Stenosis of the aortic valve acquired( stenosis of the aortic estuary)

Causes and symptoms of acquired aortic stenosis
Diagnosis
Treatment
Lifestyle behavior with stenosis
Complications and prognosis

Aortic valve flaws rank second in frequency after mitral valve failure among all acquired heart defects. In most cases, there is a combination of stenosis of the aortic aorta with aortic valve insufficiency, while in isolated form, aortic stenosis is much less common.

The aortic valve is formed by a connective tissue, and consists of three valves opening at the time of movement of blood from the left ventricle into the aorta( one of the largest blood vessels of the body, providing the whole body with oxygenated blood).Normally the aortic valve aperture area is from three to four square centimeters. If any pathological process at the mouth of the aorta( the exit point of the aorta from the left ventricle) affects the valve flaps, this leads to the development of cicatricial changes in them and to the formation of a stenosis of the valve opening.

Thus, aortic stenosis is a disease related to heart and large vascular defects caused by organic damage to the heart, as a result of which a pronounced obstruction to the flow of blood to the aorta is created, which affects the supply of arterial blood to vital organs and the whole organism.

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Allocate congenital and acquired aortic stenosis. In turn, congenital stenosis is nadvalvalnym, valvular and subvalvular, and acquired almost always localized in the valves( valvular stenosis).Below we will consider the main signs and treatment of acquired stenosis of the aortic valve.

Causes of acquired aortic stenosis

In most cases( about 70 to 80%), aortic stenosis causes rheumatism and endured bacterial endocarditis( more often in young people).In elderly people, stenosis of the aortic orifice can be caused by the development of atherosclerotic plaques on the walls of the aorta, as well as the deposition of calcium salts in valve flaps affected by atherosclerosis.

Symptoms of aortic stenosis

The clinical signs are based on a violation of hemodynamics( blood flow) both inside the heart and throughout the body. In the aorta, and, consequently, in all internal organs, blood flows much less than in a normally functioning heart. This is manifested by such symptoms as frequent dizziness, pallor of the skin, pre-fainting condition, deep fainting, muscle weakness, pronounced fatigue, sensations of strong heart beats.

Due to the fact that left ventricular muscle mass increases to overcome resistance to blood flow( left ventricular hypertrophy occurs), and coronary( own cardiac) vessels are unable to supply the heart muscle with oxygen, angina develops. In this case, the patient is troubled by attacks of chest pain, giving in the left arm or in the shoulder blade, arising during physical exertion or at rest.

As the heart muscle of other heart chambers( left atrium, right ventricle) grows, due to its inability to cope with resistance, there are signs of blood stagnation in the vessels of the lungs, liver, muscles, kidneys and other organs. The patient is disturbed by shortness of breath while walking or at rest, attacks of "cardiac" asthma with episodes of pulmonary edema( pronounced dyspnea at rest and lying down with bubbling labored breathing), pain in the right upper quadrant, abdominal enlargement due to accumulation in the abdominal cavity of the fluid, swelling of the lower extremities. Violations of the rhythm are much less common than with mitral defects, and as a rule, ventricular extrasystole is more often recorded.

All of these symptoms manifest themselves in different ways depending on the stage of the process.

For example, in , the heart of the compensates for the increased load, and the symptoms do not appear for a certain period of time( for example, for decades, if the malformation developed at a young age and the degree of constriction is not pronounced).

In , the stages of subcompensation( latent heart failure) symptoms appear when performing a significant physical exertion, especially not customary for the patient.

In the stages of the decompensation of - severe heart failure, severe heart failure and terminal - the above symptoms disturb the patient not only with the minimum household load, but also at rest.

In , the terminal stage of is fatal due to complications and irreversible changes in the cells of the heart and vital organs.

Diagnosis of aortic stenosis

Sometimes, in the absence of complaints, aortic stenosis can be diagnosed accidentally during a planned examination of the patient. In the presence of complaints from the heart, the diagnosis is established in accordance with the following research methods:

- clinical examination of : assesses complaints, the history of the disease and the appearance of the patient, and performs an auscultation( listening) of the chest, in which the doctor catches a gross systolic noise inthe projection point of the aortic valve - in the second intercostal space to the right of the sternum, wet wheezing in the lungs due to stagnation of blood in them, if any;
- laboratory methods of investigation of : general blood and urine tests, biochemical and immunological analyzes of blood reveal signs of an inflammatory process, for example, repeated rheumatic attacks or slow bacterial endocarditis;signs of impaired liver and kidney function;signs of lipid metabolism disorders in atherosclerosis - an increase in cholesterol, an imbalance of triglycerides of high and low density, etc.;
- instrumental research methods : ECG( one-time or 24-hour monitoring according to indications), phonocardiography( FCG is a method of investigation that allows to convert the sound signals of heart sounds into electrical signals, register them on photo paper and conduct a more complete analysis of sound phenomena in heart defects), chest x-ray, echocardiography( ultrasound of the heart).Ultrasound of the heart - the only non-invasive( without the introduction of the tissue of the body) methods, allowing you to clarify the diagnosis. This method evaluates the number, structure, thickness and mobility of the valves, the degree of narrowing of the valvular hole with measurement of its area, the degree of hemodynamic disorders - hypertrophy of the left ventricle with an increase in its volume, increased pressure in the left ventricle and aortic decrease, decrease in stroke volume and fractionejection( the amount of blood ejected into the aorta for one cardiac contraction).

Depending on the degree of narrowing of the valve ring at the aortic aorta, it is common to distinguish three degrees of aortic stenosis:
1 degree - minor stenosis - the area of the valve ring opening is more than 1.6 square meters.see
2 degree - moderate stenosis - the area is 0.75 - 1.6 square meters.see
3 degree - severe stenosis - constriction area less than 0.75 sq. m.see

In diagnostic and unclear cases, as well as before surgery on the valve, cardiac catheterization can be shown with a measurement of the difference in pressure in the left ventricle and in the aorta. This gradient of pressure is also the basis of classification, with a gradient of less than 35 mm Hg corresponding to an insignificant stenosis, moderate stenosis of 36-65 mm Hg, severe stenosis above 65 mm Hg, i.e., the greater the stenosis and obstruction of blood flow, thehigher pressure in the left ventricle and less in the aorta, which adversely affects the walls of the ventricle and blood supply to the entire body.

Treatment of stenosis of the aortic aorta

The choice of the optimal method of treatment is determined individually by the attending physician for each specific patient. Medicinal preparations, operations on the aortic valve and their combination are used.

From the pharmacological groups of drugs, the following can be prescribed: diuretics( veroshpiron, indapamide, furosemide), cardiac glycosides( digitoxin, strophanthin), drugs that reduce blood pressure( perindopril, lisinopril) and reduce the heart rate( concor, coronale).These drugs are prescribed strictly according to the indications in connection with a possible significant decrease in blood pressure, and about the occurrence of any deterioration in the state of health, it is necessary to notify the attending physician.

Drugs that dilate the peripheral vessels and are used in the treatment of pulmonary edema and angina pectoris( nitrates - nitroglycerin, nitrosorbide) are not always used with extreme caution, since their use in angina due to aortic stenosis( relative coronary insufficiency) is inefficient, and secondly, it is fraught with a sharp decrease in pressure, up to the development of a collapse with a restriction of the flow of blood into the organs and tissues of the body.

Radiographic treatment of aortic valve stenosis is cardiosurgical. The operation is indicated for moderate and severe degree of stenosis and presence of hemodynamic disorders and / or clinical manifestations. With moderate stenosis, valvuloplasty can be used( dissection of adhesions and adhesions in the valve flaps), and with severe stenosis, especially if it is combined with insufficiency, it is possible to replace the valve with an artificial mechanical or biological prosthesis.

Replacing the aortic valve with a mechanical prosthesis

Lifestyle with aortic stenosis

Compliance with the recommendations for a lifestyle with this defect is not much different from other cardiovascular diseases. The patient should exclude physical activity, limit the intake of liquid and table salt, stop drinking alcohol, smoking, fatty, fried, cholesterol-rich food. It is also necessary to regularly and regularly take prescribed medications and visit the attending physician with the necessary diagnostic measures.

In case of pregnancy with aortic stenosis, the doctor's tactics for maintaining pregnancy depend on the clinical stage of the process. In the stages of compensation and subcompensation, pregnancy can be prolonged, but decompensation of the defect is an indication for the termination of pregnancy. This is due to the fact that during pregnancy, the load on the circulatory system of the pregnant woman increases, and this can lead to deterioration of hemodynamic parameters, development of complications from the mother and fetus( threat of premature birth, fetoplacental insufficiency and others).

Complications of aortic stenosis

Without treatment, this disease strictly passes through all five stages of its development, that is, sooner or later dystrophic irreversible changes occur in the heart muscle, lungs, brain, liver, kidneys and other organs, which entails a fatal outcome. According to some authors, more than half of patients who do not receive treatment die within the first two to three years after the onset of severe clinical symptoms. It is also likely the development of complications that threaten human life - fatal cardiac arrhythmias( eg, ventricular fibrillation, complete atrioventricular block, ventricular tachycardia), sudden cardiac death, acute heart failure, systemic thromboembolism( thrombosis in the vessels of the lungs, heart, brain,intestines, femoral arteries).

Complications can develop not only as a result of long-term existing aortic stenosis, but also in the operation of the aortic valve, in particular, the development of bacterial inflammation on the valves of the valve as a result of the entry of pathogens into the blood - bacterial endocarditis, the formation of thrombi on the valves or in the heart cavities withpossible release into the blood vessels, disturbances of the heart rhythm, occurrence of repeated stenosis( restenosis) in the late postoperative period as a result of repeated rheumaticattacks. Prevention of such complications is a lifelong reception of anticoagulants and antiaggregants - drugs that "dilute" blood and prevent increased thrombosis, for example, curantil, warfarin, clopidogrel, aspirin and many others. In addition, the development of infectious complications prevents the use of antibiotics in the early surgical period and in the conduct of therapeutic and diagnostic manipulations and small operations in the subsequent life of the patient, for example, when the tooth is removed, bladder studies with catheterization, abortions, and so on.

Forecast

Forecast without treatment is unfavorable. After surgical correction of the defect, clinical and hemodynamic parameters improve, and the survival rate of this category of patients reaches about seventy out of a hundred within ten years after the operation, which is a good enough criterion for successful cardiosurgical treatment of aortic stenosis.

Doctor therapist Sazykina O.Yu.