Mitral stenosis or mitral valve stenosis - a significant narrowing of the atrioventricular orifice connecting the left atrium and left ventricle of the heart. At the junction of the mitral valve is composed of two wings. In mitral stenosis the leaflets thicken, grow together with each other and reduce the size of the hole.
The area of the left atrioventricular opening in the heart of a healthy 4-6 cm
. Distinct abnormalities in heart circulation appear at reducing the opening area of up to 1, 0-1, 5 cm
. When the value of the area is less than 1 cm
, Operative treatment.
Mitral stenosis or mitral valve stenosis is classified as acquired heart disease. He formed more often in women, predominantly in young or middle-aged. In most cases, mitral valve stenosis - a consequence of rheumatic fever.
Mitral stenosis: Symptoms
For a long time, with a small degree of development of the symptoms of mitral stenosis may not appear at all (latent form). At this stage, mitral valve stenosis is recognized only when clinical and instrumental studies. Even a small mitral valve stenosis usually progresses due to the propensity of patients to recurrent rheumatic fever.
The first symptoms of mitral stenosis appear in his progression as indicated:
- Pain in the heart, heart palpitations while increasing physical activity;
- Shortness of breath during normal physical exertion or when lying down;
- Frequent upper respiratory tract infection (bronchitis);
- Swelling of the feet;
- Discomfort in the chest;
- The characteristic cough with hemoptysis;
- The bluish-pink hue of the cheeks and lips (mitral blush);
- Jitter chest around the heart.
Standard age of the onset of symptoms 40-50 years, but they occur at an earlier age and in infancy. If you have these symptoms should immediately seek medical attention. As a result of the medical examination and physician survey reveals additional or secondary symptoms of mitral stenosis:
- Heart murmur;
- Pulmonary hypertension;
- The stagnation in the lungs;
- The formation of blood clots.
The degree of mitral stenosis
In 1955, Soviet scientists Bakulev and EA Damir proposed a classification of degrees of mitral stenosis dyspnea. This scheme is successfully applied in modern medicine, the majority of experts.
The degree of narrowing of the atrioventricular orifice and hemodynamic instability in a small circle appear shortness of breath five stages:
- I - there is shortness of breath. Full compensation circulation, no complaints. According to the survey found characteristic symptoms of mitral stenosis. The area of the mitral orifice 3-4 cm
, Left atrium - less than 4 cm;
- II - shortness of breath at rest there, it occurs during exercise. The relative lack of circulation, a slight increase in venous pressure. The area of the mitral orifice up to 2 cm
, The left atrium of 4-5 cm;
- Grade III mitral stenosis - a constant shortness of breath at rest. Severe initial stage of circulatory disorders. The primary phenomenon of stagnation of blood in the small and large circles. Increasing the size of the heart and liver. A significant increase in venous pressure. The area of the mitral orifice 1-1, 5 cm
, Left atrium 5 cm or more;
- IV - constant severe shortness of breath. Strongly expressed circulatory failure, significant congestion in a large circle, atrial fibrillation. A significant increase in the size of the heart, liver, large dense. High venous pressure. The area of the mitral orifice less than 1 cm
, The left atrium is greater than 5 cm;
- V - shortness of extreme gravity, around the clock. Circulatory failure terminal dystrophic. The maximum increase in the size of the heart and liver. Very high venous pressure. Accumulation of fluid in the abdomen, a strong peripheral edema. The area of the mitral orifice is significantly less than 1 cm
, Left atrium substantially more than 5 cm.
Mitral stenosis: Treatment
The degree of mitral stenosis depends on treatment selection:
- On stage I asymptomatic mitral stenosis drugs are not assigned. It is enough to have regular monitoring and compliance cardiorheumatology his appointments and recommendations;
- In stage II-III, in the presence of minor clinical manifestations prescribe diuretics and beta-blockers. Spend relapse prevention of infective endocarditis and rheumatic fever;
- In stage IV with a significant increase in the size of the left atrium, paroxysmal atrial fibrillation and thromboembolism needs regular intake of anticoagulants. This is the treatment of thromboembolism and atrial fibrillation on the standard schemes;
- At stage IV-V with decreasing size of openings atrioventricular 1, 0-1, 2 cm
, Recurrent thromboembolism, severe pulmonary hypertension require surgical treatment of mitral stenosis.
One of the first operations on the heart surgery were treated mitral stenosis. With this accumulated many years of experience of surgical treatment of mitral stenosis. Developed and practiced the following operations:
- Closed komissurotormiya or balloon valvuloplasty;
- Annuloplasty. Open (often carried out in an open komissurotormii) transvenous or closed;
- Prosthetics. Complete replacement of the natural to the artificial valve (mechanical or biological).
When the disease mitral stenosis contraindicated great physical exertion, mental and emotional stress, strong cooling. With the development of complications, there is complete incapacity.