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Mitral valve prolapse of 1,2 and 3 degree: treatment and prognosis

Mitral valve prolapse (PMC) - this diagnosis can often be seen in the results of a heart ultrasound. However, one should not immediately worry: this type of valvular blemish is often diagnosed in quite healthy people and requires only periodic observation from a cardiologist.

Therapeutic tactics directly depends not only on the severity of the prolapse (deflection) of the valve, but also on the degree of regurgitation (volume of the reverse blood flow).

Content

Mitral valve prolapse - what is it?

Mitral valve prolapse

The mitral (bivalve) valve divides the chambers of the left part of the heart: the atrium and the ventricle. The prolapse of the mitral valve is the deflection of the valve flaps at the time of contraction (systole) of the left ventricle.

Pathology is caused by a violation of the structure of the valve (its fibrous layer, less often of the tendon chords) due to connective tissue dysplasia. Valve flaps do not only bend, but can also be loosely closed.

With the contraction of the left ventricle through the remaining lumen of the valve, the blood rushes back to the atrium. This process is called regurgitation.

PMC is most often diagnosed in young people 20-35 years. Very rarely a deviation in the structure and work of the mitral valve is found in young children. Among adults, the frequency of pathology varies between 10-25%, and in the elderly, 50%.

The main reasons for the formation of valvular defect:

  • Hereditary conditioned connective tissue dysplasia (Marfan and Ehlers-Danlo syndromes) - primary valve prolapse develops;
  • Incorrectly flowing osteogenesis, leading to deformation of the chest;
  • Rheumatic heart damage, inflammatory processes in its membranes, infarction, chronic ischemia of the heart, atherosclerosis / calcification of the valve ring - secondary prolapse is formed.

According to the severity of the deflection , mitral prolapse is distinguished:

  1. 1 degree - the height of the dome-shaped deflection of the valves does not exceed 0.6 cm (norm 1-2 mm);
  2. 2 degrees - bulging up to 0.9 cm;
  3. 3 degrees - the dome of the leaf is more than 0.9 cm high.

Symptoms of prolapse in terms of regurgitation

Classification of PMC by the severity of the deflection of valve flaps is rather arbitrary. The most important factor influencing the general state of a person and medical tactics is the degree of regurgitation (1 to 3 degree), which causes a symptomatic picture of mitral insufficiency.

Mitral valve prolapse 0 degree

Prolapse

Even with a fairly pronounced deflection, the valves close tightly, and the volume of blood from the left ventricle enters the aorta in full (there is no return flow to the left atrium).

At the same time, regurgitation of grade 0 does not give any painful symptoms: a person feels completely healthy and does not complain about the work of the heart.

Mitral valve prolapse 1 degree

Mitral valve prolapse 1 degree

pain during exercise

Mitral valve prolapse and 1 regurgitation are diagnosed with minimal volume of blood returned to the atrium. There are no complaints indicating a violation of blood circulation, the patient does not present.

Some patients note the occurrence of pain in the right hypochondrium during running. This is due to insufficient right ventricular functionality to increase the amount of blood flow in the heart. The deviation is fixed during the examination:

  • Auscultation - listening to noise at the apex of the heart and a specific click caused by a sharp strain of the relaxed chords during the systole of the ventricle. Clicks are more audible in the vertical position, can completely disappear in the prone position. Sometimes (not necessarily!) The "meow" (squeaks) arising from the vibration of the chords or the valve flaps are heard.
  • Echocardiography (heart ultrasound) is a small lumen between the closed valve flaps and a fixed volume of blood returned to the atrium.

Mitral valve prolapse grade 2 - mitral failure

With the prolapse of the bicuspid valve and 2 degrees of regurgitation, ultrasound (heart doppler) records more pronounced signs of mitral insufficiency. The blood stream, returning through the partially closed valve, reaches the middle of the atrial chamber.

In the atrium, more than 25% of the blood returns from the ventricle. In this case, there are symptoms characteristic of stagnation in a small circle of circulation:

  • Heart pain is mild or moderate, not having a close connection with physical exertion or an emotional response to stress (may occur spontaneously). Admission Nitroglycerin does not have a particular effect in eliminating such pain.
  • Headache - tense, often bilateral (only sometimes imitates migraine). Headache often occurs against a background of sharp weather changes, after emotional overstrain.
  • Shortness of breath - often triggered by a syndrome of hyperventilation (deep or frequent breaths, provoked by a sense of lack of air). Dyspnoea may occur even after minimal physical exertion.
  • Vegetative dysfunction - manifested by a lump in the throat, increased sweating, rapid fatigue and morning weakness, unreasonable rise in temperature to 37.0-37.5 ° C, nausea and dizziness. At the same time, vegetative crises are repeated at least once a week, unrelated to situations threatening the patient, and the emotional side of this state is somewhat muffled. Syncope is also extremely rare. Vegetative disorders provoke the development of depressive states and emotional instability (melancholy and gloominess in the morning, anxiety and irritability in the evening). Often, patients complain of specific bodily sensations, which are sometimes perceived as a symptom of another physical illness.
  • Interruptions in the work of the heart - the patient periodically notes jerks or sinking of the heart. In this case, extrasystoles (extraordinary strokes of the heart) and tachycardia (frequency of heart rate increase) are not recorded permanently, but occur during emotional experience, physical exertion or even after drinking coffee.

Mitral valve prolapse 3 degree

Insufficiency in a small circle of blood circulation leads to an increase in the load on the right side of the heart. Gradually aggravated already existing symptoms and there are severe signs of insufficiency of a large range: swelling, increased pressure, cyanosis of the skin, insuperable weakness, fibrillation of the atria and enlargement of the liver. Such patients usually receive 1 group of disability.

The prolapse of the mitral valve is dangerous for life at the third degree of regurgitation: it may develop paroxysmal tachycardia, pulmonary edema, endocarditis and other serious complications, even sudden death.

Patients with prolapse of the bivalve valve most often suffer from cold diseases, they are often diagnosed with chronic tonsillitis.

  • Congenital dysplastic pathology of connective tissue in childhood is indicated by dysplastic changes of the hip joints, flat feet, abdominal hernias.

Mitral valve prolapse during pregnancy

The slight prolapse of the bivalve valve and insignificant mitral insufficiency is not a contraindication to pregnancy, the bearing of the child in this case is normal.

At the same time, there may even be a temporary decrease in the deflection of valve flaps due to a physiological increase in the size of the left ventricle. However, systolic murmur and clicks return 1 month after delivery.

More dangerous is the severe regurgitation and prolapse of the mitral valve during pregnancy: the risk of developing paroxysmal tachycardia attacks is significantly increased. During childbirth, rupture of valvular chords is not excluded.

In women with PMK, premature detachment of amniotic fluid and the weakness of labor pains are often recorded. The baby is prone to intrauterine asphyxia and is often born with low weight (hypotrophy).

Treatment of mitral valve prolapse

Treatment of mitral valve prolapse Therapeutic tactics are chosen in strict accordance with the degree of prolapse of the bivalve valve, the presence / absence of signs of mitral insufficiency and the complications that have arisen.

1 degree of mitral valve prolapse: health improvement measures

With a slight change in the structure of the valves (prolapse of the mitral valve with regurgitation of 1 degree), the absence of constant arrhythmia and other painful symptoms, treatment is not required. A person is recommended to be observed by a cardiologist once a year and correction of vital principles:

  • Refusal from smoking and alcohol, coffee and strong tea;
  • Balanced diet;
  • Physical loads, commensurate with the capabilities of the body;
  • Education of stress resistance;
  • Rational work schedule - rest.

Treatment of PMC and 2 degrees of regurgitation

The appearance of painful symptoms of mitral valve prolapse indicates the need for drug therapy. Treatment Scheme includes:

  • Elimination of heart pain - it is advisable to use soothing agents (valerian, sage, hawthorn, St. John's wort, motherwort);
  • The therapy of vegetovascular dystonia - andidepressants (Amitriptyline, Azafen), neuroleptics (Sonopax, Triftazin), tranquilizers (Elenium, Seduxen, Grandaxin);
  • Improved metabolism in the myocardium - Riboxin, Picture, coenzyme Q-10, Panangin, vitamins and magnesium preparations (especially effective in mitral prolapse!);
  • Restoration of the heart rhythm - Obsidan and other adrenoblockers;
  • Prophylaxis of infectious endocarditis - wide-spectrum antibiotics for every surgical intervention (tooth extraction, tonsillectomy).

Elimination of severe regurgitation with bivalve valve prolapse

To eliminate the progression of the disease and prevent severe consequences of mitral insufficiency, cardiac glycosides, diuretics, ACE inhibitors (non-hypotensive dose of Captopril - about 0.5 mg / kg of body weight per day - have a cardioprotective effect). Simultaneously with drug therapy, a surgical plastic of the bicuspid valve is performed.

Depending on the structural changes, cardiac surgeons shorten the valve chords, suturing the valves and ablation of foci of pathological impulses (elimination of arrhythmia). In severe cases, the valve is completely replaced.

The possibilities of modern medicine allow many heart operations to be performed by endovascular (transcatheter) or endoscopic access. To an open operation, cardiac surgeons resort only in extreme cases, for example, with combined vices.

Forecast

In the absence of mitral insufficiency, the outcome of the disease is usually favorable. It is worth noting that a small deflection of valve flaps in lean people and adolescent children can disappear on their own, while observing a rest regime, adequate physical activity and adequate nutrition.

The patient's health with a severe degree of mitral prolapse and rapid progression of the disease directly depends on the timeliness and adequacy of medical care.

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2017-03-16 16:22:06
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