Prolapse of the mitral valve

Description:

Prolapse of the mitral valve - a progibaniye of one or both shutters of the mitral valve in a cavity of the left auricle during a systole of a left ventricle. It is one of the most frequent forms of disturbance of activity of the valve device of heart. The prolapse of the mitral valve can be followed by a prolapse of other valves or be combined with other small anomalies of development of heart.

The prolapse of the mitral valve is revealed at 2-18% of children and teenagers, i.e. it is essential more often than at adults. At heart diseases the prolapse of the mitral valve is registered much more often: to 37% at inborn heart diseases, to 30-47% at patients with rheumatism and to 60-100% at patients with hereditary diseases of connecting fabric. The prolapse of the mitral valve can be revealed at any age, including the neonatality period, but most often it is observed at children 7 years are more senior. Up to 10 years the prolapse of the mitral valve is found with an identical frequency in boys and girls. In more senior age group the prolapse of the mitral valve is revealed twice more often at girls.

Symptoms of the Prolapse of the mitral valve:

The prolapse of the mitral valve is characterized by the various symptomatology depending first of all on expressiveness of a connective tissue dysplasia and vegetative shifts.

Complaints at children with a prolapse of the mitral valve are very various: increased fatigue, headaches, dizzinesses, faints, short wind, pains in heart, heartbeat, feeling of interruptions in cardiac performance. Are characteristic the lowered physical effeciency, psychoemotional lability, a hyperexcitability, irritability, uneasiness, depressive and hypochiondrial reactions.

In most cases at a prolapse of the mitral valve find various displays of a dysplasia of connecting fabric: an asthenic constitution, high growth, reduced body weight, the increased elasticity of skin, poor development of muscles, hyper mobility of joints, disturbance of a bearing, scoliosis, deformation of a thorax, alate shovels, flat-footedness, a myopia. It is possible to find a hypertelorism of eyes and nipples, a peculiar structure of auricles, the Gothic sky, a sandalevidny crack and other small anomalies of development. Carry to visceral displays of a dysplasia of connecting fabric a nephroptosis, anomalies of a structure of a gall bladder, etc.

Quite often at a prolapse of the mitral valve observe the change of ChSS and arterial pressure which is preferential caused by a hyper sympathicotonia. Heart borders are usually not expanded. Auskultativny data are most informative: listen to the isolated clicks or their combination to late systolic noise more often, is more rare - the isolated late systolic or golosistolichesky noise. Clicks fix in the middle or the end of a systole, usually on a top or in the fifth point of auscultation of heart. They are not carried out out of borders of the area of heart and do not exceed the II tone on loudness, can be passing or constant, appear or accrue on intensity in vertical position and at an exercise stress. Listen to the isolated late systolic noise (rough, "scraping") on a heart top (better in situation on the left side); it is carried out to the axillary area and amplifies in vertical position. The Golosistolichesky noise reflecting existence of mitral regurgitation occupies all systole, differs in stability. At a part of patients listen to the "peep" of chords connected with vibration of valve structures. In some cases (at "mute" option of a prolapse of the mitral valve) the auskultativny symptomatology is absent. The symptomatology of a secondary prolapse of the mitral valve is similar that at primary and is combined with the manifestations characteristic of an associated disease (Marfan's syndrome, inborn heart diseases, a rheumatic carditis, etc.).

Reasons of the Prolapse of the mitral valve:

By origin allocate primary (idiopathic) and secondary prolapse of the mitral valve.

    * Primary prolapse of the mitral valve is connected with a dysplasia of the connecting fabric which is shown also other microanomalies of a structure of the valve device (change of structure of the valve and papillary muscles, distribution disturbance, the wrong attachment, shortening or lengthening of chords, emergence of additional chords, etc.). The dysplasia of connecting fabric forms under the influence of the various pathological factors operating on a fruit during its pre-natal development (gestoses, a SARS and professional harm at mother, an adverse ecological situation, etc.). In 10-20% of cases of a prolapse of the mitral valve it is inherited on the maternal line. At the same time in 1/3 families of probands reveal relatives with symptoms of a connective tissue dysplasia and/or psychosomatic diseases. The dysplasia of connecting fabric can be also shown by the myxomatous transformation of shutters of the valve connected with hereditarily the caused disturbance of a structure of collagen, especially type III. At the same time due to excess accumulation of acid mucopolysaccharides there is a proliferation of fabric of shutters (sometimes also valve ring and chords), as causes effect of a prolapse.
    * The secondary prolapse of the mitral valve accompanies or complicates various diseases. At a secondary prolapse of the mitral valve, as well as at primary, initial inferiority of connecting fabric is of great importance. So, it often accompanies some hereditary syndromes (Marfan's syndrome, a syndrome of Elersa-Danlo-Chernogubova, an inborn kontrakturny spider finger, imperfect bone formation, an elastic pseudoxanthoma), and also inborn heart diseases, rheumatism and other rheumatic diseases, not rheumatic carditises, a cardiomyopathy, some forms of arrhythmia, a syndrome of vegetative dystonia, endocrine pathology (hyperthyroidism), etc. The prolapse of the mitral valve can be a consequence of the acquired myxomatosis, inflammatory damage of valve structures, disturbance of contractility of a myocardium and papillary muscles, a valve and ventricular disproportion, asynchronous activity of various departments of heart that is quite often observed at inborn and acquired diseases of the last.

Treatment of the Prolapse of the mitral valve:

Treatment at a prolapse of the mitral valve depends on its form, degree of manifestation of clinical symptoms, including the nature of cardiovascular and vegetative changes, and also on features of a basic disease.

    * At a "mute" form treatment is limited to the general measures directed to normalization of the vegetative and psychoemotional status of children without reduction of an exercise stress.
    * At auskultativny option the children who are well transferring an exercise stress and not having noticeable disturbances according to an ECG can go in for physical culture in the general group. Exclude only the exercises connected with the sharp movements, run, jumps. In some cases release from participation in competitions is necessary.
    * At identification of mitral regurgitation, the expressed disturbances of processes of repolarization on an ECG, clear arrhythmias considerable restriction of an exercise stress with individual selection of the LFK complex is necessary.
At treatment of children with a prolapse of the mitral valve correction of vegetative disturbances, both non-drug, and medicamentous is of great importance. At disturbances of repolarization of ventricles (according to an ECG) apply the means improving metabolism of a myocardium [potassium оротат, inosine (for example, inosine), B5, B15 vitamins, a left carnitine, etc.]. Drugs, corrective magnesian exchange, in particular orotovy acid, magnesian salt are effective (магнерот). In certain cases (at persistent tachycardia, frequent ventricular extrasystoles, existence of the extended Q-t interval, permanent disturbances of processes of repolarization) purpose of ß adrenoblockers (propranolol), if necessary - antiarrhytmic drugs of other classes is proved. At the expressed changes of the valve device preventive courses of an antibioticotherapia for the purpose of the prevention of development of an infectious endocarditis are shown (especially in connection with surgical intervention). Conservative or operational treatment of the centers of persistent infection is obligatory.

At the mitral insufficiency which is followed by a cordial decompensation, expressed, steady against treatment, and also at accession of an infectious endocarditis and other serious complications (the expressed arrhythmias) carrying out surgical correction of a prolapse of the mitral valve (recovery operations or prosthetics of the mitral valve) is possible.