Mitral failure and its treatment

Mitral insufficiency is a pathological process that develops most often during the following diseases: rheumatism, infective endocarditis. Significantly, it develops as a result of calcification of the mitral ring, damage to the heart valves in systemic scleroderma or systemic lupus erythematosus, as well as aortoarteritis, degenerative connective tissue diseases - Syndromes of Eulers-Danlo or Marfan. As a complication of balloon valvuloplasty, the occurrence of this pathology is also possible.

Mitral insufficiency develops due to rupture of the chord or papillary muscle, for example, with myocardial infarction. In the outcome of infective endocarditis, rapid destruction or damage to valve flaps is possible. When performing a prosthetic valve, a complication may occur-a near-valvular regurgitation.

Relative mitral insufficiency can develop due to the expansion of the chambers of the heart (with myocardial dystrophy, myocarditis, cardiomyopathy, ischemic heart disease).

There are two types of mitral insufficiency: acute and chronic.

Characteristic symptoms of acute failure are manifestations of left ventricular failure with the addition of arterial hypotension and pulmonary edema. Often there is atrial fibrillation, atrial extrasystole develops less often.

Chronic mitral failure may persist for a long time (about 10 years). Then there are already complaints, characteristic of heart failure: shortness of breath with physical activity, fatigue. Perhaps the appearance of Ortner's symptom: there is hoarseness of the voice due to compression of the enlarged heart of the recurrent nerve. Subsequently, cough and hemoptysis, swelling due to severe stagnation in small and large circles of blood circulation join.

When examining such a patient, the appearance of cyanosis of the lips is possible. This mitral heart defect is characterized by a pulse of medium filling. Perhaps tachypnea. The displacement of the apical thrust occurs to the left, it becomes diffused and strengthened; With significant mitral insufficiency, systolic tremor occurs in the region of the apex of the heart.

When auscultation with mitral insufficiency, the appearance of systolic noise at the apex, which is well performed in the axillary region, is typical. Also characteristic at the apex of the heart is the weakening of the I tone.

Mitral heart defects, including mitral insufficiency, require compulsory treatment, the exception is asymptomatic chronic. First, diuretics (furosemide) and peripheral vasodilators (sodium nitroprusside) are prescribed. To maintain hemodynamics at a normal level, it is possible to use intra-aortic balloon counterpulsation.

Surgical treatment is performed taking into account the patient's condition and the cause of mitral insufficiency. For example, with infectious endocarditis, acute mitral valve insufficiency already requires surgical intervention in the next 24 hours, and conservative therapy is a priority for myocardial infarction.

Regardless of the etiology of the defect, it is necessary to prevent infectious endocarditis.

The appearance of symptoms is an indication for surgical treatment. The operation of choice is mitral valve plastic. This allows for greater synchronicity in the contractions of the left ventricle and does not require ongoing anticoagulant therapy. In the presence of calcifications, prosthetic mitral valve is used. Annuloplasty is used in the therapy of relative mitral insufficiency.