Aortic insufficiency is a pathological abnormal movement of the connective tissue valves of the aortic valve, which results in the development of a marked reverse blood flow under a high pressure gradient into the cavity left ventricle from the lumen of the aortic vessel during diastole.
Syndrome of aortic insufficiency, as an isolated acquired defect of the cardial profile, is extremely rare. Significantly more often in different age groups of patients there is a combination of a damaged valvular heart apparatus in the form of stenosis of the aortic aorta and insufficiency, and men suffer this form of blemish more often.
Aortic insufficiency in pediatric practice occurs in less than 3% in the form of an isolated variant, but unfortunately they are established only at the stage of formation of severe cardiohemodynamic disorders.
Causes of aortic insufficiency
Aortic insufficiency, as an isolated cardiac defect, belongs to the category of polyethyological pathologies, since a wide range of factors can exert a provoking influence on the process of its development and formation.
Congenital aortic insufficiency develops with aortoannular ectasia, Marfan syndrome , cystic fibrosis , hereditary osteoporosis, Erdheim's disease. In this case, instead of three connective tissue valves of the aortic valve, one, two or four valves are formed, which inevitably provokes changes in cardiac hemodynamics of the heart. With the existing abnormal number of valves, either their prolapse into the cavity of the left ventricle or their incomplete closure is noted.
Organic aortic insufficiency of secondary or acquired genesis can be formed against a background of various diseases of infectious, bacterial, immunodeficient nature, among which 80% of cases is rheumatic heart disease. Rheumatic changes in the aortic valve are represented by deformation and thickening of the valves, which can not function adequately in the future. It should be borne in mind that rheumatism is more affected by the mitral valve, so if aortic valve changes are discovered, you should think about the combined defeat of the valvular heart apparatus.
In addition, various infectious lesions of the heart in the form of syphilis , bacterial endocarditis can also cause aortic insufficiency. The presence of infectious inflammation provokes not only a change in the shape and thickness of the valves, but can also cause damage to their integrity in the form of perforation and erosion.
Relative moderate aortic insufficiency is observed with pathological changes not valve flaps, but the walls of the aorta itself, which is observed in hypertensive heart disease , aneurysmal aortic dilatation with signs of stratification. The pronounced expansion of the aortic valve fibrotic ring in this situation can provoke complete separation (divergence) of the connective tissue valves of the aortic valve, which is an extremely unfavorable sign for the patient.
Symptoms of aortic insufficiency
In a situation where cardiohemodynamic disorders in a person with aortic insufficiency are in a compensated state, the patient can completely ignore the changes from his own health and not seek medical help. In some cases, such an asymptomatic course of aortic insufficiency lasts a long period of time. Acute growth of clinical symptoms is observed exclusively with aneurysm of the aorta that has undergone delamination, and also with infective endocarditis.
The debut of clinical manifestations with aortic insufficiency is manifested by a sensation of pulsating pain in the head and neck, a feeling of frequent and increased intensity of the heartbeat. Pulse in aortic insufficiency is not always increased, but most patients note the appearance of this symptom.
In a situation where a person has a significant defect in the valves of the aortic valve, there is an increase in hemodynamic disorders, which is manifested by the appearance of symptoms indicating a violation of cerebral circulation. "Brain" signs of aortic insufficiency are manifested in the form of dizziness , pulsating headaches, tinnitus, visual impairment and short-term episodes of loss of consciousness like a syncope, which has a clear connection with a sharp change in the position of the trunk in space.
Minimal aortic insufficiency, as a rule, is not accompanied by the appearance of cardiovascular manifestations, however, in severe hemodynamic disorders the patient has cardiac signs. Manifestations of heart failure in this case is the appearance of stenocardic pain syndrome, a violation of the rhythm of cardiac activity, respiratory disorders. In the initial stages of aortic insufficiency, the above symptoms are of a short duration and concern the patient only after excessive physical or psychoemotional activity. With severe cardiohemodynamic disturbances, signs of heart failure appear constantly and significantly worsen the prognosis of life in aortic insufficiency.
The acute course of aortic insufficiency is characterized by a lightning increase in symptoms of left ventricular failure and severe respiratory disorders. Manifestations of alveolar pulmonary edema often combine with a sharp drop in blood pressure, so this category of patients needs immediate application of a full range of emergency resuscitation measures.
Degrees of aortic insufficiency
The development of a clinical picture of aortic insufficiency occurs slowly, regardless of etiology and pathogenesis. Each of the etiopathogenetic stages of development is accompanied by the appearance of certain cardiohemodynamic disorders, which inevitably affects the patient's health. Classification of aortic insufficiency in terms of severity is used by cardiologists and cardiac surgeons in daily medical practice, because for each of these stages of disease development various methods of correction of the defect are shown. The basis of the cardiovascular classification is not only the clinical criteria, but also the data of the instrumental examination of the patient, therefore the passage of the complete examination is the main guarantee of successful treatment of aortic insufficiency.
Given the worldwide cardiological classification, aortic insufficiency is divided into four degrees of severity.
The earliest degree of development of the defect is characterized by a long latent course and compensated hemodynamic disorders. The main instrumental indicator that allows one to suspect aortic insufficiency of the 1st degree of development is the registration of the regurgitating minimum blood volume (less than 15%) on the valves of the aortic valve in the type of "blue flow" with Doppler mapping with a length of no more than 5 mm near the valves of the aortic valve. The establishment of aortic insufficiency of 1 degree is not subject to surgical correction of the defect.
2 degree of aortic insufficiency is accompanied by the appearance of symptoms of a nonspecific character that occur only after increased physical or psychoemotional activity. When electrocardiographic recording of cardiac activity, patients have signs that indicate the presence of hypertrophic changes in the left ventricular myocardium. The volume of the regulating blood flow for Doppler mapping is less than 30%, and the parameters of the "blue blood flow" are 10 mm.
3 degree of aortic insufficiency is characterized by a significant decrease in efficiency, as well as the appearance of specific anginal pains, changes in the figures of blood pressure. During electrocardiographic research, signs of ischemia are recorded simultaneously with signs of left ventricular hypertrophy. Echocardiographic indicators are the registration of the so-called "blue flow" on the valves of the aortic valve exceeding 10 mm.
4 or the extreme degree of aortic insufficiency is characterized by the appearance of severe cardiohemodynamic disorders in the form of the development of the strongest regurgitating blood flow, with a volume of more than 50%. Aortic insufficiency of the 4th stage is accompanied by a pronounced dilatation of all the cavitary structures of the heart and the development of relative mitral insufficiency .
Treatment of aortic insufficiency
Cardiologists and especially cardiac surgeons around the world adhere to the principles of expediency and continuity in the application of one or another method of treatment of aortic insufficiency. Patients with an initial degree of aortic insufficiency are not eligible for any form of treatment, in addition to observing the basic criteria for modifying the working and rest regime (minimal restriction of physical and psychoemotional activity). Drug therapy for aortic insufficiency involves the use of drugs whose pharmacological effect is aimed at leveling the manifestations of cardiovascular insufficiency , namely: drugs diuretic series (Furosemide in a daily dosage of 40 mg), ACE inhibitors (Enap in a minimum daily dose of 5 mg), cardiac glycosides (digoxin in a daily dose of 0.25 mg).
Despite the positive effect of drug treatment, the most effective way to eliminate aortic insufficiency is an operative correction of the defect. Operative allowance in one or another modification with aortic insufficiency is absolutely indicated in the development of manifestations of left ventricular failure, severe regurgitation on the valves of the aortic valve and expansion of the size of the left ventricle. With acute aortic insufficiency in any situation, it is necessary to use surgical correction.
If the aortic insufficiency develops against the background of the lesion of the connective tissue valves of the aortic valve, operative treatment means excision of the affected biological material and its replacement with a mechanical or biological prosthesis. With aneurysmal enlargement of the aortic sinus, plastic is used with the maximum possible preservation of the valve structures. The mortality rate in the postoperative period is less than 4%.
It should be borne in mind that in the absence of therapeutic measures complications of aortic insufficiency of the inflammatory, thromboembolic and ischemic profile develop.
? Aortic insufficiency - which doctor will help ? If you have or suspect aortic insufficiency, you should immediately seek advice from such doctors as a cardiologist and a cardiac surgeon.