Multivalve disease

Introduction to polyvalvular disease Multivalvular disease, when two or more heart valves are simultaneously affected, is called multivalvular disease, also known as combined valvular disease. Acquired heart disease, when two or more valves are involved, it is called combined valvular disease. Most of the causes are rheumatic heart disease. Mostly mitral valve lesions, combined with other valves. Among them, the mitral valve coexists with the aortic valve is the most common. The valvular lesion can be either narrow or incomplete. Different types of lesions change the normal blood circulation of the heart, and the left ventricular simple volume load increases, the simple pressure load increases, or both coexist. Left ventricular muscle hypertrophy, decreased compliance. The clinical manifestations are: labor palpitations, shortness of breath, angina pectoris, and audible noise in the auscultation area of the heart. Surgical treatment is the main measure. Multi-valve prosthetic valve replacement has a high risk of death and a poor prognosis. Preoperative diagnosis and clear relative decision-making are crucial. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: arrhythmia renal insufficiency

Cause of polyvalvular disease

Cause:

The cause can be divided into two major categories of rheumatism and non-rheumatic. Among them, rheumatism is the most common, especially in many developing countries including Africa, India, South America and including China; mucinous degeneration or degeneration (more common in the elderly) and infectivity in non-rheumatic causes; Endocarditis is more common. Other rare causes include systemic lupus erythematosus, carcinoid tumors, secondary hyperparathyroidism, radiation injury, trauma, Werner syndrome, and drugs such as anorexia diet pills.

Due to the different types of valvular lesions (stenosis or regurgitation) and their severity, the pathological and pathophysiological effects of the cardiopulmonary vasculature are different, and the disease progression characteristics are also different.

The causes of polyvalvular disease include:

1. A disease simultaneously damages several valve lesions. Mucin-like degeneration can involve both the mitral and tricuspid valves, and the mitral valve with tricuspid prolapse is not uncommon.

2, a valve damage caused by excessive cardiac capacity or pressure load, such as proximal valve function involvement, such as aortic valve insufficiency, left ventricular volume overload and expansion, resulting in secondary mitral regurgitation; mitral stenosis with pulmonary artery High pressure causes secondary closure of the pulmonary and tricuspid valves.

3, different diseases lead to different valvular lesions are less common. Such as congenital pulmonary stenosis with mitral stenosis.

Pathophysiology

Hemodynamic characteristics and clinical manifestations depend on the combination of the social valve and the relative severity of damage to each valve.

1. Serious damage to the occlusion and damage to the valvular lesions of different degrees, severe hemodynamic abnormalities and clinical manifestations, often masking light damage, leading to missed diagnosis of the latter.

2. When the proximal valve damage is significantly equal to the degree of damage of each valve, the effect of proximal (upstream) valve on hemodynamics and clinical manifestations is greater than that of the distal. For example, when the mitral valve and the active valve flap are combined, the mitral valve has a more influence on the kinetics and clinical manifestations.

3. Total hemodynamic abnormalities When multiple valves are damaged, the total hemodynamic abnormalities are more severe than those of the individual valves. Two signs of mild valve damage can produce more pronounced symptoms.

Multivalvular disease prevention

Since the exact cause and pathogenesis of this disease have not yet been fully clarified, no breakthrough has been made in the study of preventive measures. Current preventive measures:

1. Active treatment of prone factors such as treatment of hypertension, hyperlipidemia, diabetes, coronary heart disease, subaortic stenosis and so on.

2. Actively prevent and treat complications such as cardiac insufficiency, arrhythmia, infective endocarditis, thrombosis, etc.

With the increasing emphasis on the disease and further research on the mechanism, it is believed that in the near future, effective measures to delay the degeneration of the heart, prevent and treat valvular calcification will be found, and the incidence and mortality will be greatly reduced. .

Polyvalvular disease complications Complications arrhythmia renal insufficiency

Complications of heart valve surgery

1, low cardiac output, the patient's cardiac output will be very low, can not meet the needs of blood circulation, will produce hypotension, will result in insufficient perfusion of various tissues and organs, all aspects of complications will appear, this mortality rate The higher, milder, moderately low-hearted platoon, we are able to support him through the monitoring and treatment of the rescue. Serious low-hearted platoons are also difficult to rescue. It is not uncommon for a very serious person not to be rescued.

2, arrhythmia. Atrial fibrillation and ventricular premature beats are more common. If ventricular fibrillation or recurrent ventricular fibrillation occurs suddenly, the circulation will be arrested and the mortality rate will be relatively high. The incidence of these conditions is not very low, but many can be corrected, and there are not many patients who have not been saved.

3. ARDS. It is the patient who has mechanical ventilation but the blood oxygen saturation is always unable to come up. Due to the heart rate disorder caused by hypoxia, the influence of the nervous system, the changes of the internal environment, etc., it is necessary to use the ventilator for a long time, if the tracheal intubation In the case of intolerance, tracheotomy is also required, and infection of the respiratory tract is followed. Anti-infective treatment is also required. Most of the patients treated by these rescue treatments can also be cured.

4, renal insufficiency. Mainly seen in preoperative renal function is not good or complicated by extracorporeal circulation surgery, poor heart function, extra long-term extracorporeal circulation, etc., the impact on renal function, so that patients do not have urine, or is a serious low cardiac output heart function It is not necessary to use a large number of vasoactive drugs to rescue the heart. This drug is affected by the kidneys and can cause renal insufficiency. If oliguria or anuria is present, it is dangerous because after extracorporeal circulation. There are many obstacles to dialysis, patients with azotemia, and finally uremia, even high potassium.

5. Complications in the nervous system. Some will have conscious obstacles, and serious long-term coma.

6, bleeding. After the extracorporeal circulation surgery is more or less bleeding, one or two drainage tubes will be installed, and the bleeding will be drained. According to the blood pressure, hemoglobin and drainage, the postoperative bleeding is judged. Within the normal range or within the abnormal range, if abnormal bleeding often requires reoperation to stop bleeding, coagulopathy is often the cause of bleeding.

Symptoms of polyvalvular disease Common symptoms After angina pectoris, ventral activity, aortic valve, decidual stenosis, lobular lobular thickening, cardiac output, tricuspid stenosis, myocardial ischemia, left ventricular hypertrophy, left ventricular volume

The clinical manifestations are: labor palpitations, shortness of breath, angina pectoris, and audible noise in the auscultation area of the heart.

Common polyvalvular disease:

1, mitral stenosis with aortic regurgitation is common in rheumatic heart disease. Due to the mitral stenosis, the cardiac output is reduced, and the left ventricular enlargement is delayed and the peripheral vascular signs are not obvious. It is easy to delay the sternal left flank of the aortic valve insufficiency and the surrounding vascular signs are not obvious. Aortic regurgitation of the left sternal border of the sternal early diastolic sigh-like murmur mistakenly considered Graham Steell murmur, diagnosed as simple mitral stenosis. About 2/3 of patients with severe mitral stenosis have early astigmatism of the sternal border, most of which have aortic regurgitation, not Graham Steell murmur.

2, mitral stenosis with aortic stenosis severe mitral stenosis and aortic stenosis coexist, some of the latter performance is often masked. Mitral stenosis reduces left ventricular filling and left ventricular systolic blood pressure, delays left ventricular hypertrophy and reduces myocardial lack of oxygen consumption, so angina is not obvious. As the cardiac output is significantly reduced, the pressure difference across the aortic valve is reduced, which may lead to underestimation of the severity of aortic stenosis.

3, aortic stenosis with mitral regurgitation as a dangerous multivalvular disease, relatively rare. The former increased left ventricular afterload, aggravated mitral regurgitation, and the stroke volume decreased significantly when the two were alone, and the pulmonary congestion increased. X-ray showed left atrial and left ventricular enlargement compared with the time when the two existed separately.

4, aortic regurgitation with mitral regurgitation left ventricle with double capacity overload, left atrial and left ventricular enlargement is most obvious, which can further aggravate mitral regurgitation.

5, mitral stenosis with tricuspid valve and / or pulmonary valve insufficiency is common in advanced rheumatic mitral stenosis.

Multivalvular disease examination

1. Electrocardiogram.

2. Echocardiography.

3. X-ray and CT examination: common chest radiograph can show aortic calcification, high-exposure technique or tomography can improve the detection rate.

Diagnosis and diagnosis of multivalvular disease

Diagnosis is generally based on medical history, clinical manifestations (mainly heart murmur), combined with ECG and X-ray examinations are not difficult to make a qualitative diagnosis. Echocardiography is of great value in the qualitative and quantitative diagnosis of combined valvular disease and the determination of cardiac function. It has become the main means of diagnosing combined valvular disease. Only a small number of cases still require further cardiac catheterization and cardiovascular angiography to obtain more detailed and objective hemodynamic data to further determine the type and severity of the disease associated with valvular disease, as well as cardiac function status and presence or absence of coronary heart disease. Other heart diseases provide a more reliable basis for the rational surgical treatment of combined valvular disease.

diagnosis

1. History, symptoms:

Symptoms of both types of valvular lesions can occur.

2. Physical examination found:

The signs of the above two valve lesions can occur, but the properties of the diastolic murmurs of the two valves are different at auscultation.

3. Auxiliary inspection:

The pathological changes caused by the lesions of the two flaps are dominant, so the most suitable examination is UCG, and the degree of lesion of each valve can be clearly seen.

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