The mitral valve is a valve located between the left atrium and the left ventricle of the heart, which prevents blood pressure regurgitation into the left atrium during systole.

Mitral valve failure or mitral insufficiency - the inability of the valve prevent the blood regurgitation from the left ventricle into the left atrium.

Regurgitation is a rapid blood flow in the direction, reverse normal movement arising during systole.

Mitral insufficiency is rarely isolated (about 2% of the total number of heart diseases). It is accompanied by vices of aortic valves, stenosis of the mitral hole.

There are functional (relative) and organic mitral insufficiency.

Functional Mitral Insufficiency is due to the acceleration of blood flow during dystonia, a change in the tone of papillary muscle fibers, dilatation (expansion) of the left ventricle, which provides hemodynamic overload of the heart.

Organic Mitral Insufficiency Develops due to anatomical lesion of the connective tissue plates of the valve itself, as well as tendon filaments fixing the valve.

Hemodynamic violations of these types of mitral insufficiency are the same.

Violation of hemodynamics with various forms of mitral insufficiency

Systole - a series of consecutive contractions of the myocardial of ventricles and the atria of a certain phase of the heart cycle.

The pressure of the aorta significantly exceeds the pressure of the left atrium, which contributes to regurgitation. During systole, the reverse blood flow occurs in the left atrium, due to the incomplete cover of the atrioventricular opening of the valve with the valve. As a result of this, an additional portion of blood comes into diastole. During the ventricular diastole, the considerable amount of blood comes from the atrium into the left ventricle. As a result, the violations the overload of the left sections of the heart occurs, which contributes to an increase in the strength of the reduction in the heart muscle. Mocardium hyperfunction is observed. In the initial stages of the development of mitral insufficiency, good compensation arises.

Mitral insufficiency leads to the hyperrophy of the left ventricle and the left atrium, as a result of which the pressure in the pulmonary vessels increases. Spasm of the lung arteriole causes pulmonary hypertension, as a result of which the hypertrophy of the right ventricle develops, the insufficiency of the three-grained valve.

Mitral valve failure: symptoms, diagnostics

With a good mitral valve compensation, the symptoms are not manifested. Pronounced mitral insufficiency is characterized by the following symptomatics:

• Shortness of breath and violation of heart rhythms in physical activity (then at rest);
• Cardialgia;
• Increased fatigue;
• Cardiac asthma (attacks with sharp shortness of breath);
• Pain, swelling in the right hypochondrium, due to increased liver;
• Eveny lower extremities;
• Dry cough with a small wet compartment, in rare cases with blood impurities;
• Pain in the heart of a cigrier, gone, nocturing character, not associated with physical activity.

With compensated deficiency of the mitral valve, symptoms may not appear for several years. The severity of symptoms is due to the power of regurgitation.

The following methods are used to diagnose mitral insufficiency:

• ECG allows you to identify signs of overload and hypertrophy of the left ventricle and atrium, in the third stage - the right heart of the heart;
• Echocrine - determination of hypertrophy and dilatation of the left heart departments;
• Radiographic study of the chest organs - determination of the degree of pulmonary venous hypertension, the degree of expulsion of the atrial arc;
• Ventriaculture - determination of the presence and degree of regurgitation;
• Catethery of ventricles - determination of pressure dynamics in the ventricles of the heart.

Currently, there is a hyperdiagnosis of mitral insufficiency. Modern methods Studies have shown that the minimum degree of regurgitation may be present in a healthy body.

Mitral valve failure 1 degree: clinical picture

The lack of a mitral valve of 1 degree is characterized by compensation of hemodynamics and valve inability to prevent the reverse current of blood, which is achieved by hyperfunction of the left ventricle and atrium. This stage of the disease is characterized by the absence of symptoms of insufficiency of blood circulation, the patient's good self-sensitivity during exercise. When diagnosing the insufficiency of the mitral valve 1 degree, a slight expansion of the heart boundaries left, the presence of systolic noise is detected. On the electrocardiogram, the sign of the violation of the valve function is absent.

Mitral valve failure 2 degrees: clinical picture

The insufficiency of the mitral valve is 2 degrees is characterized by the development of the passive form of venous pulmonary hypertension. This stage is characterized by a number of symptoms of circulatory disorders: shortness of breath and a rapid heartbeat in physical activity and at rest, cough, attacks of cardiac asthma, hemoptysis. When diagnosing the lack of mitral valve 2 degrees, the expansion of the heart boundaries left (1-2 cm), to the right (up to 0.5 cm) and up, systolic noises are detected. The electrocardiogram shows the changes of the atrial component.

Lack of mitral valve 3 degrees: clinical picture

In case of insufficiency of the mitral valve of 3 degrees, hypertrophy of the right ventricle is developing, which is accompanied by characteristic symptoms: an increase in liver, the development of swelling, an increase in venous pressure.

Diagnostics of lack of mitral valve 3 degree detects a significant expansion of the boundaries of the heart muscle, intense systolic noises. The electrocardiogram shows the presence of a mitral tooth, signs of left-selling hypertrophy.

Treatment of mitral valve deficiency, forecasts

Treatment of mitral valve deficiency is regulated by the only rule: a patient with a diagnosed mitral insufficiency is a surgical patient. This pathology is not subject to medication correction. The task of the cardiologist is proper preparation Patient to surgery.

Conservative treatment of mitral valve deficiency is aimed at monitoring heart rate, as well as the prevention of thromboembolic complications, reducing the degree of regurgitation. Also used symptomatic treatment.

During the operational intervention, the mitral valve is implant.

Forecasts in mitral insufficiency are completely dependent on the degree of regurgitation, the severity of the valve defect and the dynamics of the disease.

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In the born and acquired abnormalities of the development of cardiac structures are considered frequent perpetrators of the early onset of disability among patients of all ages. Also, the death of a patient in the short term (3-5 years) is also likely.

Recovery is unlikely, but the reasons for that are not in the potential incurability of pathological processes. Everything is much easier.

On the one hand, the patients are not carefully monitored by their own health, this is the result of low medical culture and weak enlightenment.

On the other hand - in most countries there is no program of early screening of heart problems. This is unusual, given that cardiac pathologies are almost in the first place in the number of lethal outcomes.

Mitral insufficiency is a state at which the valve is not able to fully clog. Hence regurgitation or reverse blood flow from ventricles in atrium.

Working volumes liquid connective tissue Fall without reaching adequate values. The weakness of the emission determines the lack of functional activity of the structures.

Hemodynamics is broken, the tissues are not allowed oxygen and nutrients, hypoxia ends with degenerative and dystrophic changes. This is a generalized process that disrupts all organism systems.

Clinical typing of the pathogenic phenomenon is carried out on different bases. Thus, depending on the origin, the ischemic uniform is isolated, which is conjugate with the impaired hemodynamics. This is a classic variety.

The second is non-haemic, that is, is not associated with deviations in ensuring oxygen tissues. It is less common, and only at the first stages.

Another way to classify the state is based on the severity of the clinical picture.

• Acute species arises as a result of the rupture of the tendon chord of the valve, is determined by pronounced symptoms, also a high probability of complications and even death.
• Chronic and formed as a result of a long flow of the main process, without treatment and passes 3 stages. Restoration requires a lot of strength, more often it is prompt, which in itself can lead to fatal consequences (relatively rare phenomenon).

Basic clinical classification characterized by degrees of gravity of the pathological process:

• I. Phase full compensation. The body is still capable of realizing its functions, the amount of return blood is not over than 15-20% of the total (hemodynamically insignificant). This is a classic option corresponding to the very beginning of the disease. At this point, the patient still does not feel the problem or manifestation of such a meager that they do not provoke any suspicion. This is the best time for therapy.
• II. Partial compensation. The body no longer copes. The amount of blood refluxing in the atrium is more than 30% of the total. Recovery is possible by surgical methods, dynamic observation is no longer carried out, it is necessary to eliminate the problem. The atrium and ventricles are overloaded, the first are stretched, the second is hypertrophy to compensate for the stretch. It is possible to stop the work of the muscular organ.
• III. Decompensation. Complete disorder of cardiac structures. The regurgitation is equivalent to 3 degrees and is more than 50%, it leads to a pronounced clinical picture with shortness of breath, asphyxia, edema of the lungs, acute arrhythmia. Prospects for cure foggy, to say for sure how probably it is impossible to return to normal life. Even under the condition of complex impact, the risk of persistent defect and disablement is great.

A little less distinguished 5 clinical stages, which does not matter much. These are all the same options for the 3rd pathology phases, however, more differentiated from the point of view of forecasting and symptoms. Accordingly, they are talking about the dystrophic and terminal stage.
Classification is required to generate treatment paths.

Features hemodynamics

The insufficiency of the mitral valve is either degree determined by the circulatory disorder (hemodynamics) in tissues and organs.

The process is generalized, because deviations in the work of all structures are likely, it often leads to secondary processes and severe disability.

Clinical options - renal failure, liver dysfunction, encephalopathy. Vascular dementia is possible.

The essence of the process is the weakness of the mitral valve. Normally, its wall closes tightly, not giving blood from the ventricles to return to the atrium.

Against the background of the phenomenon under consideration, regurgitation (inverse blood casting from ventricles in atrium) is a characteristic feature of the disease.

The volume of the emissions of the liquid connective tissue is insufficient for adequate supply of organs. Depending on the stage, the working volume of blood ranges from 75 to 30 and less than percent. It turns out that the functional quantities are small.

In early degrees, the heart compensates for the insufficiency of the two-dimensional valve with increased reduction and increasing the frequency of impacts. But this is enough for a short time.

On the other hand, adaptive mechanisms themselves lead to the vices of cardiac structures: left ventricular hypertrophy, increase the pressure in the pulmonary artery, stretching the left atrium, and as a result of the formation of chronic heart failure.

As a result, the heart transplantation may be required, which in most cases is equal to the mortal sentence.

The most pronounced clinical picture at 3 stages of the pathological process. The terminal phase is accompanied by total polyorganic failure.

The perspectives of cure are extremely disappointing. Hence the conclusion: if there is the first suspicion of heart problems, you need to turn to the cardiologist.

Characteristic symptoms

As already noted, 3 phases of the pathological process are distinguished. A little less than 5, it is a more accurate clinical option, but to a greater extent they have scientific importance than practical.

Approximate picture is as follows:

• Dyspnea. First at the time of intense mechanical load. In this case, understand where normal physiology ends and the disease begins it is difficult. Since identical manifestations are possible in the framework of a small body training. Later, in the subcompensated and completely uncontrolled stage, the symptom occurs at rest, even when the patient lies. This significantly reduces the quality of life and leads to pulmonary problems, compensatory mechanisms destroy the entire respiratory system and lead to an increase in pressure in the artery of the same name. This is a factor of aggravation of the main disease, a worsening forecast.
• Arrhythmia. In different variations. From tachycardia before or. Extremely rarely as part of mitral insufficiency, so-called non-hazardous forms of the pathological process arise. What more often is threatening phenomena leading to a heart stop or infarction. Determine independently interruptions possible, but not always. The most accurate method of diagnosis is electrocardiography.
• Flow of blood pressure. Sometimes before critical marks, especially within the framework of the acute process. Cardigenic shock is possible. This is a fatal state, about 95% of situations, it leads to the patient's death even subject to timely resuscitation and integrated impact. Recovery is impossible, the forecasts are extremely unfavorable.
• Pulmonary edema.
• Also weakness, drowsiness, apathetic. In the acute period there is a panic attack with inadequate behavior, an increase in motor activity.
• Ascites. Or accumulation of fluid in the abdominal cavity.
• Swelling of the lower extremities. Diuretics are effective only at the first moment, then they do not bring the desired action.

Stage NMK.

The stage of the pathological process on a par with a degree plays an important role in the clinical picture.

Allocate:

• 1 stage of insufficiency MK meets the complete absence of manifestations. Or they are so insignificant that they do not pay attention.
• 2 Stage (moderate) is determined by a more pronounced clinic. The patient suffers from shortness of breath at rest and with minimal physical activity, chest pain arise unclear origin, problems with rhythm. But the quality of life is still acceptable, because many do not turn to the doctor. Especially smokers who write off their state on the consequences of the consumption of tobacco products.
• 3 Stage (pronounced) is determined by heavy symptoms, a significant decrease in important indicators.
• 4 Terminal Stage Ends with death almost always, recovery is impossible. Palliamental help is held to facilitate the state and ensuring a decent death.

Mitral insufficiency of 1 degree most favorable moment for the start of treatment. Later, as a clinical picture complicates, recovery is less likely.

Causes of the development of pathology

The factors of formation of the problem are diverse. They always have a pathogenic origin.

Congenital and acquired heart defects

No matter how paradoxically, there may be problems in the framework of other cardiac changes and genetic deviations (about it below).

So, against the background of aortic insufficiency, the muscles and tendon threads of the mitral valve are possible.

All pathological processes of this kind are quite late. Some are not allowed to know about themselves until death. Sometimes the diagnosis is already in the process of autopsy.

Valve prolapse

Clinical option for organic change cardiac structure. It is characterized by the weave of the formation of the formation of the atria.

Coronary artery disease

Typical age pathological process. Also found in patients who have undergone myocardial infarction. Accompanied by chronic disadvantage of cardiac structures, but there are no catastrophic phenomena.

Most likely a consequence of a long-term condition - necrosis of heartcorts. As a result of small trophy, dystrophy comes or weakening the mitral valve. Hence, his inability to clog tightly.

Even surgery is not a guarantee of recovery. It is necessary to deal with the root cause of the phenomenon.

Inflammatory pathology of cardiac structures

Endocarditis as an option. Accompanied by a pronounced damage of cardiomyocytes, usually infectious genesis (70% of cases), less often autoimmune origin (the remaining 30%).

Sounds and the other entails the gradual destruction of anatomical formations. Combined treatment, with elimination inflammatory process And as needed by the prosthetics of destroyed atrial.

The symptoms are pronounced, because to miss the moment of starting the process is almost impossible. Treatment stationary, under constant objective control.

Infarction

Acute disruption of myocardial meals. Accompanied by general necrosis of oran tissues. The extensity depends on which vessel has been stenosis (narrowing) or occlusion (blockage).

In all cases, this is a common process, with the dying of significant sections of cardiac structures. Even with the timely and competent treatment in the hospital, the possibility of full recovery is almost zero.

In any situation there will remain a rough scar defect, the so-called cardiosclerosis, when functional tissues are replaced by connecting, non-abbreviated and excitation.

Genetic syndromes

Due to hereditary heredity, less often in other phenomena. Classic options - Martan's disease, Elessa Dunlos.

All processes, one way or another, are manifested by a group of symptoms, many have external signs. Disproportions of limbs, deformation maxillofacial region, dysfunctional disorders of the liver, kidney, other organs.

Restore complex. Usually the diagnosis can be put back in the period of infancy, the symptoms are expressed, there are many objective signs. Communicably shown in the consultation of genetics.

Autoimmune diseases

The classic process with cardiac deviations is a systemic red lupus. Leads to the destruction of muscle and connective tissues of the body. Including heartfelt. Mitral insufficiency develops relatively late, without treatment.

Rheumatism

Another option of autoimmune disease. Accompanied by the destruction of codiocytes. It flows wave-like, attacks. Each episode aggravates the state of cardiac structures. Hence the need for constant treatment to prevent recurrence and supporting the work of the heart.

Subjective factors

So, according to clinical Studies, the main contingent of cardiologist patients with suspicion of mitral insufficiency, these are faces for 60.

Young suffer less often and that is, good pathological reasons. The elderly people have natural aging and fabric dystrophy. Mostly risk smokers, alcoholics, faces with chronic and especially.

Men sick more than two women, the ratio of about two to one. What this is connected - it is not known for now. It is assumed to, with severe work and a tendency to harmful habits.

Diagnostics

Cardiologists are engaged in leading patients with mitral insufficiency and suspicions. Planning radical treatment falls on the shoulders of specialized surgeons.

Approximate survey scheme:

• Oral survey. On the early stages There will be no complaints at all, the later symptom complex is obvious.
• Collect anamnesis. Family history, genetic factors, clarification of bad habits and lifestyle.
• Listening to cardiac sound (auscultation), rating the frequency of contractions. Allows you to detect arrhythmia at an early stage. Many deviations, however, are not determined by routine methods.
• Daily monitoring on the holder. Hell is detected for 24 hours at small intervals. It is better to conduct a similar event in conditions of the house. So the result will be more accurate.

• Electrocardiography. Research of rhythm using a special apparatus. Notices the slightest deviations in the work of the organ.
• Echocardiography. Ultrasonic technique. Directed to identify changes from the myocardium. Classic finds - left ventricular hypertrophy, expansion of atrial chambers.
• Angiography.
• As needed - MRI or CT.

Events are gradually held. If the acute state is observed, follows the minimum list.

Symptoms of mitral insufficiency can be nonspecific, because during suspicious complaints it is necessary to hospitalize the patient at least for several days for an urgent assessment of the nature of the state.

Treatment

Therapeutic effect is combined, using surgical methods and conservative ways. Depending on the stage. Those or other methods prevail. The main characteristic of the corporation is feasibility.

Medicate

Mitral deficiency of 1 degree is eliminated by medicines, while the specific choice of drugs falls on the shoulders of the doctor.

Approximate scheme:

• Use of antihypertensive agents. From APB inhibitors to calcium antagonists and beta blockers. This is a classic treatment hypertensive disease and symptomatic increase in outtiral pressure.
• Antiagregants. To normalize the rheological properties of blood. The fluidity is one of the main qualities of liquid connective tissue. Aspirin Cardio is appointed.
• Statins. Against the background of cholesterolemia and atherosclerosis in this regard.

Other pathological processes, extracardial kind, but insufficient insufficiency itself, are eliminated, respectively.

With systemic red lupus, corticosteroids and immunosuppressors are prescribed, for recovery during hepatic insufficiency, hepatoprotectors, etc.

Operative

Surgical ways are shown somewhat less often, it is an extreme measure. In fact, even the lack of mitral valve 2 degrees are not yet a reason for intervention.

The grounds for radical chickens are the vital indicators, depending on the degree of their decline. Perhaps a long dynamic observation and the use of medicines within the supporting assistance.

When the restoration is not possible, it is impossible to do without cardiac surgery.

Assigns:

• prosthetics (replacement) of the mitral valve on biological, or mechanical;
• excision of adhesions during stenosis;
• stenting coronary arteries, Other methods.

Particularly severe cases require organ transplantation. This is akin to the mortal sentence, since the probability of finding a donor is extremely small even in developed states, especially in backward countries.

Changing the lifestyle is inefficient. Unless you can abandon smoking and alcohol. Folk remedies are strictly contraindicated. The insufficiency of the MK is eliminated only by classical methods.

Forecast and probable complications

Possible consequences:

• Myocardial infarction.
• Heart failure.
• Polyorgan deficiency.
• Stroke.
• Cardiogenic shock.
• Pulmonary edema.

This is potentially lethal phenomena. The forecast against the background of treatment is favorable only in the early stages. Survival rate of 85%. With a long flow of the pathological process, mortality reaches 60% in a five-year period. When connecting complications - 90%. Ischemic form of mitral insufficiency gives the worst forecast.

Degenerative changes of the mitral valve, such as insufficiency - common heart rate. The frequency is determined by 15% of all congenital and acquired states.

Treatment conservative at the initial stage or surgical in developed stages, under the control of the cardiologist. The probability of complete disposal of the pathology is small in the later stages. The process is difficult to detect at the initial moment, but this is the best time for therapy.

Nonspecific resistance of the body is characterized by the concept of " interferon status"Serving an integral criterion functional state IFN systems.

The term "interferon status" was proposed by F. Gershov in 1986. At the same time, a methodology for determining the IFN status was developed and the scientific evidence of changes in various links of the IFN system was presented different forms pathology. In subsequent years, this technique is widely used to determine the indicators of the IFN system in patients with viral hepatitis, influenza and ORVI, herpes, with autoimmune, onco- and allergic diseases and other forms of pathology and, as a result, the effect on the IFN status of exogenous drugs IFN-A, -B, -G and Inductors of IFNs is shown. As it turned out, the reduced interferonogenesis indicates the chronization of the disease, the progression of viral infection. Iphsal syndromes with full or partial loss of various links of the IFN system (alpha or gamma-IFN) are the cause or consequence of sharp and chronically recurrent viral infections, congenital or acquired defects accompanying stressful effects, autoimmune, allergic, oncological diseases and AIDS. It should be noted that at 10 - 20% of cases, even practically healthy people are determined different kinds Interferonization disorders. Generally, " interferon status ", As an indicator of the functional activity of the interferon system, it allows you to judge the immunoreactivity of the body in situ.

Currently, the method of determining the "interferon status" is carried out by a micrometeode according to the technique in the virological box, observing sterile conditions. For the study uses whole heparinized blood of healthy and sick people. Statution of IFN status should be carried out on the day of blood fence. The method of determining the IFN status allows you to determine the following main quantitative parameters (un / ml):

• circulating (serum) IFN in blood;
• the level of IFN - A leukocytes in the stimulation of their Newcastle disease virus (TBN), Kansas strain, and subsequent inactivation of the in vitro inductor virus;
• production level of IFN-G leukocytes during induction by them mitogen - phytohemagglutinin (FGA P, "DIFCO") at a dose of 10 μg / ml in vitro.
• production level of spontaneous IFN in vitro.

Statution of IFN status in more than 500 solid blood samples of practically healthy persons allowed to determine average quantitative values \u200b\u200bof the physiological norm of indicators of the IFN status. So, for the indicators of IFN-A fine for adults Take values \u200b\u200bof 640 units / ml, IFN-G - 128 units / ml, serum IFN< 2-8 Ед/мл, спонтанно продуцируемого ИФН < 2 Ед/мл. При недостаточности интерфероногенеза 1, 2, 3, 4 степени продукция a-ИФН лейкоцитами соответственно составляла 320, 160-80, 40 и менее 40 Ед/мл, продукция g-ИФН лейкоцитами – 64, 32-16, 8, 4 и менее Ед/мл. За показатели ИФН-a в норме for kidsup to 14 years old are taking values \u200b\u200bof 320 units / ml, IFN-G - 64 units / ml, serum IFN< 2-8 Ед/мл, спонтанно продуцируемого ИФН < 2 Ед/мл. При дефиците интерфероногенеза 1, 2, 3, 4 степени продукция a-ИФН лейкоцитами соответственно составляла 160, 80-40, 20 и менее 20 Ед/мл, продукция g-ИФН лейкоцитами – 32, 8-16, 4 и менее Ед/мл. Следует подчеркнуть, что у пожилых людей старше 60 лет в 70% случаев обнаруживается физиологическая недостаточность системы ИФН по 2 или 3 показателям, причём у каждого второго доминирует дефицит продукции g-ИФН (иммунного ИФН), что коррелирует со снижением у них показателей врожденного и адаптивного иммунитета.

It should be noted that the above physiological norms were identified almost 20 years ago. At present, the ecological situation is constantly deteriorating. For example, a persistent herpes viral infection is determined by almost every individual, socio-psychological tensions and stressful situations increase in society, which gradually leads to the fact that the indicators of physiological norms of the IFN status decrease.

An important addition to the definition of IFN status is developed later. identifying the individual sensitivity of a particular patient to the drugs inductors of IFN and immunomodulators, which is estimated at the increase in the titers of IFN-A and -G after the effect of these drugs on peripheral blood leukocytes in vitro. The sensitivity of leukocytes to the preparations is estimated depending on the multiplicity of increasing titles:

• With more than 4x-fold increases, strongly pronounced;
• At 3-4x-fold increases, expressed;
• With a 2x-fold increase in alpha, gamma-IFN titles, under the influence of the preparation, weak sensitivity;
• If the value of the IFN alpha, -gamma under the influence of the drug does not change - no sensitivity.

The study of the IFN status with the determination of sensitivity to drugs should be prescribed prior to the start of therapy to identify the optimal sensitivity of blood leukocytes to specific drugs in a particular patient, which makes it possible to recommend the use for therapy of the most active drugs.

Evaluation of identified changes can serve as a guide in the diagnosis, treatment and forecast of diseases both viral and non-revational etiology. We note the following testimony under which the study of IFN status is needed:

1. viral infections: sharp and chronic forms;
2. allergic and autoimmune diseases;
3. recurrent opportunistic infections;
4. often sick children, older faces;
5. congenital and acquired defects of the IFN system;
6. clinical trials of the drugs of IFN, inductors of IFN and immunomodulators;
7. clinical use of the above-mentioned drugs and evaluating the effectiveness of therapy;
8. development of individual treatment of IFN preparations, its inductors and other immunoactive drugs.

The following can be noted: stresses, sharp viral infections, allergic conditions are accompanied by an increase in the level of circulating interferon and a decrease in the level of induced products of A- and G-IFN leukocytes. For bronchial asthma, allergic Ranti, atopic dermatitis, Horpivnice, the level of circulating interferon often correlates with the severity of the disease. Chronic viral infections (influenza, herpes, hepatitis) are accompanied by the suppression of all indicators of interferon status. It is typical for autoimmune diseases (systemic red lupus, rheumatoid arthritis, scarm sclerosis, nonspecific ulcerative colitis, psoriasis). Acute lympholoicosis, malignant formations are accompanied by a deficit of products induced by a gamma interferon.

It should be noted that the results of the interferon status research must be considered in the complex with the rest of laboratory and clinical and anamnestic data. Reducing alpha and gamma interferon products, which may be the cause, and a consequence of acute and chronic viral diseases, indicates a congenital or acquired deficit of the interferon system and can be considered as an indication for interferon-stimulating therapy.

The study of interferon status parameters is used to select and evaluate the effectiveness of therapy when using exogenous interferon preparations, inductors of interferon and immunomodulators.

With clinical trials of the drugs of the IFN and their inductors and / or during their subsequent clinical application There is a need to study monitoring indicators of IFN status as the criterion for the effectiveness of the proposed therapy.

Given the pronounced antitronogenic activity of G-IFN, its close direct and feedback with the system of interleukins and natural killers, the deficiency of G-IFN products in the elderly, in the absence of other causes of its reasons, can be considered as a preclined marker of oncogenic diseases. Frequently ill-sick children and women of childbearing age can also be included in the risk group, especially in the presence of various gynecological diseases associated with papilloma, herpes, cytomegalovirus and chlamydial infections, given that, as a rule, these infections have a latent persistent nature.

All of the above indicates the feasibility of periodic testing of the IFN system in humans. When identifying the functional inferiority of the IFN system in different age groups of increased risk and under various pathological conditions, the IFN system is corrected. The scientifically based tactics of the preventive and therapeutic correction of defects of the IFN system with the help of the drugs of the IFN and its inductors, as well as immunomodulators, makes it possible to increase the nonspecific resistance of the organism under various pathological conditions and, as a rule, detects a correlation with clinical results. Normalization of interferon status indicators usually coincides with time with recovery processes.

As mentioned above, an exogenous IFN (natural and especially its recombinant forms) was widespread in therapeutic practice. It should be noted that long use Interferonotherapy in cancer, hepatitis B and C, scarm sclerosis, papillomatosis, leads to the formation of antibodies capable of partially neutralize the effect of the drug (NAT-neutralizing antibodies). Testing (identification and quantification) NAT It is one of the most important components of assistance to such patients, since it provides information on one of the most important factors determining the clinical response to the IFN therapy.

The prospect of the widespread clinical use of IFN inductors and immunomodulators as prevention and treatment requires the definition of healthy individuals and patients with various forms of pathology of the sensitivity of their leukocytes to these drugs and scientifically based control over the effectiveness of their action. Determining the indicators of the status of the status and their assessment makes it possible to carry out such control, as well as the choice of adequate (preventive and therapeutic) schemes for the use of these and other biologically active drugs.

Evaluating informativeness of IFN Status Indicators, You can do conclusions:

• indicators of the IFN status as a whole make it possible to judge the immunoreactivity of the body in situ;
• increasing serum IFN titles may indicate an acute stage of the disease;
• there is a direct connection between the indicators of the IFN of the 1st and 2nd types and the severity of the disease and feedback with the number of serum IFN;
• the decrease in IFN-A and IFN-G products indicates the defectivity of the IFN system (congenital or acquired) and is an indication for IFN-stimulating therapy;
• low products of the IFN-G or its absence in persons over 60 years old in the absence of other reasons may be an extension marker of oncological diseases;
• recovery (normalization) Indicators of IFN status usually coincides with the processes of recovery;
• the definition of IFN status in dynamics using exogenous IFN drugs, IFN inductors or immunomodulators can serve as a criterion for the effectiveness of the treatment of therapy in patients.

Significance The indicators of the IFN status are great, especially in assessing the clinical condition of both a healthy individual and a sick person. At the set of indicators of the IFN status, one or another degree of insufficiency of the system for the ability to produce IFN blood leukocytes or interpret elevated levels Circulating IFN in the blood and its spontaneous-produced synthesis.

It should be taken into account that the designated, individually selected treatment with a preliminary test on the determination of the sensitivity of the leukocytes of a particular person to the drugs of inductors of IFN and / or immunomodulators will result in the correction of indicators of IFN status of this individual and faster clinical stabilization / recovery .

Considering the above, it should be noted that changes in the IFN status with various forms Pathology with the necessary subsequent correction of these violations are associated with the use of corrective action drugs, to which the drugs of the IFN can be attributed, inductors of the IFN, immunomodulators.

Literature

• Grigoryan S.S., Major I.A., Ivanova A.M., Ershov F.I. Evaluation of interferon status of people in solid blood samples. Questions of virology. 1988; 4: 433-436.
• Grigoryan S.S., Oswelnikova TP, Ershov F.I. Determination of individual sensitivity of people to interferon inductors and other drugs (on the impact on interferon status). Guidelines. Moscow. 2000; 14c.
• Ershov F.I. Interferon system is normal and pathology. M., Medicine. 1996, 239c.

The mitral valve exists in every person and is located between the atrium and the ventricle of the heart. The state when the gap remains between the valve flaps is called the deficiency of the mitral valve. This disease is dangerous to progression and interconnection with other vices of the cardiac system.

The causes of this pathology can act as congenital heart disease and unbalanced infections. Almost always, this ailment is accompanied by other diseases of the heart.

Unfortunately, all, even small kids are subject to mitral insufficiency. Consider more detail what is the insufficiency of the mitral valve, etiology and pathogenesis of the illness, the main symptoms, methods of treatment and prevention.

Mitral Valve Insufficiency - Description

Mitral insufficiency is a heart disease, in which the opposite movement of blood from the left ventricle in the left atrium occurs during the reduction of the ventricles of the heart due to the incomplete closure of his sash. Mitral insufficiency is the most common type of violation of the valve apparatus of the heart.

It is detected in half patients with heart vices, mainly in combination with mitral stenosis (narrowing of the right atrial and ventricular opening) and with aortic vices - stenosis (narrowing of the aorta at the valve level) or the lack of aorta valves (a delicate closure of the aorta valve flaps at the time of ventricular relaxation ).

The lack of a mitral valve is rarely encountered insulated (that is, without other heart defects) - only every five-way patient with heart disease.

The essence of this vice consists in violation of the closure function of the valve due to the fibrous deformation of the sesters, sublocked structures, dialing the fibrous ring or impaired the integrity of the elements of the mitral valve, which causes the return of the blood from the left-free ventricle in the atrium.

These disorders of intracardiac hemodynamics are accompanied by a decrease in the minute volume of blood circulation, the development of pulmonary hypertension syndrome.

The main indicator of the deficiency of the mitral valve is what there is a blood regurgitation back to the left atrium. Accordingly, this is distinguished by the degree of failure.

1. I degree - regurgitation expressed weakly. There is a slight blood flow in atrium, which is determined at the valve.

This leads to the fact that more blood accumulates in atriums than is supposed to (what comes in the norm + abandoned). This blood enters the ventricle and forces it reduces with more power than it is supposed.

This leads to ventricular hypertrophy (left). Thus, the vice compensation occurs.

2. II degree - the flow of regurgitating blood reaches the middle of the atrium.

Blood is thrown back more. Now atrium is no longer able to push all the blood without significant pressure fluctuations. There is an increase in pressure and in the left atrium. Accordingly, pressure and pulmonary vessels increase.

3. III degree - a stream of blood reaches the rear wall of the atrium. The decompensation of vice comes.

There is an expansion of the left atrium, because the muscle is no longer capable of pouring all the blood. In particularly launched cases, it may increase in size and right ventricles (it is difficult to pump blood into the lungs, where stagnation). However, it is rare enough.

All deficiency of the mitral valve can be divided into three groups, depending on what is the root cause of the defect.

1. Organic failure. In these cases, the reason for insufficiency lies in the valve itself, which is affected by any factor.

Approximately 75% of people are rheumatism. There are still a number of causes of organic disorders:

• systemic red lupus - the valve includes a lot of connective tissue, which is amazed at an autoimmune disease;
• sclerodermia - this disease also relates to diseases of the connective tissue;
• myxomatous degeneration of the mitral valve - its sash is affected, losing the ability to close the atrioventricular opening tightly;
• infectious endocarditis - quite often the microorganisms are affixed by the valve sash;
• calcification rings of the mitral valve;
• it is also worth mentioning a number of states in which the valve or chords that give it the shape are taken away.

The insufficiency of the mitral valve in gravity is divided into four degrees. Prolapse 1 stage - the most light form. In this case, the reverse blood flow is not more than 20% and the entire volume remains at the foresee. Very often, this disease is diagnosed with other heart problems.

Lack of 1 degree is difficult diagnosed, as it almost does not cause visible symptoms, and also allows a person to lead a familiar lifestyle. The disease does not prevent pregnancy. All the reasons that led to the appearance of 1 degree of the disease are divided into congenital and acquired.

In the first case, heart disease can be hereditary, arise during intrauterine development. But most often the disease acquired (in 99.4% of cases). The reasons resulting from the development of the disease 1 degree become:

1. Rheumatism. This defeat is expressed as inability immune system Fight with some types of streptococcus. At the same time, the rheumatism of the joints is developing, the defeat of other valves.
2. Coronary artery disease. Chords and papillary muscles responsible for closing the valve are weakened or burst.
3. Traumatic damage. Most often lead to a more pronounced course of the disease.
4. Systemic red lupus. The patient develops the damage to the connecting tissues, the lack of a mitral valve may be congenital and acquired including those included in the valve.


5. Infectious endocarditis. The damage to the pathogenic microorganisms of the flaps of the mitral valve.
6. Sclerodermia. Another disease affecting the cells of the connective tissue.
7. Mitrical valve mixture degeneration. Sashes separating atrium lose their ability to choke tightly, the lumen remains.
8. Relative failure. The valve is normal, but due to the deformation of the left ventricle and stretching the hole loses the ability to close it tightly.
9. Functional failure. Pathologists associated with nipple muscles and myocardium.

The disease is manifested in men and women, especially during pregnancy. The most common cause (75% of cases) is an infectious disease, pathogenic microorganisms. Timely treatment of diseases will be best prevention Lack of 1 degree.

Mitral valve failure in children

This condition is often found in young children and is congenital or acquired. The disease may begin to develop from the baby in the morning of the mother, which can happen for the following reasons:

• upon receipt of the future mom dose of radiation irradiation;
• under the influence of X-ray irradiation of the mother;
• in the event of a carriage of the future, the baby of various infections;
• heredity;
• genetic defects for the development of the baby in the mum womb, including associated with the problems of connective tissue (Martan and Elessa-Danlos syndromes).

Registration of this disease at the child significantly later is binding to the influence on its body of the following factors:

• experienced earlier surgical interventions on the heart;
• endocarditis;
• walvulita;
• heart injuries.

There are such problems of the health of the child, in which the double valve undergoes functional failure, in particular:

• tumor education;
• death or partial deformation of some areas of the hearts near the valve and responsible for its movement;
• the tensile tissue, by which the heart muscle contacts with papillary muscles;
• the discrepancy of the valve flaps due to the increase in the boundaries of the fibrous ring.

Other reasons of the disease in children can be:

• rheumatism;
• dilatation cardiomyopathy;
• system red lupus;
• myocarditis;
• mitral valve prolapse;
• coronary artery disease;
• arterial hypertension;
• aortic heart defects.

An innate version of the disease develops very rapidly and provokes heart failure from a child. Symptoms in general manifestations are characterized by:

• the inability of the child to long-term exercise or activity;
• weight loss, growth slowdown;
• disorders of appetite;
• painful sensations in the heart and chest;
• the appearance of shortness of breath;
• the presence of dry cough;
• lethargy;
• leakage of noise in the heart;
• the formation of the heart hump.

The initial stage of mitral insufficiency in childhood may occur without visible manifestations, letting themselves know only during the transition period in a more severe form. Often this condition is accompanied by various heart problems - stenosis, prolapse and so on.

The clinical picture of the disease varies in accordance with its stage:

1. The first - manifestations of insufficiency are minimal due to the double work of the left of the child's heart departments.

Regurgitation (the opposite of normal) is up to 20% of the systolic blood volume (the so-called the amount of blood, which is thrown off the ventricles of the heart for one reduction).

2. The second is the volume of blood flowing in the opposite direction is 20-40% of systolic. In the lungs can begin to accumulate blood, forming the stool.

As a result, the well-being of the baby worsens, it feels fast fatigue, shortness of breath, suffer from bouts of dry cough, sometimes with bloody splashes in sputum.

3. The third is a hardening form of the disease. In the wrong direction, about 40-60% of blood moves, which provokes the development of heart failure;
4. The fourth - regurgitation is more than 60%, the blood flow fills the entire left atrium, causing hemodynamic disorders.

Diagnosis of disease in childhood is carried out through non-invasive heart procedures:

• ultrasound research;
• electrocardiograms;
• echocardiography;
• spiral computed tomography;
• magnetic resonance tomography;
• radiography.

In private situations, additional diagnostic procedures are required - coronary cardiography and catheterization of the heart cavities.

The doctor carefully examines the child, assesses its physical development, tint and elasticity of the skin, measures the pulse and pressure. An important part of the inspection is listening to heart rhythms, tones and noise, as well as the search for extraneous sounds when easy to operate.

Percussion of the chest area allows you to clarify the dimensions of the heart, its position and boundaries. Collection and analysis of the anamnesis of illness and life implies the clarification of the complaints, the symptoms of the ailment, as well as the cause of the disease. In addition to this, urine and blood tests are prescribed.

The absence of treatment leads to irreversible complications and defeats of the internal organs of the child, up to death. Since the kid's body is constantly growing, the heart is also increasing in size, and therefore the heart surgery has to repeated. The child is located on a lifelong observation at the cardiologist and cardiac surgeon.

Since often mitral insufficiency acts as a complication of any causal disease, it is important to eliminate this disease to restore the valve function.

Asymptomatic flow chronic stage This disease does not need to appoint special healing measures. The remaining stages of the disease imply a reception of special drugs, in whose tasks include:

• maintenance / stabilization of heart rhythms;
• prevention / treatment of blood circulation deficiency.

Conservative therapy does not allow proper effect in the case of late stages of insufficiency, which explains the need for surgical operations (plastic or using a prosthesis).

The main reason for the development of the deficiency of the mitral valve has rheumatic nature. In addition, organic mitral insufficiency may occur with infectious endocarditis, warts of libman-sacca endocarbage, with systemic diseases of the connective tissue.

Functional (relative) Mitral regurgitation can occur with a sharp dilatation of the left ventricle in the aortic vices ("Mitraralization" of the aortic vices, dilatation cardiomyopathy, left ventricular aneurysm, the propagation of the mitral valve sash, calcine the valve ring), which violate the mechanism of its narrowing during the stomach systole.

The possibility of the development of mitral failure after the mitral commissurotomy is not excluded. For the flow, it is customary to allocate sharp and chronic mitral insufficiency.

Acute Mitral Insufficiency:

• gap tendon chord as a result infectious endocarditis, myocardial infarction, injuries;
• damage to papillary muscles;
• valve defeat as a complication of surgical interventions on the heart, perforation with infectious endocarbage.

Chronic Mitral Insufficiency:

• rheumatic defeat;
• systemic diseases;
• congenital or hereditary diseases;
• hypertrophic cardiomyopathy;
• calcification of the mitral valve;
• tumors.

The incomplete closure of the mitral valve flaps provides reverse blood flow (regurgitation) from the ventricle in the atrium during systole. The excessive amount of blood in the left atrium stretches its walls, while at the same time an increased blood flow into the left ventricle causes its dilatation, and then hypertrophy.

In the future, when weakening the left atrium and under the influence of regurgitation waves, myocardia atrium loses its tone, the pressure in the left atrium cavity increases, which is retrograde is transmitted to pulmonary veins, it arises venous pulmonary hypertension, which ends with the progressive referee decompensation.

Features of hemodynamics in mitral insufficiency:

• regurgitation up to 5 ml does not matter;
• clinical manifestations - with regurgitation into the left atrium at least 10 ml;
• long-term damage compensation (provided by the hypertrophied left ventricle according to the mechanism of Frank Starling);
• fast progression during decompensation.

An increase in shock and minute heart volumes, a decrease in the finite systolic volume and the absence of pulmonary hypertension - indicators of the compensated state of hemodynamics.

This vice is quite successfully compensated by the internal reserves of the body (primarily the heart). Therefore, patients have some discomfort for a long time and do not turn to doctors for help. However, a number of more or less specific symptoms can be noted.

1. The cough, first dry, then with the addition of sputum with streaks of blood, appears when the severity of blood stagnation in the lung vessels appears.
2. Dyspnea - arises as a result of blood stagnation in the lung vessels.
3. The rapid heartbeat, the feeling of the neurotic heartbeat, the fading of the heart, coups in the left half of the chest - occurs during the development of arrhythmias (heart rate disorders) due to damage to the muscles of the heart of the same process that caused a mitral valve insufficiency (for example, heart injury or myocarditis - heart muscle inflammation ) And by changing the structure of the atrium.
4. The overall weakness and reduction of working capacity are associated with a violation of blood distribution in the body.

However, all these symptoms may also appear with other vices and heart diseases, so the clinical picture cannot appear to the basis for the diagnosis, a number of studies are carried out.

Clinically, in the amount of damage compensation, patients feel satisfactory, can perform significant physical exertion, pathology is detected by chance.

In the future, with a decrease in the reduction function of the left. The ventricle and the increase in pressure in a small circle of blood circulation patients impose complaints on shortness of breath during exercise and heartbeat. Cardiac asthma attacks, shortness of breath alone, can join.

Perhaps the appearance of cough, rarely - hemoptia. Cardialgias are observed - stitching, noving, gone, without a clear connection with exercise. The right-torsic failure can join the left-deceased failure (swelling, pain in the right hypochondrium by increasing the liver and stretching the capsule), later - total decompensation.

In physical research, acricyanosis and Fades Mitralis are drawn to, sometimes "heart hump". When palpation find a reinforced spilled apical impetus, due to hypertrophy and dilatation of the left ventricle, which is localized in the fifth intercostal dust from the midcurceptor or in the sixth intercostal (more often in young patients).

The boundaries of relative heart dullness are expanded to the left, up and right. Auscultation of the heart: The first tone is weakened at the top (up to its complete absence) - because there is no "valve closure period", oscillations caused by regurgitation wave can be laid.

Often listened to the reinforced pathological third tone of the heart, due to the oscillation of the walls of the left ventricle. The tone has the main differences: deaf on the timbre listened in a limited zone.

The decisive sign of the vice is systolic noise - a soft, blowing, declining, ends earlier than the second tone appears, it applies to the axillary region, the most suspended on a deep breath in the patient's position lying on the left side. The louder and longer than systolic noise, the hardest mitral insufficiency.

Over the pulmonary artery - the accent of the second tone is expressed moderately and is associated with the development of stagnant phenomena in a small circle. It is often listened to the splitting of the second tone associated with the delay of the aortic tone component, since the period of expulsion of an increased amount of blood from the left ventricle becomes longer.

In the study of the lungs, signs show indicating congestive phenomena in a small circle of blood circulation (impaired breathing, shortening of the percussion sound, attitudes or finely populic unrivorous wet wets in the posterior lungs).

In the future, the weakening of the right ventricle leads to a stagnation of blood and big Circle blood circulation, which is clinically manifested by an increase in liver, swelling of the lower extremities. Latest stages develop stagnation of liver, ascites.

Pulse I. arterial pressure With compensated vice, remain normal, during decompensation - the pulse is rapidly, the blood pressure can slightly decrease. In later stages, flickering arrhythmia is often observed.

Already in the usual inspection, the change in the mitral valve can be suspected:

• the characteristic complaints of the patient make it possible to estimate the degree of heart failure;
• with auscultation, noises are revealed;
• with percussion, the boundaries of heart dullness are shifted to the left side.

The main diagnostically significant method in mitral insufficiency is the ultrasound of the heart, which can be supplemented with dopplerography, allowing more to visually assess the degree of regurgitation.

With echo-kg, there is an opportunity to determine the cause of the appearance of heart defect, as well as the complications of this state. Based on the obtained measurements, one can judge the degree of failure.

It should be noted that the isolated patch of the mitral valve is quite rare and in most cases caused by rheumatic changes.

Much more often, with ultrasound of the heart, the combined insufficiency of the mitral and tricuspid valve is detected. Such changes faster lead to decompensation of heart failure and require speedy medical intervention.

Auxiliary diagnostic methods are:

1. ECG, which varies only with the secondary transformation of the heart muscle.
2. Radiography of the chest, at which you can suspect the overall increase in the heart in size.
3. Trans-esophageal ECG helps diagnose atrial rhythm disorders.
4. Daily monitoring is performed with arrhythmia paroxysms.
5. Phonocardiography allows you to identify noise.
6. With ventriculography with the use of special contrast, you can more accurately identify the degree of regurgitation.
7. Coronaryography is performed as a preoperative preparation or if the ischemic nature is suggested.
8. Analysis of the anamnesis of the disease and complaints - how long ago there were shortness of breath, heartbeat, cough (first dry, then with a wet wet with a blood impression), with which the patient binds their occurrence.
9. Anamnesis analysis of life. It turns out that the patient and his close relatives were sick, who was a patient by profession (whether he had contact with the causative agents of infectious diseases), were infectious diseases.

A history may be indications of the rheumatic process, inflammatory diseases, chest injuries, tumors.

10. Physical inspection. During the inspection, cyanosis (sinushesiness) of the skin, "Mitral Rushenets" (bright red painting of the patient's cheeks due to a blood enrichment disorder with oxygen), "heart hump" is a pulsating protrusion to the left of the sternum (the central bone of the chest, to which the ribs are fixed) An account of a significant increase in the left ventricle of the heart.

When percussion (climbing), the expansion of the heart is determined to the left. With auscultation (listening) of the Heart, noise is revealed in systole (period of reduction of heart ventricles) in the field of heart top.

11. Blood and urine test. It is carried out to identify the inflammatory process and concomitant diseases.
12. Blood chemistry. The level of cholesterol (zip-like substance), sugar and a common protein of blood, creatinine (protein decomposition product), uric acid (product decomposition product - substances from the cell nucleus) to identify the concomitant damage to organs are determined.
13. Immunological blood test. The content of antibodies to different microorganisms and the muscle of the heart (produced by the body, special proteins, capable of destroying alien substances or cells of their own organism) and the level of C-reactive protein (protein, the level of which increases in blood at any inflammation).
14. Electrocardiographic examination (ECG) - allows you to evaluate the rhythm of heartbeats, the presence of disorders heart Rhythm (for example, premature heart cuts), the size of the departments of the heart and its overload.

For the insufficiency of the mitral valve, the identification of the left atrium and the left ventricle is most characteristic of the ECG.

15. The phonocardiogram (method of analyzing heart noise) with deficiency of the mitral valve demonstrates the presence of systolic (that is, during the reduction of heart ventricles) noise in the projection of the double valve.
16. Echocardiography (EchoCG - ultrasound procedure (Ultrasound) Hearts) - the main method of determining the state of the mitral valve.

The area of \u200b\u200bthe left atreservantic hole is measured, the sash of the mitral valve is being studied for changes in their shape (for example, wrinkling the valves or the presence of breaks in them), a loose closure during the reduction of heart ventricles, the presence of vegetation (additional structures on valve sfolders).

Also, with echochg, the size of the cavities of the heart and the thickness of its walls, the state of the other heart valves, the thickening of the endocardium (the inner sheath of the heart), the presence of a fluid during the pericardia (by a break-sized bag).

When Doppleghokg (ultrasound examination of blood flow through vessels and heart cameras) reverse blood flow from the left ventricle in the left atrium during the reduction of ventricles, as well as an increase in pressure in pulmonary arteries (blood vessels bringing to light).

17. Radiography of the chest organs - evaluates the size and arrangement of the heart, changing the configuration of the heart (protrusion of the shade of the heart in the projection of the left atrium and the left ventricle), the appearance of stagnation of blood in the lung vessels.
18. The catheterization of the cavities of the heart is a diagnostic method based on the introduction of catheters in the cavity (medical instruments in the form of a tube) and pressure measurement in the left atrium and the left ventricle.

With deficiency of the mitral valve, the pressure in the left atrium becomes almost the same as in the left ventricle.

19. Spiral computed tomography (SKT) - a method based on a series of X-ray series at different depths, and magnetic resonance tomography (MRI) - a method based on building chains of water when exposed to human body of strong magnets, allow you to get an exact image of the heart.
20. Coronicardiography (KKG) - a method in which the eigencraft and cavity of the heart is injected into the eigen vessels of the heart and the cavity of the heart, which allows them to obtain their exact image, as well as estimate the flow of blood flow.

Conducted when planning operational treatment vice or suspicion of concomitant ischemic disease Hearts.

Treatment of mitral insufficiency

Easy degree of illness, which is not accompanied by the appearance of symptoms, does not require special treatment.

Moderate deficiency of the Mitral Valve is not an indication for operational intervention. In this case, treatment is carried out with the help of medicines:

• aCE inhibitors prevent secondary heart myocardial transformation and reduce heart failure symptoms;
• beta blockers reduce the frequency of abbreviations of the left ventricle, due to which the emission fraction increases;
• diuretics accelerate the removal of fluid from the body and eliminate the symptoms of stagnation;
• vasodilators reduce the load on the heart by depositing blood and fluid in peripheral arteries;
• cardiac glycosides stimulate heart abbreviations and help in the fight against arrhythmias;
• anticoagulants make sense to apply with constant form of atrial flications;
• antibiotics are prescribed with infectious endocarditis;
• hormonal drugs may affect rheumatism.

In the case of acute regurgitation development, intarautral balloon counterpulcation can be used. During this procedure, a special oval inflating cylinder is introduced into the patient's aorta, which opens in antipasis of heart cuts.

As a result, coronary blood flow increases, as well as the ejection fraction increases. This temporary measure is mainly for ischemia of papillary muscles, or as a preoperative preparation.

1. It is necessary to treat the main disease - the causes of the lack of mitral valve.
2. Drug treatment is shown in complications of mitral insufficiency (for example, treatment of heart failure, heart rate disorders, etc.)
3. The insufficiency of the mitral valve is insignificant or moderate does not require special treatment.

   With severe and severe mitral insufficiency surgery: plastic or prosthetics of the mitral valve.

4. Surgical treatment of deficiency of the tricuspid valve is carried out exclusively under artificial blood circulation (during surgery, blood is not pumped throughout the body, but an electric pump).

Types of operations:

• Plastic Operations (that is, normalization of blood flow through the left atreservantic hole with the preservation of its own mitral valve) is performed in the insufficiency of the mitral valve 2-3 degrees and the absence of pronounced changes of its sash.

• Ring annulhoplasty (valve plastic) by stitching the reference ring at the base of the mitral valve flaps. The ring consists of a metal base covered with a synthetic cloth;
• Shortening chord (tendon threads attached to the muscle of the heart Papillary muscles - the inner muscles of the heart, providing valve movements);
• Removal of a part of the elongated rear flap of the mitral valve.

• biological prostheses (made of aortic (that is, the largest vessel) of animals) - apply in children and women who are planning pregnancy;
• mechanical valves (made of special medical alloys of metals) are used in all other cases.

• After implantation (implantation) of the mechanical prosthesis, patients need constant reception of drugs from the group indirect anticoagulantov (preparations that reduce blood clotting by blocking the synthesis of liver of substances required for coagulation).
• After implantation of biological prosthesis, anticoagulant therapy is carried out briefly (1-3 months).
• After plastic valve, anticoagulant therapy is not carried out.

Along the way with the treatment of the underlying disease on 1 and 2 stages of insufficiency, supporting and corrective symptomatic medicia treatment:

1. The use of vasodilator for the regulation of systolic pressure in the aorta, the effect of the IAPF in this case is considered the most studied;
2. Adrenoblockers;
3. Use of anticoagulants to avoid thrombosis;
4. Diuretic and antioxidants;
5. Antibiotics as prevention, especially during prolapse.

It should be noted the futility of drug treatment and not allow the deterioration of the patient's condition to such an extent that the irreversible consequences in the heart will lower the forecast of a successful operation or make an operation impossible, since the more difficult the operation is the higher mortality.

With the help of medicines, you can stabilize the patient's condition, but even against the background of medicines, the disease is often progressing.

Operation for the disease

Medicatically fully cure the defects of the mitral valve, especially at the border 2, it is impossible for 3 and 4 stages.

If the disease progresses or acute insufficiency arises, and there is no reasonable reason for cancellation of the operation - surgical intervention is the only effective treatment method.

During the operation, plastic or prosthetics of the necessary sections is carried out, the patient during the operation is connected to the system of artificial blood circulation.

Plastic operations apply when there are no pronounced changes in the structure of the mitral valve flaps. Depending on the pathology (prolapse, the "thump" sash, etc.) spend:

• Valve sample size correction;
• Shortening tendon threads (regulation of valve motion);
• Correction of the sizes of a mitral ring, at the base of its sashs, the special ring is stitching (annulhoplasty).

Commissionwriting (expanding the lumen of the mitral valve) can be carried out translate, without connecting to the apparatus of artificial blood circulation. In the event of observation and low mobility of the valve, a full-fledged operation is carried out with the connection of artificial circulation.

Commourotomy allows to eliminate serious defects, but after such an operation, stenosis can later develop.
Walvoplasty is aimed at restoring the narrowed valve.

Balloon holvoplasty does not require a disconnection of the heart from the circulatory system, the operation is carried out through an incision on the artery or vein of the thigh. This is the safest operation that gives the minimum number of complications.

Valve-cooling reconstructive operations in children, such as decalcification of sash, and commouroplasty have a favorable forecast. But in three cases out of ten have to make a re-operation on prosthetic mitral valve.

To avoid this to avoid the preoperative period, the degree of regurgitation is carried out, the exact parameters of the mitral valve, the mitral ring are determined, the indicators are compared with the body's body parameters, and the presumptive forecast is calculated according to which it is advisable to perform a reconstructive operation, or immediately carry out the prosthetics of the mitral valve.

The prosthetics of the mitral valve is used with pronounced valve changes or when the plastic turned out to be unsolved. For children, the biological prostheses made from the aorta animals are used, which, as a rule, are well attached.

The operation allows you to eliminate almost any vices, it does not subsequently cause the development of stenosis and after a semi-annual postoperative period The child will be able to conduct a full-fledged lifestyle.

For the prevention of the disease, annual surveys are held if the disease proceeds asymptomaticly, the only prophylactic measure becomes the annual ultrasound procedure of the heart. It is necessary to warn and reveal any changes in the work of the heart.

Preventive measures are also assigned in the case of secondary occurrence Vice. In this case, all measures are aimed at eliminating chronic infection foci leading to insufficiency. Additionally eliminate signs of hypercholesterolemia. The patient must regularly perform diagnostics and attend a doctor.

Subject to all the recommendations of the doctor, as well as if adhere to healthy image Life, then the problems of the mitral valve may not express themselves throughout life. This disease does not significantly affect human performance and has no contraindications.

The lack of a mitral valve of 1 degree is a minor form of the disease. Different with complex diagnostics. Does not require surgical operations.

Treatment of any heart failure is mandatory, without timely treatment develop stagnation in organs and irreversible complications various degreesBut even using deterrent medication, mortality remains high.

Naturally, any operation on the heart is a risk, mortality after operations on the open heart is 1 - 3% for children and increases with the number of concomitant diseases.

Walvoplasty and Kamisurotomy are temporary measures, the treatment of insufficiency by these methods is impossible and with time the procedures will have to be repeated periodically. After prosthetics, the patient receives postoperative treatment and is listed under the supervision of the doctor.

During the reception, a mandatory auscultation of the heart of the child is carried out, the remaining studies are appointed as necessary.

Source »hospital-israel.ru; Look studentBook.ru; pirogov-center.ru; iserdce.ru; mirbodrosti.com; Detstrana.ru; Bone-Surgery.ru; lecheniedetej.ru »

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Description of the disease

N IMK (Mitral Valve Insufficiency) is the most popular cardiac anomaly. Of all sick crops 70% suffer from an isolated form of NMC. Usually rheumatic endocarditis is the main root cause of the disease. Often a year after the first attack, the condition of the heart leads to chronic insufficiency, the cure of which is rather difficult.

The greatest risk group includes people sick with Walvulitis. This disease damages the valve sash, as a result of which they are exposed to wrinkling processes, destruction, gradually become shorter compared to the initial length. If Walvulitis is in late step, calcification is developing.

Septic endocarditis leads to the destruction of many heart structures, so the NMC has the strongest manifestations. The valve flaps are adjacent to each other are not enough tight. With their incomplete closure through the valve occurs too strong blood outletthat provokes it to reboot and the formation of congestive processes, an increase in pressure. All signs lead to the increasing deficiency of MK.

Causes and risk factors

NMC suffer from people with one or more of the following pathologies:

1. Congenital predisposition.
2. Syndrome connecting displasia.
3. Mitral valve prolapse, characterized by regurgitation 2 and 3 degrees.
4. Destruction and choser chord, rupture of MK leafs due to injury in the chest injury.
5. Gaps of lesions and chords in the development of endocarditis of infectious nature.
6. Destruction of the apparatus combining valves, with endocarditis, which occurred due to diseases of the connective tissue.
7. Infarction parts of the mitral valve followed by the formation of the scar in the sublink area.
8. Changing the shape of the flaps and tissues under the valves, rheumatism.
9. Increase the mitral ring with dilatation cardiomyopathy.
10. Insufficiency of the function of the valve in the development of hypertrophic cardiomyopathy.
11. MC insufficiency due to the operation.

Mitral insufficiency is often accompanied by another defect - stenosis of the mitral valve.

Types, shapes, stages

With NMK. the overall shock volume of the left ventricular blood is estimated.. Depending on its number, the disease is divided into 4 degrees of gravity (as a percentage is part of the blood, which is redistributed incorrectly):

• I (most soft) - up to 20%.
• II (moderate) - 20-40%.
• III (medium shape) - 40-60%.
• IV (the hardest) - over 60%.

According to the forms of flow, the disease can be divided into acute and chronic:

In determining the peculiarities of the movement of mitral flaps allocated 3 types of pathology classification:

• 1 - the standard level of mobility of the sash (in this case, painful manifestations are consisting in dilatation of the fibrous ring, softening vessels).
• 2 - destruction of sash (the greatest damage takes chords, as their pulling or gap occurs, also manifests a disruption of the integrity of the nobble muscles.
• 3 - Reducing the mobility of the sash (forced connection of the commission, reduction of the length of chord, as well as their splicing).

Danger and complications

With the gradual progression of NMC, such violations are manifested:

1. The development of thromboembolism on the basis of constant stagnation of a large part of blood.
2. Valve thrombosis.
3. Stroke. Of great importance in the risk of risk of stroke occupies the previously occurred valve thrombosis.
4. Cleaning arrhythmia.
5. Symptoms of chronic heart failure.
6. Mitral regurgitation (partial refusal to perform functions with a mitral valve).

Symptoms and signs

The severity and severity of the ICT depends on the degree of its development in the body:

• 1 Stage Diseases have no specific symptoms.
• 2 Stagedoes not allow patients to exercise physical Load in accelerated mode, since shortness of breath, tachycardia, pain in chest, knocking down the heart rhythm, discomfort. Auscultation in mitral insufficiency determines the increased intensity of the tone, the presence of a noise background.
• 3 Stage Characterized by deficiency of left ventricle, pathologies of hemodynamics. Patients suffer from a permanent shortness of breath, ortopnoe, accelerating the rhythm of the heart, feel discomfort in the chest, their skin is paler than in a healthy state.

Learn more about mitral insufficiency and hemodynamics with it from a video clip:

When to contact the doctor and to what

When identifying the symptoms characteristic of MTC immediately turn to the cardiologist, To stop the disease in the early stages. In this case, you can avoid the need for consultation with other doctors.

Sometimes there are suspicions of rheumatoid etiology of the occurrence of the disease. Then you should visit the rheumatologist to form a diagnosis and prescribing proper treatment. If there is a need for operational intervention, treatment and subsequent elimination of the problem conducts cardiac surgery.

Common methods for identifying NMK:

More about symptoms and diagnostics Find out of the video:

It is necessary to distinguish the NMC from other pathologies of the heart:

1. Myocarditis in severe form.
2. Congenital and acquired heart defects of adjacent etiology.
3. Cardiomyopathy.
4. Prolapse MK.

Methods of therapy

With pronounced symptoms of the NMC, the patient shows surgical intervention. An introduced operation is performed for the following reasons:

1. In the second and later stages, despite the fact that the volume of blood release is from 40% of its total.
2. In the absence of the effect of antibacterial therapy and exacerbation of an infectious endocarditis.
3. Strengthened deformations, sclerosis of flaps and tissues located in the linked space.
4. If there are signs of the progressive dysfunction of the left ventricle together with the overall heart failure flowing at 3-4 degrees.
5. Heart failure in the early stages can also be caused for the operation, however, for the formation of testimony, thromboembolism is to be found in the size of vessels located in a large circulation circle.

Operations are practiced:

• Valve-cooling reconstructive operations are necessary for the correction of the NMC in childhood.
• Commuroplasty and decalcification of sash are shown in pronounced MK insufficiency.
• Chordoplasty is designed to normalize mobility of sash.
• Translocation Cord is shown in their disposal.
• Fixing parts of the papillary muscle is carried out using teflon gaskets. This is necessary when the muscle head is separated with the rest of the components.
• The prosthetics of chord is necessary when they are complete degradation.
• Walvoplasty avoids the rigidity of the sash.
• Analoplasty is designed to get rid of the patient from regurgitation.
• The valve prosthetics is carried out in its strong deformation or the development of irreparable and interfering normal vital activity of fibrosclerosis. Mechanical and biological prostheses are used.

Learn about minimally invasive operations in this disease from the video clip:

What to wait and measures of prevention

With the development of the NMC, the forecast determines the severity of the course of the disease, that is, the level of regurgitation, the emergence of complications and irreversible changes in heart structures. Survival for 10 years after diagnosis is higher than in similar heavy pathologies.

If the lack of valve is manifested in moderate or medium, women have ability to enter and give birth to children. When the disease acquires chronic flowAll patients should take an ultrasound every year and attend cardiologist. With the appearance of deterioration, it is necessary to apply visits to the hospital more often.

The prevention of the NMC is in the prevention or early treatment of diseases causing this pathology. All diseases or manifestations of mitral valve deficiency due to its improper or reduced valve must be quickly diagnosed and conduct timely treatment.

NMC is a dangerous pathology leading to severe destructive processes in heart tissue, therefore needs proper treatment. Patients subject to the doctor's recommendations may some time after the start of treatment

Mitral insufficiency is a variety of valve heart defects. The pathogenesis is due to the incomplete closure of the mitral opening, which is preceded by violations of the structure of the flaps, tissues under the valves.

Pathology is characterized by the regurgitation of blood into the left atrium from the left ventricle. Consider in detail what it is, the nature of development and clinical picture Mutral valve deficiency currents at 1, 2 and 3 degrees of the disease, methods of its treatment and the forecast of return to normal life.

N IMK (Mitral Valve Insufficiency) is the most popular cardiac anomaly. Of all sick crops 70% suffer from an isolated form of NMC. Usually rheumatic endocarditis is the main root cause of the disease. Often a year after the first attack, the condition of the heart, which is quite difficult to cure.

The greatest risk group includes people sick with Walvulitis. This disease damages the valve sash, as a result of which they are exposed to wrinkling processes, destruction, gradually become shorter compared to the initial length. If Walvulitis is in late step, calcification is developing.

Additionally, due to the listed diseases, the length of the chord is reduced, dystrophic and sclerotic processes occur in papillary muscles.

Septic endocarditis leads to the destruction of many heart structures, so the NMC has the strongest manifestations. The valve flaps are adjacent to each other are not enough tight. With their incomplete closure through the valve occurs too strong blood outletthat provokes it to reboot and the formation of congestive processes, an increase in pressure. All signs lead to the increasing deficiency of MK.

Causes and risk factors

NMC suffer from people with one or more of the following pathologies:

1. Congenital predisposition.
2. Syndrome connecting displasia.
3. Mitral valve prolapse, characterized by regurgitation 2 and 3 degrees.
4. Destruction and choser chord, rupture of MK leafs due to injury in the chest injury.
5. Tarve the leaf and chord during development.
6. Destruction of the apparatus combining valves, with endocarditis, which occurred due to diseases of the connective tissue.
7. Infarction parts of the mitral valve followed by the formation of the scar in the sublink area.
8. Changing the shape of the flaps and tissues under the valves, rheumatism.
9. Increase the mitral ring with dilatation cardiomyopathy.
10. Insufficiency of the function of the valve in the development of hypertrophic cardiomyopathy.
11. MC insufficiency due to the operation.

Types, shapes, stages

With NMK. the overall shock volume of the left ventricular blood is estimated.. Depending on its number, the disease is divided into 4 degrees of gravity (as a percentage is part of the blood, which is redistributed incorrectly):

• I (most soft) - up to 20%.
• II (moderate) - 20-40%.
• III (medium shape) - 40-60%.
• IV (the hardest) - over 60%.

According to the forms of flow, the disease can be divided into acute and chronic:

In determining the peculiarities of the movement of mitral flaps allocated 3 types of pathology classification:

• 1 - the standard level of mobility of the sash (in this case, painful manifestations are consisting in dilatation of the fibrous ring, softening vessels).
• 2 - destruction of sash (the greatest damage takes chords, as their pulling or gap occurs, also manifests a disruption of the integrity of the nobble muscles.
• 3 - Reducing the mobility of the sash (forced connection of the commission, reduction of the length of chord, as well as their splicing).

Danger and complications

With the gradual progression of NMC, such violations are manifested:

1. Thrombembolia on the basis of constant stagnation of a large part of blood.
2. Valve thrombosis.
3. Stroke. Of great importance in the risk of risk of stroke occupies the previously occurred valve thrombosis.
4. Cleaning arrhythmia.
5. Symptoms of chronic heart failure.
6. Mitral regurgitation (partial refusal to perform functions with a mitral valve).

Mitral valve deficiency is a variety of valve-type heart defects. The pathogenesis is due to the incomplete closure of the mitral opening, which is preceded by violations of the structure of the flaps, tissues under the valves. Pathology is characterized by the regurgitation of blood into the left atrium from the left ventricle.

Symptoms and signs

The severity and severity of the ICT depends on the degree of its development in the body:

• 1 Stage Diseases have no specific symptoms.
• 2 Stagedoes not allow patients to exercise physical activity in accelerated mode, as shortness of breath, tachycardia, pain in the chest, knocking the heart rhythm, unpleasant sensations is immediately manifested. Auscultation in mitral insufficiency determines the increased intensity of the tone, the presence of a noise background.
• 3 Stage Characterized by deficiency of left ventricle, pathologies of hemodynamics. Patients suffer from a permanent shortness of breath, ortopnoe, accelerating the rhythm of the heart, feel discomfort in the chest, their skin is paler than in a healthy state.

Learn more about mitral insufficiency and hemodynamics with it from a video clip:

When to contact the doctor and to what

When identifying the symptoms characteristic of MTC immediately turn to the cardiologist, To stop the disease in the early stages. In this case, you can avoid the need for consultation with other doctors.

Sometimes there are suspicions of rheumatoid etiology of the occurrence of the disease. Then you should visit the rheumatologist to form a diagnosis and prescribing proper treatment. If there is a need for operational intervention, treatment and subsequent elimination of the problem conducts cardiac surgery.

Symptoms Mitral Insufficiency can be similar to the signs of other acquired heart defects. More about how they manifest themselves, we wrote.

Diagnostics

Common methods for identifying NMK:

More about symptoms and diagnostics Find out of the video:

It is necessary to distinguish the NMC from other pathologies of the heart:

1. Myocarditis in severe form.
2. Congenital and acquired heart defects of adjacent etiology.
3. Cardiomyopathy.
4. Prolapse MK.

And how to cure from this problem? All details can be found in an affordable review.

On the symptoms of the lack of aortic valve and the differences of this heart defect from the material described in this article in another material.

Read also with information about how the Behalet's disease is also dangerous, with methods of treating this.

Methods of therapy

With pronounced symptoms of the NMC, the patient shows surgical intervention. An introduced operation is performed for the following reasons:

1. In the second and later stages, despite the fact that the volume of blood release is from 40% of its total.
2. In the absence of an effect on antibacterial therapy and exacerbation of an infectious endocarditis.
3. Strengthened deformations, sclerosis of flaps and tissues located in the linked space.
4. If there are signs of the progressive dysfunction of the left ventricle together with the overall heart failure flowing at 3-4 degrees.
5. Heart failure in the early stages can also be caused for the operation, however, for the formation of testimony, thromboembolism is to be found in the size of vessels located in a large circulation circle.

Operations are practiced:

• Valve-cooling reconstructive operations are necessary for the correction of the NMC in childhood.
• Commuroplasty and decalcification of sash are shown in pronounced MK insufficiency.
• Chordoplasty is designed to normalize mobility of sash.
• Translocation Cord is shown in their disposal.
• Fixing parts of the papillary muscle is carried out using teflon gaskets. This is necessary when the muscle head is separated with the rest of the components.
• The prosthetics of chord is necessary when they are complete degradation.
• Walvoplasty avoids the rigidity of the sash.
• Analoplasty is designed to get rid of the patient from regurgitation.
• The valve prosthetics is carried out in its strong deformation or the development of irreparable and interfering normal vital activity of fibrosclerosis. Mechanical and biological prostheses are used.

Learn about minimally invasive operations in this disease from the video clip:

What to wait and measures of prevention

With the development of the NMC, the forecast determines the severity of the course of the disease, that is, the level of regurgitation, the emergence of complications and irreversible changes in heart structures. Survival for 10 years after diagnosis is higher than in similar heavy pathologies.

If the lack of valve is manifested in moderate or medium, women have ability to enter and give birth to children. When the disease acquires a chronic course, all patients should every year to do an ultrasound and visit the cardiologist. With the appearance of deterioration, it is necessary to apply visits to the hospital more often.

With a worsening of the state, surgery is being taken, so patients should always be prepared for a given extent from the disease.

The prevention of the NMC is in the prevention or early treatment of diseases causing this pathology. All diseases or manifestations of mitral valve deficiency due to its improper or reduced valve must be quickly diagnosed and conduct timely treatment.

NMC is a dangerous pathology leading to severe destructive processes in heart tissue, therefore needs proper treatment. Patients subject to the doctor's recommendations may some time after the start of treatment