Aortic stenosis and heart valve stenosis
Aortic stenosis (stenosis of the heart valve, aortic stenosis, stenosis of the aortic opening) is the fusion of the aortic valve leaflets or the area below or above it, leading to its narrowing and interfering with the normal blood supply to the body. It is the most common of all heart defects (up to 85%). Valve stenosis is 3 times more common in men than in women.
A narrowed left ventricular valve impedes the release of blood into the aorta, and significantly increases the load on the ventricle itself. This leads to its hypertrophy, which makes it possible to compensate for the defect for a long time. However, after 15-20 years, decompensation occurs, which in turn leads to the development of heart failure.
Valve stenosis can be congenital (3-10% among patients with malformations) or acquired. There are three forms of aortic stenosis: valvular, subvalvular and supravalvular (they belong to aortic stenosis due to a similar course). All forms can be both congenital and acquired, except for the supravalvular. It is only congenital.
Congenital stenosis (congenital heart disease) rarely occurs in a child from birth. Also, congenital malformations include a bicuspid valve of the heart, instead of a tricuspid valve (normal). At an early age, such a valve may not cause any discomfort, but with age, it is more likely to narrow and cause heart failure. Such people should be regularly examined and consult a doctor. The causes of congenital aortic stenosis are not known.
The main causes of stenosis of the heart valve are age-related deposition of calcium salts in the tricuspid aortic valve, rheumatic valve disease, acute rheumatic fever, aortic atherosclerosis, infective endocarditis. Less commonly, due to chronic kidney disease, diabetes mellitus, systemic lupus erythematosus, Paget's disease, carcinoid syndrome.
Symptoms of stenosis of the heart valve may not appear for a long time during the period of compensation and only manifest themselves during the period of decompensation. In this case, the patient is worried about aching, constricting pain in the chest and heart, increased heartbeat, dizziness, fatigue, nausea, shortness of breath, fainting may occur. Failure develops, leading to cardiac asthma in the later stages.
To detect stenosis of the heart valve and aortic stenosis, the following diagnostic methods are used:
· Auscultation - listening with a stethoscope to a rough noise over the aorta during the contraction of the left ventricle;
· X-ray examination - allows you to diagnose an increase in the left ventricle;
· Electrocardiogram - allows you to detect ventricular hypertrophy;
· Echocardiogram - allows you to identify changes in the valve apparatus using ultrasound;
· Cardiac catheterization is an invasive method of diagnosis and treatment that requires insertion of a catheter into an artery. Allows you to determine the localization of narrowing, intracardiac pressure, valve condition, presence of defects, oxygen concentration in the blood of the heart.
· Angiocardiographic examination - provides the most complete information necessary for making a decision on the need for surgical correction. It is divided into two stages: ventriculography and oortography.
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There are no methods for preventing aortic stenosis. The only effective treatment is surgery. Each of the forms of aortic stenosis has its own methods of surgical treatment; they can be divided into two groups: valve-saving and valve replacement.
Valve-saving methods include closed commissurotomy. But recently this method was abandoned in favor of valvuloplasty: percutaneous balloon or open. Percutaneous (percutaneous) valve replacement is a commonly used procedure. Previously, for its execution, it was required to open the chest, but today the need for open access has disappeared. The operation is performed using a catheter.
Open aortic valve replacement is still the main treatment for heart disease. A sternotomy (dissection of the sternum) or thoracotomy (opening of the pleural cavity) is performed, the heart is opened, the valve is removed. Then the valve is replaced with a mechanical one (it has a risk of thrombus formation) or a less durable biological one (human; sometimes its own; cow; porcine).
Valve-sparing surgery is the removal of calcium salts from the valve and adjacent areas.
With valvular aortic stenosis, it becomes necessary to expand the valve leaflets. This can be achieved in two ways: surgical or balloon valvuloplasty. With supravalvular stenosis, the affected area is removed, and the parts of the vessel are stitched together. With subvalvular stenosis, they penetrate the heart through the aortic valve and remove the affected tissue.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".
