Mitral stenosis: symptoms and treatment of mitral valve

What is it? In medical practice, the characteristic of mitral stenosis is defined as the pathology of the cardiovascular system caused by an abnormal organic defect( constriction of the left atrioventricular orifice) that creates an obstruction of the passage of blood from the atrium to the ventricle, as a result of prolapse due to degenerative changes( thickening) of the bivalve mitralvalve.

Because of the difficult ejection of blood into the artery from the left atrioventricular orifice, as a result of the defect of the atrial septum caused by "stricture"( narrowing of the hollow channel), a gradual increase in blood pressure is noted in the small( pulmonary) circulatory system, causing volumetric overloadcoronary sinus) of the right ventricle of the heart. In his chamber, the lower arterial pressure builds up, causing sclerotic and dystrophic changes in the myocardium( in the striated cardiac muscle tissue).In the right atrium, working under conditions of increased stress, pathological changes gradually take place.

With prolonged course of the disease, cachexia( depletion of adaptive-compensatory mechanisms) and lack of appropriate treatment, blood circulation disorders occur in the( systemic), large circle. This may be the cause:

• development of a stroke;Atrial fibrillation
  
• ;
  
• cerebral infarction;
  
• spasm of cerebral vessels, with all the ensuing consequences;
  
• infarction of the kidneys and intestines;
  
• cardiac asthma.

Classification of the disease

1. 1) According to the anatomical characteristic of the constriction, a tie that resembles a loop of a jacket. The funnel-shaped narrowing, in the form of a fish mouth, a narrowing of a double character.
   
2. 2) Depending on the size of the valve opening, the degree of damage.
   
3. 3) The minimum shape is the minimum hole area.
   
4. 4) Sharp shape - the total area of ​​the hole - less than 0.5 cm2
   
5. 5) The pronounced form - the total area within 0,5кв.sm.-1кв.см.
   
6. 6) Moderate form of stenosis - with a total area of ​​1 sq.cm.-1.5kv.sm.and more than 1,5 sq. cm.

The disease develops slowly, imperceptibly, for a long time - about twenty years. The peak of development falls on the forty-year line, preferring the female half of the population. In the initial period can not behave in any way. Development of violations of a gamodynamic nature, cause destructive changes in the lungs:

• pulmonary edema;
  
• fibrosis of the vascular walls of the lungs;
  
• Kataev's reflex( spasm of small pulmonary arteries);
  
• prolonged spasm causes cardiac left-ventricular failure - hypertension and premature death.

For the convenience of determining the severity of the course of the disease, in accordance with the development of hemodynamic disorders, mitral stenosis was divided into five stages.

Stages of stenosis of the mitral valve

1. The first stage is the determination of complete compensation, only some manifestations of stenosis are revealed. No complaints.
   
2. The second stage is manifestations of pulmonary hypertension. Complaints about the manifestation of symptoms cause physical activity.
   
3. The third stage - elevated CVP, increased heart and liver - the result of blood stagnation in both circles of the circulation.
   
4. The fourth stage is the appearance of hydrocephalus( ascites), edema of inflammatory nature, diffuse liver changes, atrial fibrillation.
   
5. The fifth stage is of a dystrophic( terminal) nature. The pathological condition of the circulatory system leads to irreversible changes in the body, such as cirrhosis, hydrocele, inflammatory edema, dyspnea even in a calm state, cardiomegaly. Conservative treatment methods are ineffective

Causes of

The main factor in the development of the disease is:

1. 1) Rheumatic attacks( manifestations of fever) caused by complications resulting from streptococcal infections that stimulate the thickening of valve flaps and causing restriction of their functions;
   
2. 2) Congenital pathologies leading to heart disease;
   
3. 3) Tumor neoplasms, thrombi and outgrowths blocking the mitral valve;
   
4. 4) Deposits of petrificates( calcium deposits) blocking the valve and causing stenosis;
   
5. 5) Consequences of the action of certain medications and ionizing radiation.

Symptoms of mitral stenosis

In a healthy person, the first symptoms of mitral valve stenosis manifest themselves:

• with cardiac disruptions;
  
• heart palpitations;
  
• by cough and hemoptysis;
  
• with general weakness;
  
• increased fatigue;
  
• hoarseness of voice;
  
• pallor and cyanosis of the skin;
  
• hyperemia;
  
• with pallor of the nasolabial triangle;
  
• with palpation in the region of the left ventricle department is characterized by sounds resembling "cat's purring."

Treatment of mitral stenosis

The method of treatment of mitral stenosis provides for conservative, mostly preventive treatment, and surgical intervention.

The use of the conservative method does not provide a complete cure for the blemish. Basically, it is used to eliminate complications - pulmonary edema, heart failure, arrhythmia and other complications.

1. 1) The prevention of infectious endocarditis and rheumatic attacks is carried out.
   
2. 2) Treatment of a constant form of fibrillation( ciliary arrhythmia) is the use of anticoagulants and disaggregants.

When there are no severe symptoms of the disease, the treatment consists in the constant monitoring of the condition of the heart.

• blood thinning is controlled by the use of anticoagulants;
  
• the withdrawal of excess fluid from the body is regulated by diuretics;
  
• for arrhythmia - antibiotics and antiarrhythmic preparations.

Good indicators in the treatment of the critical stage of the disease, when there is a clear violation of the blood circulation are applied:

• minimally invasive method of intervention in the form of balanced valvuloplasty;
  
• open method of surgical intervention.

The operation is based on the dissection of interlocking wings, at the same time removing the formed thrombi from the cavities, as well as cleaning the valve leaflets from calcinates.


In severe heart failure, a modern method of valve replacement with the method of transvenous annuloplasty is used. The advantage of this method is that its use excludes an open-type operation. Delivery of a special device intended for remodeling the mitral valve is carried out over a large cardiac vein. This operation excludes the manifestation of restenosis( re-narrowing of the artery) in the next ten years.

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