Heart valve disease

Introduction Rheumatic Valvular Disease is caused by recurrent rheumatic carditis, heart valve and its accessory structures (chossy, papillary muscle), valve dysfunction caused by stenosis and regurgitation, and hemodynamics Obstruction, that is, chronic rheumatic valvular disease, patients with heart valve damage often have a history of repeated rheumatic activity, but nearly 1/2 patients have no history of rheumatic fever and valvular heart disease. This disease is one of the common heart diseases in China, and it is more common in adults aged 20-40.

Cause

During the pathogenesis of rheumatic fever, about 3/4 of the lesions invaded the heart, causing damage to the myocardium, endocardium, pericardium, and valvular disease. Recurrent episodes of rheumatic endocarditis produce chronic heart valve disease. Chronic valvular vitium of the heart refers to an organic disease caused by various pathogenic factors or congenital dysplasia, which is characterized by stenosis and/or insufficiency. One of the chronic heart diseases.

an examination

Related inspection

M-mode echocardiography (ME) Doppler echocardiography two-dimensional echocardiogram electrocardiogram

First, mitral stenosis: mitral stenosis is often accompanied by varying degrees of regurgitation, but observations during surgical treatment have shown that the proportion of simple mitral stenosis is twice as high as that of mitral stenosis. Therefore, this type is the most common lesion in chronic rheumatic heart valve damage.

Second, mitral regurgitation: due to mitral valve leaflets, chordae, papillary muscles and other fibrosis shortened, adhesion and deformation, resulting in the valve does not close well.

Patients with mild mitral regurgitation may have no symptoms. Heavier patients often have fatigue, fatigue, palpitations and difficulty breathing after exertion, and sometimes symptoms of right heart failure. However, patients with acute pulmonary edema and hemoptysis are far less likely to have mitral stenosis.

Third, aortic valve insufficiency: due to aortic valve inflammation and granulation tissue formation, resulting in thickening, hardening, shortening and deformity of the valve, the formation of aortic valve insufficiency. Symptoms of mild patients often have no obvious symptoms. Severe patients may have a strong pulsation of the heart and various parts of the body, especially the head and neck. Angina can occur in about 5% of patients. In the advanced stage, left ventricular dysfunction and right ventricular dysfunction may occur.

Fourth, aortic stenosis: due to adhesion and fusion at the aortic valve leaf junction, the valve gradually calcified to form aortic stenosis. At present, simple aortic stenosis is mostly caused by congenital or senile degenerative diseases, while rheumatic aortic stenosis is mostly combined with active avalanche insufficiency or mitral valve disease.

Mild stenosis is more asymptomatic. When the lesion is aggravated, due to decreased cardiac output, there may be symptoms such as fatigue, difficulty breathing after exercise, dizziness, fainting and angina, and even palpitations (ventricular arrest or ventricular fibrillation).

Differential diagnosis

Mitral valve disease:

Mitral stenosis: the majority is caused by rheumatic endocarditis, a small number of congenital malformations and left atrial tumors, neoplasms or thrombosis and other non-valve tissue obstruction of the mitral valve orifice.

Rheumatic mitral stenosis: accounts for about half of rheumatic valvular heart disease. The age of patients is 20-40 years old, and the incidence rate is higher in women, about 2 times higher than male.

Mitral regurgitation: the synergy of the six anatomical devices, such as the mitral valve leaflets, annulus, chordae, papillary muscle, atrium, and ventricular free wall, is an important factor in ensuring the normal function of the mitral valve, any of which Dysfunction can cause mitral regurgitation. There are many causes of mitral regurgitation, but rheumatoid arthritis is the most common. Others are degenerative, infective endocarditis, papillary muscle dysfunction, cardiac trauma, primary cardiomyopathy, and congenital valvular malformation. To the cause.

Aortic valve disease:

Aortic stenosis: A stenotic lesion can occur in the valve itself, on the flap, or under the flap.

Valvular aortic stenosis: simple stenosis rheumatoid is rare. Generally, in children or adolescents, several are congenital valvular malformations; most of the adulthood is calcified aortic stenosis, or congenital malformation or rheumatism.

Aortic regurgitation: Chronic aortic regurgitation is most common with rheumatic and often accompanied by stenosis. In addition, relative insufficiency caused by congenital valvular malformation or due to various causes, such as aortic atherosclerosis, Maltese syndrome or syphilitic aortitis, caused by ascending aortic roots. Acute aortic regurgitation is seen in patients with infective endocarditis, ascending aortic dissection, thoracic contusion involving aortic valve, and mucoid degeneration.

Tricuspid valve, pulmonary valve and combined valvular disease:

Tricuspid valve disease: relative is more common, while organic is less common. Simple tricuspid stenosis is less common, and several are congenital, and are also rare in congenital cardiovascular disease. Rheumatic patients have more mitral and/or aortic valve lesions, and more often with varying degrees of regurgitation.

Pulmonary valve disease: a rare type of valvular heart disease, organic type is mostly congenital malformation, and acquired people are mostly relative pulmonary insufficiency. Pulmonary stenosis is seen in congenital cardiovascular disease.

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