Tricuspid insufficiency: treatment, diagnosis and prevention
Tricuspid valve, aka tricuspid valve, located between the atrium and the ventricle on the right. If it is open, the blood moves freely from the atrium to the ventricle, and then fold closed. For a number of reasons the smooth operation of the valve can be off. In such cases, disturbed blood flow, and this background may occur tricuspid insufficiency.
Insufficiency of the tricuspid valve occurs in different ways, and to establish a correct diagnosis it is important to identify the form of the disease. For this purpose a number of criteria: period of occurrence, area of the valve in which the identified violations, the severity of regurgitation.
Congenital and acquired defects
In the period of occurrence of the pathology is of two types. Almost always it is acquired and develops due to inflammation. Birth defect is extremely rare. It is characterized by:
- displacement of the valve below the normal location;
- abnormal anatomy of the valves (a congenital cleft, etc.);
- degeneration (thickening of the valves, reducing their density).
Organic and functional pathology
On the basis of what part of the valve affected, also there are two forms of pathology. Organic failure is accompanied by changes in the valves. They are deformed, wrinkled, covered with limescale.
The functional valve is completely closed, there appear anomalies of the valve apparatus.
The degree of tricuspid insufficiency
Determine according to the severity of regurgitation — reverse flow directed from the ventricle to the atrium:
- with 1 degree of hemodynamic no;
- at 2 degree of regurgitation is detected 2 cm from the valve;
- with 3 degree reverse blood flow is more than 2 cm from the valve;
- at 4 degrees revealed severe regurgitation of the lengthy segment.
A congenital form of the disease — are extremely rare, it develops in the fetus if the mother during pregnancy is faced with the action of harmful factors. It can be infectious diseases, radiation, x-ray irradiation.
In most cases pathology is acquired, and its causes can be diverse, ranging from rheumatism to cancer and heart surgeries.
Why change the valve folds?
Changes folds characterizing the organic form of tricuspid insufficiency, occur under the influence of the following factors:
- Rheumatism — a systemic inflammation, affecting different organs and systems. The most common cause of pathology.
- Closed cardiac trauma with rupture of the valve flaps.
- Carcinoid syndrome — damage to various organs caused by the carcinoid. It is a small intestinal tumor. From it active substances are released into the bloodstream and attack the endocardium. Then they go to the lung blood vascular and are destroyed. In such circumstances, the tricuspid valve may not fully close.
- Infectious endocarditis is characterized by inflammation of the endocardium.
- Mitral comissurotomy the surgery to separate conjoined between the flaps of the mitral valve. The results of this treatment increase blood flow, which can exhibit symptoms previously hidden tricuspid insufficiency.
Why the valve can no longer close?
Reduction in the functionality of the valve during its relative failure occurs when damaged, the papillary muscles or the annulus is expanded.
The papillary muscles located within the ventricles and support the mobility of the valves. In myocardial infarction they are damaged, which leads to reduced efficiency of the tricuspid valve.
Fibrous ring, located in the cardiac walls, is connected to the valve flaps. Its expansion can cause various pathologies:
- Myocarditis is an inflammatory disease of the heart muscle.
- Dilated cardiomyopathy — a disease with the growth of the cardiac cavities and thinning of the myocardium.
- Birth defects causing the growth of the right ventricle. For example, when the hole in the interventricular septum, the ejection of blood is from left to right.
- Breaks chords. Due to these tendinous threads are connected to the myocardium and papillary muscles in the heart, supports the motor ability of the valves.
- Complicated by pulmonary hypertension — a significant increase in blood pressure.
- Tumors and other lesions that hinder the free flow of blood from a ventricle.
Babies have pathology manifests itself by cyanosis of the skin and symptoms of severe heart failure. The older children and adults received the following complaints:
- severe fatigue;
- shortness of breath;
- blueness of the skin.
In 25% of patients have rapid pulse, dizziness and pain in the chest or neck. Symptoms of supraventricular tachycardia, which indicates the syndrome Wolff-Parkinson-white.
When the secondary valve insufficiency, there are additional symptoms associated with underlying medical conditions.For example, you might have pain in right ventricular infarction or hemoptysis and arrhythmias in the mitral valve disease.
Often accompanied tricuspid insufficiency the pathology of mitral valve stenosis, making it difficult to diagnose. Therefore conducted an extensive examination of the patient using a variety of methods — from medical history to blood tests, ECG and x-rays.
A survey and examination of the patient
During the oral questioning of the patient the doctor examines him regarding the way of life, finds out how sick his close relatives. It is also important to establish the profession of the patient, as perhaps the nature of their activities, he was faced with infectious diseases.
- During the examination the doctor determines the presence of cyanosis of the skin, swelling of the veins in the neck and abdomen (ascites occurs when due to the accumulation of excess fluid).
- If in the middle of the upper abdomen under sternum detected by the pulsation, this indicates the rhythmic contractions increased in volume the right ventricle, which in a healthy person is above.
- When tapping the doctor can set the extension to the right side of the heart, when listening to the noise.
- A doctor checks the heart rate of the patient and the pressure (when measured it is reduced).
Under-diagnosis is performed several laboratory analyses:
- General blood and urine tests;
- blood biochemistry;
- immunological analysis.
These studies established the presence of inflammation and ongoing disease.
For further diagnosis may be required:
- ECG (identification of blockages, increasing the volume of the atrium and ventricle).
- Phonocardiogram (shows a systolic murmur).
- Echo (the main method shows the deformation and thinning of the flaps, the formation of new structures, etc.).
- Spiral computed tomography (provides an informative picture of the heart).
- X-ray (detects the parameters of heart blood stagnation).
- Catheterization of heart cavities (confirms that the pressure in the atrium reached the level of the ventricular).
- Koronaroangiografii (conducted before the operation; due to the introduction of contrast in vascular is their clear image, blood flow is assessed).
Many forms of tricuspid insufficiency can be treated with medicines, so surgery can be avoided. Surgical intervention is used only in extreme cases when medications are either not working or there is a threat to patient's life.
If no signs of pulmonaryhypertension, even severe tricuspid insufficiency can be treated with medicines. Patients are usually prescribed:
- nitrates (orally and in the form of patches);
- ACE inhibitors and inotropy (for refractory failure).
If diagnosed with pulmonary hypertension, diuretics, and vasodilators in some cases help to reduce blood pressure in preparation for surgical intervention. In infective endocarditis the patient is prescribed antibiotics. Sometimes it helps to avoid surgery.
Surgery prescribed to patients with 3-4 degrees of pathology, gross deformations of the valves or of the expressed violations of function. Also indications for surgical intervention become severe concomitant disease that is life threatening, and heart failure in the last stage.
When the primary pathology and the safety valve apparatus used annuloplastic. It is that on the affected area impose U-shaped seams. If the operation has been ineffective, there are gross structural changes of the valve, infectious endocarditis or abnormalities of Ebstein, the patient is put a biological valve.
If pathology is not treated, it will progress, leading to serious complications. Among them:
- Pulmonary embolism. The clot formed gradually block the artery, and eventually will come off.
- Atrial fibrillation and other forms of abnormalities of cardiac rhythm from normal.
- Atrioventricular block with difficulty of the movement impulse.
- Atresia of the aorta (the overlap of her mouth rising part).
- The secondary development of infective endocarditis.
Some of these complications can be provoked by surgery.
Thus, in the operated areas are often formed thrombus. If the patient was established the biological prosthesis, it can cause calcification which causes decrease of mobility of the patient. It is also possible to thrombosis or destruction of the installed valve, which often requires re-operation.
Prevention of tricuspid insufficiency
The best way to protect yourself from this disease have regular visits with a cardiologist and treat diseases that affect the heart. Since the most common cause of disease is rheumatism, it is important to prevent recurrence of this disease.
Also doctors give their patients a few tips that help to maintain the functionality of the heart and allit departments:
- Maintaining a healthy diet, rich in vitamins and minerals.
- To control the intake of salt and fluids to prevent edema.
- To give up Smoking and alcohol.
- To avoid dynamic and excessive exercise.
- To prevent hypothermia.
- To deal with stress.