Mitral stenosis

The mitral stenosis or stenosis of the mitral valve is a considerable narrowing of the atrioventricular opening connecting the left auricle and a left ventricle of heart. In a junction the mitral valve consisting of two shutters is located. At a mitral stenosis of a shutter of the valve are thickened, growing together with each other, and reduce the opening size.

The area of the left atrioventricular opening in healthy heart of 4-6 ^cm2. Clear disturbances in cordial blood circulation appear at reduction of the area of an opening to 1,0-1,5 ^cm2. When the size ^{of the area less than 1 cm2}, operational treatment is shown.

The mitral stenosis or stenosis of the mitral valve is classified as the acquired heart disease. It forms more often at women, it is preferential at young or middle age. In most cases a stenosis of the mitral valve – a consequence of rheumatism.

Mitral stenosis: symptoms

Long time, at small extent of development, symptoms of a mitral stenosis can not be shown absolutely (latent form). At this stage the stenosis of the mitral valve is distinguished only at kliniko-tool researches. Even the insignificant stenosis of the mitral valve progresses usually owing to tendency of patients to recurrent rheumatism.

The first symptoms of a mitral stenosis appear at its progressing when it is noted:

• Pain in heart, a cardiopalmus at increase in an exercise stress;
• Asthma at a usual exercise stress or in a prone position;
• Increased fatigue;
• Frequent diseases of upper respiratory tracts (bronchitis);
• Hypostasis of legs;
• Discomfort in a breast;
• Characteristic cough with a pneumorrhagia;
• Bluish-pink shade of cheeks and lips (mitral flush);
• Trembling of a thorax in heart.

Standard age of manifestation of symptoms of 40-50 years, but they meet at earlier age and in infancy. In the presence of such symptoms it is necessary to see a doctor at once. As a result of medical examination and inspection the doctor reveals additional or secondary symptoms of a mitral stenosis:

• Arrhythmia;
• Cordial noise;
• Pulmonary hypertensia;
• Stagnation in lungs;
• Formation of blood clots.

Degrees of a mitral stenosis

In 1955 the Soviet scientists A. N. Bakulev and E. A. Damir offered classification of degrees of a mitral stenosis by expressiveness of an asthma. This scheme with success is applied in modern medicine by most of specialists.

Extent of narrowing of an atrioventricular opening and disturbance of a hemodynamics in a small circle are shown by an asthma of five stages:

• I – there is no asthma. Full compensation of blood circulation, complaints is not present. By results of inspection symptoms, characteristic of a mitral stenosis, are found. The area of a mitral orifice is 3-4 ^cm2, the left auricle - no more than 4 cm;
• II – do not have an asthma at rest, it arises at an exercise stress. Relative circulatory unefficiency, slight increase of venous pressure. The area of a mitral orifice is up to 2 ^cm2, the left auricle of 4-5 cm;

• The III degree of a mitral stenosis – a constant asthma at rest. The expressed initial stage of disturbance of blood circulation. Primary phenomena of stagnation of blood in small and big circles. Increase in the size of heart and liver. Substantial increase of venous pressure. The area of a mitral orifice is 1-1,5 ^cm2, the left auricle of 5 cm and more;
• IV – a constant heavy asthma. Strongly expressed circulatory unefficiency, considerable stagnation of blood in a big circle, a ciliary arrhythmia. Considerably the heart increased in sizes, the big sizes a dense liver. High venous pressure. The area of a mitral orifice less than 1 ^cm2, the left auricle is more than 5 cm;
• V – asthma of extreme severity, round-the-clock. The circulatory unefficiency is terminal dystrophic. Most increased sizes of heart and liver. Very high venous pressure. Accumulation of liquid in an abdominal cavity, severe peripheral hypostases. The area of a mitral orifice is much less than 1 ^cm2, the left auricle is essential more than 5 cm.

Mitral stenosis: treatment

The choice of tactics of treatment depends on degree of a mitral stenosis:

• Medicines are not appointed to the I stages of asymptomatic course of a mitral stenosis. Rather regular observation at the cardiorheumatologist and observance of its appointments and recommendations;
• In the presence of insignificant clinical manifestations, appoint diuretics and beta-blockers to the II-III stages. Carry out prevention of a recurrence of an infectious endocarditis and rheumatism;
• At the IV stage at significant increase in sizes of the left auricle, a paroxysmal form of a ciliary arrhythmia and a thromboembolism regular reception of indirect anticoagulants is necessary. At the same time treatment of a thromboembolism and ciliary arrhythmia according to standard schemes is carried out;
• At the IV-V stage at reduction of the sizes of an atrioventricular opening to 1,0-1,2 ^cm2, the recurrent thromboembolism, heavy pulmonary hypertensia needs surgical treatment of a mitral stenosis.

Operations on treatment of a stenosis of the mitral valve were one of the first operations on heart. Thanks to it long-term experience of operational treatment of a mitral stenosis is acquired. The following types of operations are developed and practice:

• Komissurotormiya;
• The closed komissurotormiya or balloon valvuloplasty;
• Annuloplasty. Opened (it is often carried out during an open komissurotormiya) or the closed transvenous;
• Prosthetics. Full replacement of the natural valve on artificial (mechanical or biological).

At a disease of a mitral stenosis big exercise stresses, intellectual and emotional pressure, strong cooling are contraindicated. With development of complications total loss of working capacity is observed.