Insufficiency of the mitral valve

The mitral valve – the valve located between the left auricle and a left ventricle of heart which prevents blood regurgitation in the left auricle during a systole.

Insufficiency of the mitral valve or mitral insufficiency – inability of the valve to interfere with blood regurgitation from a left ventricle in the left auricle.

Regurgitation – a bystry blood flow in the direction, the return to the normal movement, arising during a systole.

Mitral insufficiency seldom meets is isolated (about 2% of total number of heart diseases). It is followed by defects of aortal valves, a stenosis of a mitral orifice.

Distinguish functional (relative) and organic mitral insufficiency.

Functional mitral insufficiency is caused by acceleration of a blood-groove at dystonia, change of a tone of papillary muscle fibers, dilatation (expansion) of a left ventricle that provides a hemodynamic overload of department of heart.

Organic mitral insufficiency develops owing to anatomic defeat of connective tissue plates of the valve, and also the tendinous threads fixing the valve.

Hemodynamic disturbances of these types of mitral insufficiency have identical character.

Disturbance of a hemodynamics at various forms of mitral insufficiency

Systole – a series of consecutive reductions of a myocardium of ventricles and auricles of a certain phase of a cardial cycle.

Aorta pressure considerably exceeds pressure of the left auricle that promotes regurgitation. During a systole there is a return blood flow in the left auricle caused by incomplete cover of an atrioventricular opening valve shutters. As a result of it the additional portion of blood comes to a diastole. During a diastole of ventricles the considerable volume of blood comes from an auricle to a left ventricle. Thereof disturbances there is an overload of the left departments of heart that promotes increase in force of reductions of a cardiac muscle. Myocardium hyperfunction is observed. At initial stages of development of mitral insufficiency there is good compensation.

Mitral insufficiency leads to a hypertrophy of a left ventricle and the left auricle therefore pressure in pulmonary vessels increases. The spasm of arterioles of lungs causes pulmonary hypertensia owing to what the hypertrophy of a right ventricle, insufficiency of the three-leaved valve develops.

Insufficiency of the mitral valve: symptoms, diagnosis

At good compensation of insufficiency of the mitral valve symptoms are not shown. The expressed mitral insufficiency is characterized by the following symptomatology:

• Asthma and disturbance of cordial rhythms at physical activity (then at rest);
• Cardialgias;
• Increased fatigue;
• Cardiac asthma (attacks of sharp short wind);
• Pains, puffiness in right hypochondrium, the caused increases in a liver;
• Hypostases of the lower extremities;
• Dry cough with small department of a phlegm, in rare instances with blood impurity;
• The pains in the heart pricking, pressing, the aching character which are not associated with physical activity.

At the compensated insufficiency of the mitral valve symptoms can not be shown within several years. Expressiveness of symptomatology is caused by regurgitation force.

For diagnosis of mitral insufficiency use the following methods:

• The ECG allows to reveal signs of an overload and a hypertrophy of a left ventricle and an auricle, in the third stage – the right department of heart;
• ЭхоКГ – definition of a hypertrophy and dilatation of the left departments of heart;
• Radiographic research of bodies of a thorax – definition of degree of pulmonary venous hypertensia, extent of protrusion of arches of auricles;
• Ventrikulografiya – definition of existence and degree of regurgitation;
• Catheterization of ventricles – determination of dynamics of pressure in heart ventricles.

Now hyper diagnosis of mitral insufficiency is observed. Modern methods of a research showed that the minimum degree of regurgitation can be present at a healthy organism.

Insufficiency of the mitral valve of 1 degree: clinical picture

Insufficiency of the mitral valve of 1 degree is characterized by compensation of a hemodynamics and inability of the valve to interfere with the return blood flow which is reached by hyperfunction of a left ventricle and an auricle. This stage of a disease is characterized by lack of symptomatology of a circulatory unefficiency, good health of the patient at exercise stresses. At diagnosis of insufficiency of the mitral valve of 1 degree are found insignificant expansion of borders of heart to the left, existence of systolic noise. On the electrocardiogram signs of dysfunction of the valve are absent.

Insufficiency of the mitral valve 2 degrees: clinical picture

Insufficiency of the mitral valve 2 degrees is characterized by development of a passive form of venous pulmonary hypertensia. This stage is characterized by a number of symptoms of disturbance of blood circulation: an asthma and a cardiopalmus at physical activity and at rest, cough, attacks of cardiac asthma, a pneumorrhagia. At diagnosis of insufficiency of the mitral valve 2 degrees are found expansion of borders of heart to the left (1 – 2 cm), to the right (to 0,5sm) and up, systolic noise. The electrocardiogram shows changes of an atrial component.

Insufficiency of the mitral valve 3 degrees: clinical picture

At insufficiency of the mitral valve 3 degrees develop a hypertrophy of a right ventricle that is followed by characteristic symptomatology: increase in a liver, puffiness development, increase in venous pressure.

Diagnosis of insufficiency of the mitral valve 3 degrees finds considerable expansion of borders of a cardiac muscle, intensive systolic noise. The electrocardiogram shows existence of a mitral tooth, signs of a left ventricular hypertrophy.

Treatment of insufficiency of the mitral valve, forecasts

Treatment of insufficiency of the mitral valve is regulated by the only rule: the patient with the diagnosed mitral insufficiency – the surgical patient. This pathology is not subject to medicamentous correction. A task of the cardiologist is the correct training of the patient for operation.

Conservative treatment of insufficiency of the mitral valve is directed to control of heart rate, and also to prevention of tromboembolic episodes, decrease in degree of regurgitation. Also the symptomatic treatment is applied.

During an operative measure implantation of the mitral valve is made.

Forecasts at mitral insufficiency completely depend on degree of regurgitation, expressiveness of valve defect and dynamics of a disease.