The aortal stenosis, or stenosis of the mouth of an aorta – the inborn or acquired disease which is characterized by narrowing of the taking-out path of a left ventricle in the field of the aortal valve which provokes difficulty of outflow of blood from a left ventricle and also promotes sharp increase of a pressure gradient between an aorta and a ventricle.
Distinguish three types of an aortal stenosis:
Are the main reasons for the acquired aortal stenosis:
Rheumatic defeat of valve shutters (rhematoid endocarditis) provokes reduction of shutters of the valve, as a result they become rigid and dense, as is the reason of narrowing of a valve opening. Calcification of the aortal valve which promotes a bigger reduction of mobility of shutters is quite often observed.
At an infectious endocarditis the similar changes leading to development of an aortal stenosis are observed. Often the system lupus erythematosus and a pseudorheumatism become the reasons of formation of a disease.
Atherosclerosis of an aorta is followed by the expressed degenerative processes, a sklerozirovaniye, rigidity and calcification of shutters of a fibrous valve ring that also promote difficulty of outflow of blood from a left ventricle.
Sometimes elderly people have the reason of an aortal stenosis primary and degenerative changes of the valve. This phenomenon received the name "idiopathic calcific stenosis of the mouth of an aorta".
The inborn aortal stenosis results from defects and anomalies of development of the valve. At late stages of a course of a disease the expressed calcification which aggravates the course of a disease joins symptoms of an aortal stenosis.
Thus, at all patients on a certain degree of an aortal stenosis, irrespective of an origin, deformation of the aortal valve and the expressed calcification is observed.
Depending on degree of an aortal stenosis, patients can not feel any discomfort throughout a long time, i.e. for a long time the disease has no symptoms.
At the expressed narrowing of a valve opening patients begin to complain of emergence of attacks of stenocardia, bystry fatigue and weakness at exercise stresses, faints and dizzinesses at bystry change of position of a body, an asthma. In especially hard cases a symptom of an aortal stenosis are suffocation attacks (a fluid lungs or cardiac asthma).
Patients with the isolated stenosis of the mouth of an aorta can have complaints connected with emergence of signs of right ventricular insufficiency (weight in right hypochondrium, hypostases). There are these symptoms of an aortal stenosis at the considerable pulmonary hypertensia caused by defects of the mitral valve in combination with an aortal stenosis.
At the general survey of the patient it observes characteristic pallor of integuments.
The main methods of tool diagnosis of an aortal stenosis are:
At heavy degree of an aortal stenosis drug treatment is, as a rule, inefficient. The only radical method of treatment is prosthetics of the aortal valve. After manifestation of symptoms of a disease chances to survive without carrying out operation sharply are reduced. On average, patients after manifestation of such symptoms as heartaches, left ventricular failure signs, faints, live no more than five years.
After installation of the diagnosis "the stenosis of the aortal valve" to the patient surely is recommended by preventive measures from an infectious endocarditis.
At an asymptomatic aortal stenosis drug treatment is directed to maintenance of a sinoatrial rate, prevention of an ischemic heart disease and normalization of the ABP.
After emergence of complaints at impossibility of carrying out operation appoint drug treatment. So, in the presence of heart failure by means of medicines try to eliminate stagnation in a small circle of blood circulation by means of reception of diuretics. However their too active use can promote development of an excess diuresis, a hypovolemia and arterial hypotonia. At systolic dysfunction of a left ventricle as symptomatic means appoint Digoxin, especially at a ciliary arrhythmia.
At an aortal stenosis vazodilatator as their use can lead to faints are contraindicated to the patient. However at heavy heart failure careful introduction of Sodium nitroprussidum is allowed.
At an inborn aortal stenosis at children aortal balloon valvuloplasty can be applied. This method allows to lower the maximum transvalve gradient by 65%, however preferential this technique demands repeated operation for 10 years. After carrying out valvuloplasty at patients aortal insufficiency can develop.
The most effective treatment of an aortal stenosis is the surgical method of prosthetics of the valve of an aorta. Prosthetics of the valve of an aorta is shown at heavy degree of an aortal stenosis in the following cases:
The surgical method of treatment of an aortal stenosis significantly improves health of the patient and the forecast of survival. It with success can be seen off even at patients of old age without risk of development of heavy pathologies. For prosthetics use autografts, allogenic prostheses, allotransplants, mechanical prostheses or pork bioprostheses and prostheses from a bull pericardium.
In the aspiration to pull out the patient, doctors often go too far. So, for example, a certain Charles Janszen during the period from 1954 to 1994 endured more than 900 operations on removal of new growths.
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