
- ECG and echoECG;
- cavity catheterization;
- lab tests;
- angiopulmonography using a contrast medium.
In addition, the doctor looks for other signs, such as swelling of the jugular veins. During auscultation, noises are sometimes heard; the doctor can determine the duration of these noises and can make an assumption about their nature. However, his assumption still needs to be confirmed using the above procedures. If the pulmonary valvearteries are functioning normally and there are no extraneous noises, no procedures are required.
Pregnant women have a special ultrasound to find out if there is a risk of heart pathologies in the fetus.
Medicines
Acquired heart defects, including pulmonary valve defects, in the stage of compensation can be treated with some drugs:
- Anticoagulants.
- Cardioprotectors.
- Cardiac glycosides.
- Beta-blockers.
If the cause of grade 2 pulmonic regurgitation is infective endocarditis, anti-inflammatory drugs are used.
How is the prosthetic surgery going?
The operation is assigned to those persons who are diagnosed with subcompensated or decompensated pulmonary valve disease. Judging by the situation, the doctor decides whether to keep the valve or put in a new one. Artificial valves exist both mechanical and biological. However, the service life of the biological is only 15 years, then the operation must be repeated. Therefore, young people are immediately given a mechanical one.
Those people who have had a stroke or myocardial infarction, surgery is contraindicated. It is also forbidden to carry out such a serious operation for diabetics.
Before the operation for 12 hours, the patient is forbidden to eat and cancel all medications. On the eve, a person is offered to drink a sedative so that he does not set himself up for bad thoughts and is not afraid. After allthe operation is performed on the open heart, and at this time its function is performed by the heart-lung machine. But the risk, thanks to honed craftsmanship and teamwork, is minimal.
After the operation, the patient must undergo a course of rehabilitation. The course program usually includes physiotherapy exercises and special breathing exercises.
Prevention of malformations
The best prevention of valve dysfunction at all times is to lead a he althy lifestyle. No vitamin supplements or "golden formulas" of youth will help maintain he alth if a person smokes from an early age and does not follow a sleep and wakefulness regimen.
The human heart is a very vulnerable organ. Smoking and alcohol bring irreparable harm to him. And another factor in heart he alth is that a person is designed to move. At any age, he should go in for sports, but moderate. Heavy loads for the sake of results are also harmful.
Women during pregnancy should avoid various mutagenic factors and do not take medications without consulting their doctor. Many drugs in utero can cause pulmonary valve disease.
Conclusion
Mitral and aortic valve defects are more common than those of the pulmonary valve. Valve failure of the left side of the heart usually follows after the left side fails at the stage of decompensation; and then the right side of the heart "breaks" as well.
Also a common cause of pulmonary valve diseaseartery is considered infective endocarditis. Older people are advised to engage in the prevention of endocarditis and visit a cardiologist more often for preventive examinations.
However, if he is still diagnosed after a detailed examination, then the patient needs to completely reconsider his life.
