The main muscle of the human body is the heart. This is a complex mechanism, the components of which are valves. On the right side is the tricuspid valve. It separates the atrium and ventricle. When its work fails, the blood flow in this part of the muscle is disturbed. The result is a life-threatening condition. In medical practice, it is also known as "tricuspid valve insufficiency". Today's article will look at the main causes, symptoms and treatments for this disease.
Anatomical reference
The human heart is a muscular organ. Its cavity is divided into 2 atria and 2 ventricles. Communication between these structures occurs through valves. They are responsible for the flow of blood in one direction.
On the right side of the heart, the chambers are connected through the tricuspid valve. It consists offollowing anatomical formations:
- three leaflets (septal, anterior and posterior);
- tendon course;
- papillary muscles;
- annulus fibrosus.
During one atrial contraction, the tricuspid valve opens. Gradually, the blood fills the ventricle. After that, the myocardium begins to contract alternately, while the valve flaps slam shut under strong pressure. Such a well-established mechanism prevents the reverse reflux (regurgitation) of blood. Under the influence of certain factors, sometimes his work fails. In this case, they say that the tricuspid valve is experiencing insufficiency. However, he can no longer fulfill his functions fully.
With this pathology, blood from the right ventricle returns to the atrium. A slight increase in fluid volumes practically does not affect the functioning of the main muscle of the body. With severe insufficiency, the chambers of the heart are deformed, the pressure indicators in them change dramatically. It can increase up to 8 times compared to natural values.
Brief description of the disease
Tricuspid insufficiency is a heart disease that develops due to inadequate closure of the valve leaflets, the backflow of blood from the right ventricle into the atrium. Against the background of constant regurgitation, the diastolic volume and pressure in this structure of the heart increase. This entails hypertrophy and dilatation of its walls. As a result of disruption of the compensatory mechanisms, the patient develops congestion in the body.
Tricuspid insufficiency is often accompanied by other congenital heart defects. For example, a patent foramen ovale or an atrial septal defect.
Main causes and forms of pathology
Tricuspid valve insufficiency always has a different course. To make an accurate diagnosis, it is first necessary to determine the form of the pathological process. For this purpose, various criteria are used in medical practice: the period of occurrence, the localization of the damaged area of the valve, the severity of regurgitation.
Depending on the time of development, the disease in question is of two types. As a rule, in all cases it is not acquired, but occurs after the inflammatory process. Congenital malformation is diagnosed extremely rarely and develops in the womb. Its appearance is influenced by the action of negative factors on the body of a pregnant woman. It could be radiation, an infectious disease, or X-ray exposure.
Based on which part of the tricuspid valve is damaged, insufficiency can take two forms. The organic variant is accompanied by a physiological change in the valves. They are gradually deformed, covered with bloom. With a functional form of the disease, the valve does not close completely.
The development of acquired organic tricuspid insufficiency occurs under the influence of the following reasons:
- Rheumatism is an inflammation that spreads to the systems of internal organs.
- Carcinoid syndrome -damage to various organs caused by a small intestinal tumor. Pathogenic elements from the neoplasm enter the bloodstream and begin to attack the endocardium. They then enter the pulmonary vessels.
- Infective endocarditis is an inflammatory lesion of the lining of the heart.
- Mitral commissurotomy. This is an operation that is used in the treatment of stenosis.
Acquired functional (relative) insufficiency of the tricuspid valve develops due to damage to the papillary muscles or expansion of the fibrous ring. In the first case, the presented structures are responsible for maintaining the motor ability of the valves. In myocardial infarction, the papillary muscles are damaged. This leads to dysfunction of the tricuspid valve.
Pathologies of the annulus can cause various disorders. These include myocarditis, chordal ruptures, tumors and neoplasms that prevent blood from flowing out of the ventricle.
Stages of deficiency development
Based on the severity of the process of regurgitation, it is customary to distinguish several stages during the course of the disease:
- Grade 1. Reverse blood flow maintains minimal values, is not accompanied by hemodynamic disorder.
- Degree 2. At this stage, the pathology is accompanied by the advancement of the reverse blood stream to a distance that does not exceed 2 cm.
- Grade 3. Blood flow moves into the atrium more than 2 cm from the valve surface.
- Degree 4. At the time of regurgitation, blood penetrates into the upper zone of the atrium, passing throughoutcamera.
What symptoms accompany each of the stages of the development of the disease will be discussed below.
Signs of tricuspid valve insufficiency
At the initial stage, heart disease practically does not manifest itself. Sometimes, after exercise, patients notice the appearance of a strong pulsation of the veins in the neck. It is possible to detect a pathological process only with the help of Doppler sonography. A normal ECG does not show significant changes in the work of the heart.
Tricuspid valve insufficiency of the 2nd degree is accompanied by an increase in the volume of reverse blood flow. Right ventricular disorder leads to an increase in the size of the heart. As a result, the clinical picture is supplemented by the following symptoms:
- loss of strength, decreased physical and mental activity;
- frequent urination at night;
- pronounced swelling of the lower extremities;
- shortness of breath;
- feeling of heaviness under the ribs;
- dyspeptic disorders.
When listening to the heart, pansystolic murmurs and atrial fibrillation are determined.
As a result of the progression of the pathology, the number of symptoms manifested increases. It is not recommended to ignore their occurrence. It is better at the initial stage of the development of the disease to seek qualified medical help. Tricuspid valve insufficiency of 1-2 degrees can still be cured with medication. The transition of the disease to the next stage always requires surgicalintervention. Even after the operation, complications cannot be ruled out.
Features of the disease in children
Newborn babies with severe regurgitation and the presence of concomitant cardiac pathologies are prone to the rapid development of right ventricular failure. Very often it ends in death.
The acquired form of the disease develops against the background of complications of other diseases. Most often it is a streptococcal infection, which entails a rheumatic lesion.
Other causes of childhood deficiency include:
- acute form of hypertension;
- myocardial disease;
- traumatic injury;
- malignant neoplasms.
At the initial stage, tricuspid valve insufficiency in children is considered as an anatomical feature. The first degree of the pathological process does not require treatment. With age, the disease usually resolves on its own.
Mitral and tricuspid valve insufficiency
Very often, a violation of the valve on the right side is combined with dysfunction of the structures of the left half. In this area, the main load falls on the so-called mitral valve. The symptoms of the disorder are cumulative. The combination of such disorders negatively affects the work of the right ventricle, which is complicated by the occurrence of pulmonary hypertension. Patients diagnosed with mitral and tricuspid valve insufficiency 1degree” surgery is recommended.
Diagnostic Methods
Early detection of the disease plays a direct role in the success of treatment, and also affects the life expectancy of the patient. Since tricuspid valve insufficiency of the 1st degree is almost asymptomatic, the pathology is detected only after it has passed to the next stage of development.
Diagnosis begins with questioning the patient, studying his medical history and physical examination. By asking various questions to the patient, the doctor determines the clinical picture, the time of the onset of the first symptoms. He also needs to know what diseases preceded the deficiency. An external examination usually reveals cyanosis of the skin and swelling, and auscultation reveals a violation of the heart rhythm.
As part of the diagnosis, several laboratory tests are required. Among them, the blood test and the study of the patient's immunological status are the most informative. Based on the results of laboratory tests, one can judge the presence of inflammatory processes in the body, along with ongoing ailments.
To clarify the diagnosis, the doctor can use hardware examination methods. These should include:
- EKG. It is carried out in order to detect an increase in atrial volumes.
- Phonocardiogram. Demonstrates the presence of systolic murmurs.
- Spiral CT. Provides an informative picture of the body's major muscle.
- X-ray. Gives an idea of the size of the heart, reveals congestion.
- Coronocardiography. Used before surgery to evaluate blood flow.
- EchoCG. Shows the deformation of the valves, the presence of new formations on them.
Based on the results of a complete examination, the doctor gets an idea of what condition the tricuspid valve is in. The insufficiency of this structure responds well to treatment only at the initial stage of development. More detailed treatment options for this disease will be discussed below.
Principles of treatment
Tricuspid valve insufficiency of the 1st degree does not require therapy. If the disease moves to the next stage of development, the patient is prescribed treatment. It can be both medical and surgical. The help of the latter is resorted to in especially serious cases, when the use of pills and injections does not work.
For the entire period of treatment, the patient must adhere to the following rules:
- Completely quit smoking.
- Avoid hypothermia and stressful situations.
- Follow a diet to reduce stress on the heart.
- Reduce the intensity and amount of physical activity.
Compliance with the above recommendations increases the effectiveness of the therapy, and is also a kind of prevention of complications.
Medicated treatment
Mild tricuspid valve insufficiency is not considered an indication for surgery. In this casetreatment is carried out with the help of drugs. The standard treatment regimen involves the use of the following medications:
- Diuretics ("Britomar", "Hydrochlorothiazide"). Eliminate congestion in the body, accelerate the process of removing fluid.
- Potassium preparations ("Panangin", "Asparkam"). Help the body not accumulate excess fluid.
- Venous dilators (Corvaton, Nitrosorbide). Reduce the workload on the heart by depositing blood.
- Anticoagulants (Warfarex, Warfarin).
- Cardiac glycosides ("Digoxin", "Korglikon"). Help in the fight against arrhythmia.
- Beta-blockers ("Diltiazem", "Carvedilol"). Reduce the frequency of contractions of the left ventricle.
The regimen and dosage of drugs are determined individually, taking into account the severity of the disease.
Surgery
Tricuspid valve insufficiency of the 3rd degree is considered the main indication for surgical intervention. Also, the operation is recommended for patients with serious deformations of the valves or severe failures in their work.
If the valve apparatus is preserved, annuloplasty is used. During the operation, the doctor applies U-shaped sutures to the damaged area.
If the intervention turned out to be ineffective, there are obvious structural changes, the patient is given an artificial cap. After implantation of the prosthesis, anticoagulant therapy is required. When implanting a biological prosthesis, she wearsshort term character. If it is made of medical alloys, treatment of tricuspid valve insufficiency takes a little longer.
Possible complications and prognosis for recovery
Lack of timely treatment can lead to the progression of the disease. The pathological process in this case affects not only the tricuspid valve. Insufficiency gradually leads to the fact that the body begins to look for new compensatory mechanisms. Thus, he tries to cope with the existing violations. Depending on the neglect of the disease, the following disorders may appear:
- pneumonia;
- enlarged liver, cirrhosis;
- pulmonary embolism;
- ascites.
According to statistics, the listed complications develop in 90% of cases.
As for the prognosis for recovery, it depends solely on the degree of development of the disease. Grade 2 tricuspid valve insufficiency responds well to medical treatment, and the likelihood of complications is almost zero. With the third degree of the pathological process, the five-year survival rate is approximately 60-70%. Such figures are typical for patients who have already undergone surgery. In decompensated forms of insufficiency, accompanied by chronic pulmonary diseases, the prognosis is disappointing.
