Treatment of aortic valve stenosis. Aortic stenosis: symptoms, degrees, treatment

Aortic stenosis is a disease that is defined as a heart defect. It is also called aortic stenosis. It is characterized by narrowing of the efferent vessel, that is, the aorta of the left ventricle, which is located near the aortic valve. This leads to the fact that the outflow of blood from the left ventricle is difficult, and the pressure difference between the left ventricle and the aorta increases sharply. What happens in the heart in this disease?

On the way of blood flow to the systole of the left ventricle, there is already a narrowed opening of the aortic valve, due to which the load on the left ventricle increases, which leads to its hypertrophy. If the narrowing is very sharp, not all blood is expelled into the aorta, a certain part of it remains in the left ventricle, which leads to its expansion. Due to the slow flow of blood into the aorta, arterial systolic pressure decreases. The contractility of the left ventricle decreases, resulting in stagnation of blood in the pulmonary circulation. This brings with it shortness of breath and attacks of cardiac asthma. It becomes clear that such a condition is a threat to human health and life. What are the causes of this heart disease?

Causes of the disease

Consider the most common causes of aortic stenosis.

1. Rheumatism. This is a complication of angina. Rheumatism is dangerous because cicatricial changes may appear on the heart valves, leading to a narrowing of the aortic valve. Due to such cicatricial changes, the surface of the valves becomes rough, so calcium salts are easily deposited on it, which can independently cause stenosis of the aortic orifice.

1. Congenital defect. This means that the baby was already born with a defect in the aortic valve. This doesn't happen often, but it does happen. Congenital aortic valve disease can also present as a bicuspid aortic valve. In childhood, this may not carry with it any serious consequences, but at a more mature age it can lead to a narrowing of the valve or to its insufficiency.
2. Infective endocarditis.
3. atherosclerosis of the aorta.

Main symptoms

Symptoms of aortic stenosis largely depend on the degree of the disease, so in this section we will consider the classification of the disease. First, there are three degrees of severity of aortic valve stenosis.

1. Minor stenosis.
2. Moderate degree.
3. severe stenosis.

The degree is determined depending on the magnitude of the opening of the valve leaflets, which occurs at the time of cardiac contraction. It also depends on the pressure difference after the valve and before it.

Let's single out five more stages, which will give important information, although this classification is not used very often.

1. Full compensation. At this stage, there are usually no complaints, but the defect itself can be identified by listening to the heart. Ultrasound shows a slight degree of stenosis. In this condition, it is only necessary to observe and correct the comorbidity without surgical intervention.
2. Latent heart failure. At this stage, there is increased fatigue, shortness of breath during physical exertion, and sometimes dizziness. ECG and fluoroscopy may reveal some changes. This stage may involve surgical correction of the defect.

1. Relative coronary insufficiency. There are cases when aortic stenosis is accompanied by angina pectoris, which usually occurs just at this stage. Shortness of breath increases, fainting and fainting are sometimes noted. A very important point in the treatment of aortic valve stenosis in the third stage is surgical treatment. If you miss the moment you need in this regard, then it will be too late or ineffective to intervene surgically.
2. Severe heart failure. The complaints of the patients are very similar to those described in relation to the previous stage, although at this stage they are more pronounced. For example, there is also shortness of breath, but it begins to be felt at rest. It is also possible the appearance of night attacks of suffocation. Surgical treatment is no longer possible, although there are cases when this option is still possible, but such cases are strictly individual.
3. Terminal stage. At this stage, heart failure progresses seriously. The patient's condition worsens greatly due to edematous syndrome and shortness of breath. Drug treatment does not help, improvement lasts only a short time, and surgical treatment cannot be used, since at this stage there is a high surgical mortality. In view of this, it becomes clear that it is impossible to bring the state of one's heart to the fifth stage.

It is necessary to recognize aortic valve stenosis in time, conduct an examination and begin to treat the disease.

Diagnostic methods

Aortic stenosis is diagnosed by several methods, but it must be borne in mind that clinical manifestations are absent for a long time. It is important for the patient to tell the doctor about chest pain, shortness of breath and other symptoms. The most frequent manifestations:

• angina attacks;
• syncope;
• symptoms of chronic insufficiency.

Sometimes the defect is found out after death, which occurred suddenly. Rarely, but there are bleeding in the gastrointestinal tract. There are several diagnostic methods that help identify aortic stenosis.

1. ECG. This examination reveals left ventricular hypertrophy. The presence of arrhythmias, and sometimes heart blockades, is also determined.
2. Phonocardiography. It registers such changes as a rough systolic murmur over the aorta and valve, as well as muffling of the first tones on the aorta.
3. radiographs. They are useful during the period of decompensation, since during this period the LV shadow expands, which manifests itself in the form of an elongated arc of the left cardiac contour. In the same period, aortic configuration of the heart and signs of pulmonary hypertension are observed.

1. Echocardiography. It reveals LV wall hypertrophy, thickening of the aortic valve flaps, and other changes that help identify aortic stenosis.
2. Probing of the cavities of the heart. It is performed in order to measure the pressure gradient, which helps to determine the degree of stenosis.
3. Ventriculography. Helps to identify concomitant mitral regurgitation.
4. Coronary angiography and aortography.

Treatment of the disease

The treatment of aortic stenosis has its limitations. This is especially true for medical treatment. However, it must be used before aortic valve replacement, as well as before balloon valvuloplasty. This includes the use of the following groups of drugs:

• diuretics;
• cardiac glycosides.

In addition, during this period it is very important to treat atrioventricular blockade and atrial fibrillation. For surgical intervention, there are indicators that relate to aortic valve replacement in the case when aortic stenosis is diagnosed:

• asymptomatic aortic stenosis with severe course and normal LV function;
• severe degree of stenosis, which manifests itself clinically;
• stenosis in combination with LV dysfunction, we also include asymptomatic stenosis here.

Why is aortic valve replacement recommended? Because this method allows to improve the functional class and survival, as well as reduce the number of complications and symptoms.

Balloon valvuloplasty may also be performed. Its purpose is to relieve pressure or compression as the aortic orifice enlarges. Balloon dilatation is done on a working organ under fluoroscopy. A thin balloon is inserted into the valve opening. To expand the hole, this balloon is inflated at the end. Valvuloplasty is considered a less risky operation, although if it is performed on a patient at an advanced age, then the effect of it is temporary.

Possible consequences

In the beginning, we list the complications that aortic valve stenosis can bring with it:

• angina;
• fainting;
• progressive stenosis;
• infectious endocarditis;
• heart failure;
• hemolytic anemia.

It is expected that the average life expectancy in patients affected by aortic stenosis is five years after the onset of angina pectoris, three years due to the manifestations of syncope, and two years in combination with severe heart failure.

Sudden death may occur. This occurs in twenty percent of cases and in those patients in whom the disease is accompanied by severe clinical manifestations.

Prevention

Preventive measures are aimed at preventing atherosclerosis, rheumatism and other risk factors. It is very important to constantly monitor the condition of your heart and go to the doctor in case of any deviations from the norm.

It cannot be argued that the disease we are discussing really threatens human life. Therefore, in order to prolong life, it is necessary to lead a healthy lifestyle and be regularly examined by a doctor.

(arising in vivo, as a result of an illness).

Stenosis of the aortic opening is one of the types of changes in the valvular apparatus. In the presence of this defect, the valve leaflets are fused with each other, preventing normal blood flow.

As a result of aortic adhesions during systole (contraction), blood from the left ventricle of the heart hardly enters the aorta, because of this, the muscle (myocardium) is significantly hypertrophied, and the left ventricle is stretched.

Stages and degrees of aortic stenosis

There are several degrees of severity of aortic stenosis. They are determined by the opening area of ​​the valve leaflets at the time of systole and the pressure difference.

Note:pressure gradient - an indicator indicating the difference in pressure before and after the valve. It is determined by using or catheterization of the heart.

Severity of aortic stenosis:

• I degree(minor stenosis) - the valve opening is at least 1.2 cm 2, and the gradient is from 10 to 35 mm Hg.
• II degree(moderate stenosis) - the area of ​​the valve opening is 1.2 - 0.75 cm 2 with a pressure gradient of 36 to 65 mm Hg.
• IIIdegree(severe stenosis) - the size of the valve opening does not exceed 0.74 cm 2, and the gradient is more than 65 mm Hg.
• IVdegree(critical stenosis) - the narrowing is 0.5 - 0.7 cm 2, the pressure gradient is more than 80 mm Hg.

It is also worth paying attention to the stages of development of stenosis, each of them has certain symptoms that help to establish the most accurate diagnosis.

4 stages of aortic stenosis:

• Compensation- asymptomatic period. The heart fully copes with the increase in load, and symptoms may not appear for several decades.
• Subcompensation - the first symptoms appear, mainly during heavy physical exertion, especially those that are unusual for the patient.
• Decompensation - severe and severe heart failure. Symptoms appear not only after minor exertion, but also at rest.
• Terminal - due to complications and catastrophic changes in the heart and organs, death occurs.

Causes of aortic stenosis, risk factors

This acquired defect is most often found in the elderly (in every 10 patients). More than 80% of stenosis occurs due to age-related changes in the cusps of the artery valve (sclerosis), and 10% of cases are due to. A risk factor is also the presence of such a congenital malformation as a bicuspid aortic valve, which causes stenosis in a third of patients with this feature.

A separate role is played by heredity, bad habits, high blood cholesterol and arterial hypertension.

Symptoms of the disease

The symptomatology of diseases directly depends on how narrowed the aortic opening, that is, on the degree of the disease.

I degree aortic stenosis

This stage of the disease is characterized by a rather long asymptomatic course (more than 10 years). Most often, pathology is detected during examinations aimed at finding other diseases or during medical examinations. After the detection of stenosis, the patient is registered with a cardiologist, who, with the help of regular heart examinations (), will be able to control the development of the disease and prescribe treatment in time, preventing the occurrence of complications.

Over time, it occurs, during physical activity, fatigue increases. The first signs appear.

Symptoms of the II degree of aortic stenosis

During the transition of the disease to the second level, during physical work, short-term and stress may occur (pressing pain behind the sternum, “angina pectoris”). Nighttime shortness of breath is also possible, and in severe cases, attacks of cardiac asthma and join.

III degree

The symptomatology grows and worries not only with pronounced loads, but also at rest. A significantly hindered outflow of left ventricular blood provokes an increase not only in intracardiac pressure, but also in pressure in the pulmonary vessels. There is suffocation, and in the future attacks of cardiac asthma are permanent.

IV degree of aortic stenosis

As the hypertrophy of the heart chambers, blood stagnation in other vessels increases: the liver, lungs, kidneys, muscles. Increasingly, pulmonary edema occurs, which are life-threatening for patients, cardiac edema (lower limbs), ascites (swelling of the abdomen),.

Important: If you notice the above symptoms in yourself, seek the advice of a cardiologist.

Complications

Aortic stenosis, in the absence of proper treatment, leads to. It grows gradually, due to the fact that it becomes more and more difficult for the left ventricle to “push” blood into the aorta. In the future, the myocardium is increasingly difficult to cope with the increasing load, which can first cause atrophy of the left ventricle, and then similar processes will be observed in the muscle of the whole heart.

Aortic valve stenosis increases the susceptibility of the endocardium to various viruses and bacteria, which can lead to endocarditis.

Important:before certain medical interventions, after consulting with your doctor, you should take antibiotics for prevention. For example, this must be done before tooth extraction.

Diagnosis of aortic stenosis

Usually, the first suspicions of a cardiologist arise after listening to characteristic pathological murmurs in the heart during auscultation. Further, additional research methods are assigned to confirm or exclude the diagnosis.

In the diagnosis of this disease, the following methods are used:

Treatment of aortic valve stenosis

If your medical record contains a diagnosis of aortic stenosis, you should exclude sports, heavy physical exertion, even if the symptoms do not interfere with your life. At least once a year, it is necessary to visit a cardiologist to prevent the progression of the disease and endocarditis.

Conservative treatment

These drugs will not widen a narrowed aortic opening, but will help improve circulation and overall heart health:

1. Dopaminergic drugs - Dopamine
2. Diuretics (diuretics) - Trifas
3. Vasodilators - Nitroglycerin
4. Antibiotics - Cephalexin

Note:all drugs are taken STRICTLY as prescribed by the doctor and after prescribing the dosage you need, which is correlated with the degree and stage of the disease!

Surgery for aortic stenosis

The method of surgical intervention is most effective for stenosis. The operation must be performed before the development of left ventricular failure, otherwise the likelihood of complications is high.

The operation is indicated for moderate and severe degree of stenosis or in the presence of clinical symptoms. Valvuloplasty (dissection of adhesions and adhesions in the valves) is performed with moderate stenosis. If the stenosis is severe, especially if it is combined with insufficiency, a more appropriate treatment would be to replace the damaged valve.

Prevention

Aortic stenosis is prevented by preventing diseases such as endocarditis and eliminating risk factors as much as possible.

special diet

Productive treatment of aortic stenosis is impossible without an appropriate diet.

The following foods should be excluded from the diet:

• excessively spicy, salty, smoked, fatty;
• "fast" food - hamburgers, shawarma;
• drinks with gas and desserts containing dyes;
• alcohol, smoking.

Must be present:

• lean meats and fish
• dairy products
• fruits, vegetables, their juices

Note:despite the diet, the body needs a complex of vitamins and minerals. In this situation, synthetic vitamin complexes will be the best way out.

Features of the course of aortic stenosis in children and pregnant women

At the initial stage of the disease, the child behaves in the same way as usual, and parents often do not go to the doctor. And minor symptoms: slight pallor, poor sucking reflex and in infants do not suggest turning to a cardiologist.

In adolescence, the course of stenosis is similar to that in adults.

The course of pregnancy with aortic stenosis

Due to the fact that pregnancy makes the heart work in an enhanced mode, termination of pregnancy is indicated in case of severe stenosis, due to the high probability of death of the mother and child, and the risk of developing congenital heart disease in the baby is more than 20%.

Both in the case of interruption and in the case of maintaining pregnancy, endocarditis prophylaxis is carried out.

Tavaluk Natalia, medical commentator

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Aortic stenosis is a pathological condition in which there is a narrowing of the opening in the valve of the same name. For this reason, there is a violation of the outflow of blood from the left ventricle. It belongs to the category of heart defects.

Features of pathogenesis

From the left ventricle, blood flows through the aorta to the main organ systems. This is a large circle of blood circulation. Its weak link is the aortic valve at the mouth of the vessel. It has 3 flaps and opens, passing a portion of the biological fluid into the vascular system. With a contraction, each time the ventricle pushes it out. Closing, the valve is an obstacle to the reverse reflux of blood. In this place, pathological changes occur.

In the case of stenosis, the soft tissues of the cusps and aorta undergo various changes. These may be scars or adhesions, deposits of calcium salts, atherosclerotic plaques or adhesions. As a result, the following violations are observed:

• the lumen of the vessel begins to narrow gradually;
• valve walls lose their elasticity;
• the opening and closing of the valves is not fully carried out;
• blood pressure in the ventricle increases.

Against the background of ongoing changes, there is a lack of blood supply to the main organ systems.

The reasons

Aortic stenosis has a congenital or acquired etiology. In the first case, the occurrence of an anomaly is due to a genetic predisposition or pathological abnormalities in the development of the fetus. Normally, the valve has 3 leaflets. With a congenital form of stenosis, this element consists of 2 or 1 cusps.

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However, most often narrowing of the aorta refers to acquired defects. Causes may include the following health problems:

• rheumatoid arthritis;
• Paget's disease;
• diabetes;
• calcification/atherosclerosis of the aorta;
• lupus erythematosus;
• advanced renal failure;
• infectious endocarditis.

Doctors identify a number of factors in the presence of which the risk of pathology increases. These include smoking and hypertension.

Classification

Depending on the location, stenosis of the aortic orifice can be:

• subvalvular;
• supravalvular;
• valve.

To assess the severity of aortic stenosis, the classification implies pressure gradient results. This is the difference in blood pressure before and after the aortic valve. In a healthy person, this indicator is minimal. The greater the constriction, the higher the pressure. For example, with grade I stenosis, the gradient ranges from 10 to 35 mm Hg. Art. IV degree is considered critical. In this case, the pressure gradient is more than 80 mm Hg. Art.

In addition, there are several stages in the development of the pathological process. Each of them has a characteristic clinical picture that helps to establish an accurate diagnosis:

• stage of compensation. This period is not accompanied by severe symptoms. The heart fully copes with the assigned load. The defect is detected only by auscultation of the muscle.
• subcompensation stage. There are initial symptoms of malaise (fatigue, shortness of breath), which increase after physical exertion. Determined by conducting an ECG.
• stage of decompensation. It is characterized by obvious heart failure. Symptoms of angina pectoris remain even in a calm state.
• Terminal stage. Due to irreversible pathological disorders, death occurs.

Symptoms

In aortic stenosis, symptoms do not make themselves felt for several decades. At the initial stages, when the lumen of the vessel closes by 50% or more, it manifests itself as weakness after exercise.

As the disease progresses, shortness of breath persists after moderate exertion. Almost always it is accompanied by general fatigue and dizziness. When the lumen of the vessel is closed by 75% or more, the patient develops the main signs of heart failure.

Also, the pathology is manifested by the following symptoms:

• pallor of the skin;
• loss of consciousness;
• pressing pains in the sternum;
• swelling of the ankles;
• violation of the heart rhythm.

Stenosis can cause sudden death without visible external manifestations.

The course of the disease in children

In newborns and preschool children, the disease is often asymptomatic. As they grow, the clinical picture becomes more pronounced due to an increase in the size of the heart. However, the narrow lumen in the aortic valve remains unchanged.

It is possible to diagnose pathology in the fetus already at the 6th month of pregnancy by means of echocardiography. In rare cases, stenosis appears immediately after the birth of the child. In 30% of cases, the condition suddenly worsens by 5-6 months. Among the main symptoms of a violation in newborns, doctors distinguish the following:

• frequent regurgitation;
• weight loss;
• rapid breathing;
• the skin has a bluish tint;
• lack of appetite.

aortic stenosis

Aortic stenosis or stenosis of the aortic orifice is characterized by a narrowing of the outflow tract in the region of the aortic semilunar valve, which makes it difficult for the systolic emptying of the left ventricle and the pressure gradient between its chamber and the aorta sharply increases.

The share of aortic stenosis in the structure of other heart defects accounts for 20-25%. Aortic stenosis is 3-4 times more common in men than in women.

Isolated aortic stenosis in cardiology is rare - in 1.5-2% of cases; in most cases, this defect is combined with other valvular defects - mitral stenosis, aortic insufficiency, etc.

Classification of aortic stenosis

By origin, there are congenital (3-5.5%) and acquired stenosis of the aortic orifice. Given the localization of the pathological narrowing, aortic stenosis can be subvalvular (25-30%), supravalvular (6-10%) and valvular (about 60%).

The severity of aortic stenosis is determined by the systolic pressure gradient between the aorta and the left ventricle, as well as the area of ​​the valvular orifice.

With a slight aortic stenosis of the 1st degree, the opening area is from 1.6 to 1.2 cm² (at a rate of 2.5-3.5 cm²); the systolic pressure gradient is in the range of 10–35 mm Hg. Art. Moderate aortic stenosis of the II degree is spoken of with an area of ​​the valve opening from 1.2 to 0.75 cm² and a pressure gradient of 36-65 mm Hg.

Art. Severe grade III aortic stenosis is noted when the area of ​​the valvular orifice is narrowed to less than 0.74 cm² and the pressure gradient increases above 65 mm Hg. Art.

Depending on the degree of hemodynamic disorders, aortic stenosis can proceed according to a compensated or decompensated (critical) clinical variant, in connection with which 5 stages are distinguished.

I stage(full refund). Aortic stenosis can be detected only by auscultation, the degree of narrowing of the aortic orifice is insignificant. Patients need dynamic monitoring by a cardiologist; surgical treatment is not indicated.

II stage(hidden heart failure). Complaints are made of fatigue, shortness of breath with moderate physical exertion, dizziness. Signs of aortic stenosis are determined by ECG and radiography, pressure gradient in the range of 36–65 mm Hg. Art., which serves as an indication for surgical correction of the defect.

III stage(relative coronary insufficiency). Typically increased shortness of breath, the occurrence of angina pectoris, fainting. The systolic pressure gradient exceeds 65 mm Hg. Art. Surgical treatment of aortic stenosis at this stage is possible and necessary.

IV stage(severe heart failure). Worried about shortness of breath at rest, nocturnal attacks of cardiac asthma. Surgical correction of the defect in most cases is already excluded; in some patients, cardiac surgery is potentially possible, but with less effect.

V stage(terminal). Heart failure is steadily progressing, shortness of breath and edematous syndrome are pronounced. Drug treatment can achieve only short-term improvement; surgical correction of aortic stenosis is contraindicated.

Acquired aortic stenosis is most often caused by rheumatic lesions of the valve leaflets. In this case, the valve flaps are deformed, spliced ​​together, become dense and rigid, leading to a narrowing of the valve ring.

The causes of acquired aortic stenosis can also be aortic atherosclerosis, calcification (calcification) of the aortic valve, infective endocarditis, Paget's disease, systemic lupus erythematosus, rheumatoid arthritis, terminal renal failure.

Congenital aortic stenosis is observed with congenital narrowing of the aortic orifice or developmental anomaly - a bicuspid aortic valve. Congenital aortic valve disease usually presents before the age of 30; acquired - at an older age (usually after 60 years). Accelerate the process of formation of aortic stenosis smoking, hypercholesterolemia, arterial hypertension.

Hemodynamic disturbances in aortic stenosis

With aortic stenosis, gross violations of intracardiac and then general hemodynamics develop. This is due to the difficulty in emptying the cavity of the left ventricle, as a result of which there is a significant increase in the systolic pressure gradient between the left ventricle and the aorta, which can reach from 20 to 100 or more mm Hg. Art.

The functioning of the left ventricle under conditions of increased load is accompanied by its hypertrophy, the degree of which, in turn, depends on the severity of the narrowing of the aortic orifice and the duration of the defect. Compensatory hypertrophy ensures long-term preservation of normal cardiac output, which inhibits the development of cardiac decompensation.

However, in aortic stenosis, a violation of coronary perfusion occurs quite early, associated with an increase in end-diastolic pressure in the left ventricle and compression of the subendocardial vessels by the hypertrophied myocardium. That is why in patients with aortic stenosis, signs of coronary insufficiency appear long before the onset of cardiac decompensation.

As the contractility of the hypertrophied left ventricle decreases, the magnitude of stroke volume and ejection fraction decreases, which is accompanied by myogenic left ventricular dilatation, an increase in end-diastolic pressure, and the development of systolic dysfunction of the left ventricle.

Against this background, the pressure in the left atrium and the pulmonary circulation increases, i.e. arterial pulmonary hypertension develops. In this case, the clinical picture of aortic stenosis may be aggravated by the relative insufficiency of the mitral valve (“mitralization” of the aortic defect).

High pressure in the pulmonary artery system naturally leads to compensatory hypertrophy of the right ventricle, and then to total heart failure.

At the stage of complete compensation of aortic stenosis, patients do not feel any noticeable discomfort for a long time. The first manifestations are associated with narrowing of the aortic orifice to approximately 50% of its lumen and are characterized by shortness of breath on exertion, fatigue, muscle weakness, and palpitations.

At the stage of coronary insufficiency, dizziness, fainting with a rapid change in body position, angina attacks, paroxysmal (nocturnal) shortness of breath, in severe cases, attacks of cardiac asthma and pulmonary edema join. The combination of angina pectoris with syncopal conditions and especially the addition of cardiac asthma is unfavorable prognostically.

With the development of right ventricular failure, edema and a feeling of heaviness in the right hypochondrium are noted.

Sudden cardiac death in aortic stenosis occurs in 5-10% of cases, mainly in the elderly with severe narrowing of the valvular orifice.

Complications of aortic stenosis can be infective endocarditis, ischemic disorders of cerebral circulation, arrhythmias, AV blockade, myocardial infarction, gastrointestinal bleeding from the lower digestive tract.

Diagnosis of aortic stenosis

The appearance of a patient with aortic stenosis is characterized by pallor of the skin ("aortic pallor"), due to a tendency to peripheral vasoconstrictor reactions; in the later stages, acrocyanosis may be noted. Peripheral edema is detected in severe aortic stenosis. With percussion, the expansion of the borders of the heart to the left and down is determined; palpation felt the displacement of the apex beat, systolic trembling in the jugular fossa.

Auscultatory signs of aortic stenosis are a rough systolic murmur over the aorta and over the mitral valve, muffled I and II tones on the aorta. These changes are also recorded during phonocardiography. According to the ECG, signs of left ventricular hypertrophy, arrhythmia, and sometimes blockade are determined.

During the period of decompensation, radiographs reveal an expansion of the shadow of the left ventricle in the form of an elongation of the arc of the left contour of the heart, a characteristic aortic configuration of the heart, post-stenotic dilatation of the aorta, and signs of pulmonary hypertension. On echocardiography, thickening of the aortic valve flaps, limitation of the amplitude of movement of the valve leaflets in systole, hypertrophy of the walls of the left ventricle is determined.

In order to measure the pressure gradient between the left ventricle and the aorta, probing of the heart cavities is performed, which makes it possible to indirectly judge the degree of aortic stenosis.

Ventriculography is necessary to detect concomitant mitral regurgitation.

Aortography and coronary angiography are used for the differential diagnosis of aortic stenosis with an aneurysm of the ascending aorta and coronary artery disease.

Treatment of aortic stenosis

All patients, incl. with asymptomatic, fully compensated aortic stenosis should be closely monitored by a cardiologist. They are recommended to conduct echocardiography every 6-12 months.

In order to prevent infective endocarditis, this contingent of patients needs preventive antibiotics before dental (caries treatment, tooth extraction, etc.) and other invasive procedures. Pregnancy management in women with aortic stenosis requires careful monitoring of hemodynamic parameters.

The indication for termination of pregnancy is a severe degree of aortic stenosis or an increase in signs of heart failure.

Drug therapy for aortic stenosis is aimed at eliminating arrhythmias, preventing coronary artery disease, normalizing blood pressure, and slowing down the progression of heart failure.

Radical surgical correction of aortic stenosis is indicated at the first clinical manifestations of the defect - the appearance of shortness of breath, anginal pain, syncope. For this purpose, balloon valvuloplasty can be used - endovascular balloon dilatation of aortic stenosis.

However, this procedure is often ineffective and is accompanied by a subsequent recurrence of stenosis. In case of minor changes in the leaflets of the aortic valve (more often in children with congenital malformation), open surgical plastic surgery of the aortic valve (valvuloplasty) is used.

In pediatric cardiac surgery, the Ross operation is often performed, which involves transplanting a pulmonary valve into the aortic position.

With appropriate indications, they resort to plastic surgery of supravalvular or subvalvular aortic stenosis.

The main treatment for aortic stenosis today remains aortic valve replacement, in which the affected valve is completely removed and replaced with a mechanical analogue or a xenogenic bioprosthesis.

Patients with a prosthetic valve require lifelong anticoagulation. In recent years, percutaneous aortic valve replacement has been practiced.

Forecast and prevention of aortic stenosis

Aortic stenosis can be asymptomatic for many years. The appearance of clinical symptoms significantly increases the risk of complications and mortality.

The main, prognostically significant symptoms are angina pectoris, fainting, left ventricular failure - in this case, the average life expectancy does not exceed 2-5 years. With timely surgical treatment of aortic stenosis, the 5-year survival rate is about 85%, the 10-year survival rate is about 70%.

Measures to prevent aortic stenosis are reduced to the prevention of rheumatism, atherosclerosis, infective endocarditis, and other contributing factors. Patients with aortic stenosis are subject to medical examination and observation by a cardiologist and rheumatologist.

Source: http://www.krasotaimedicina.ru/diseases/zabolevanija_cardiology/aortic-stenosis

Aortic valve stenosis: how and why it occurs, symptoms, how to treat

From this article you will learn: what is aortic stenosis, what are the mechanisms of its development and the causes of its occurrence. Symptoms and treatment of the disease.

Aortic stenosis is a pathological narrowing of a large coronary vessel, through which blood from the left ventricle enters the vascular system (into the systemic circulation).

What happens in pathology? For various reasons (congenital malformations, rheumatism, calcification), the aortic lumen narrows at the outlet of the ventricle (in the valve area) and makes it difficult for blood to flow into the vascular system. As a result, the pressure in the ventricular chamber increases, the volume of blood ejection decreases, and over time, various signs of insufficient blood supply to organs appear (fatigue, weakness).

The disease is completely asymptomatic for a long time (decades) and manifests itself only after narrowing of the lumen of the vessel by more than 50%. The appearance of signs of heart failure, angina pectoris (a type of coronary disease) and fainting greatly worsens the patient's prognosis (life expectancy is reduced to 2 years).

Pathology is dangerous for its complications - long-term progressive stenosis leads to an irreversible increase in the chamber (dilation) of the left ventricle.

Patients with severe symptoms (after narrowing the lumen of the vessel by more than 50%) develop cardiac asthma, pulmonary edema, acute myocardial infarction, sudden cardiac death without obvious signs of stenosis (18%), rarely - ventricular fibrillation, equivalent to cardiac arrest.

There is no cure for aortic stenosis.

Surgical methods of treatment (valve replacement, expansion of the lumen by balloon dilatation) are indicated after the first signs of aortic narrowing appear (shortness of breath with moderate exertion, dizziness).

In most cases, it is possible to significantly improve the prognosis (more than 10 years for 70% of those operated on). Dispensary observation is carried out at any stage throughout life.

Click on photo to enlarge

Patients with aortic stenosis are treated by a cardiologist, surgical correction is performed by cardiac surgeons.

The essence of aortic stenosis

The weak link in the systemic circulation (blood from the left ventricle through the aorta enters all organs) is the tricuspid aortic valve at the mouth of the vessel. Opening, it passes portions of blood into the vascular system, which the ventricle pushes out during contraction and, closing, does not allow them to move back. It is in this place that characteristic changes in the vascular walls appear.

In pathology, the tissue of the valves and the aorta undergoes various changes. These can be scars, adhesions, adhesions of connective tissue, deposits of calcium salts (hardening), atherosclerotic plaques, congenital malformations of the valve.

Due to these changes:

• the lumen of the vessel gradually narrows;
• valve walls become inelastic, dense;
• insufficient opening and closing;
• blood pressure in the ventricle increases, causing hypertrophy (thickening of the muscle layer) and dilation (increase in volume).

As a result, insufficient blood supply to all organs and tissues develops.

Aortic stenosis can be:

1. Supravalvular (from 6 to 10%).
2. Subvalvular (from 20 to 30%).
3. Valve (from 60%).

All three forms can be congenital, acquired - only valvular. And since the valvular form is more common, then, speaking of aortic stenosis, this form of the disease is usually meant.

Pathology very rarely (in 2%) appears as an independent one, most often it is combined with other defects (mitral valve) and diseases of the cardiovascular system (ischemic heart disease).

Causes and risk factors

Characteristic symptoms

For decades, stenosis proceeds without showing any signs. In the early stages (before the lumen of the vessel is closed by more than 50%), the condition may manifest as general weakness after serious physical exertion (sports training).

The disease progresses gradually: shortness of breath appears with moderate and elementary exertion, accompanied by increased fatigue, weakness, dizziness.

Aortic stenosis with a decrease in the lumen of the vessel by more than 75% is accompanied by severe symptoms of heart failure: shortness of breath at rest and complete disability.

Common symptoms of narrowing of the aorta:

• shortness of breath (first with severe and moderate exertion, then at rest);
• weakness, fatigue;
• painful pallor;
• dizziness;
• sudden loss of consciousness (with a sharp change in body position);
• chest pain;
• violation of the heart rhythm (usually ventricular extrasystole, a characteristic sign - a feeling of interruptions in work, "falling out" of the heart beat);
• ankle swelling.

The appearance of pronounced signs of circulatory disorders (dizziness, loss of consciousness) greatly worsens the prognosis of the disease (life expectancy is not more than 2-3 years).

After narrowing of the vessel lumen by 75%, cardiovascular insufficiency progresses rapidly and becomes more complicated:

• attacks of angina pectoris with characteristic sharp pains in the chest and asthma attacks;
• myocardial infarction with acute chest pain, shortness of breath, weakness, sweating, nausea, vomiting, dizziness;
• cardiac asthma with palpitations, suffocation, cough, blue face;
• pulmonary edema with suffocation, severe blue face (cyanosis), cough with bloody foam, bubbling breath;
• ventricular fibrillation with frequent and chaotic contractions, impaired contractile function of the heart.

Aortic valve stenosis can cause sudden death without any external manifestations and preliminary symptoms.

Treatment Methods

It is completely impossible to cure the pathology. A patient with any form of aortic narrowing needs to be observed, examined and follow the recommendations of a cardiologist throughout his life.

Drug therapy is prescribed in the early stages of stenosis:

• when the degree of narrowing is small (up to 30%);
• not manifested by severe symptoms of circulatory disorders (shortness of breath after moderate physical exertion);
• diagnosed by listening to noises over the aorta.

Treatment goals:

1. Suspend the development of stenosis (if acquired).
2. Prevent the development of myocardial ischemia.
3. Correct concomitant conditions (hypertension).
4. Normalize the manifestations of arrhythmia.

At later stages, drug therapy is ineffective, the patient's prognosis can only be improved with the help of surgical methods of treatment (balloon expansion of the aortic lumen, valve replacement).

Drug therapy

The attending physician prescribes a complex of drugs individually, taking into account the degree of stenosis and symptoms of concomitant diseases.

The following medicines are used:

In the early stages, acquired aortic valve stenosis must be protected from possible infectious complications (endocarditis). Patients are recommended a prophylactic course of antibiotics for any invasive procedures (tooth extraction).

Surgery

Methods of surgical treatment of aortic stenosis are indicated at the following stages of the disease:

• the patient complains of shortness of breath after moderate exercise, weakness, fatigue, dizziness;
• shortness of breath appears after any physical activity (walking on a flat surface) and increases with moderate exertion (climbing stairs);
• there are attacks of acute pain in the chest, fainting after sudden changes in body position.

In the later stages (the lumen of the vessel is closed by more than 75%), surgical intervention is contraindicated in most cases (in 80%) due to the possible development of complications (sudden cardiac death).

Balloon dilatation (expansion)

Aortic valve repair

Aortic valve replacement

Ross prosthetics

Patient for life:

• is registered with a cardiologist;
• is examined at least twice a year;
• after prosthetics - constantly takes anticoagulants.

Prevention

Prevention of acquired stenosis is reduced to the elimination of possible causes and risk factors for the development of pathology.

Necessary:

1. Treat sources of chronic infection (chronic tonsillitis, carious teeth, pyelonephritis).
2. Normalize the diet to prevent the development of atherosclerosis.
3. Stop smoking (nicotine increases the risk of developing cardiovascular pathologies in 47% of cases).

For patients with cardiovascular pathologies, the optimal balance of potassium, sodium, calcium in the diet is of great importance, so the diet should be discussed with the attending physician.

Forecast

Aortic stenosis has been asymptomatic for decades. The prognosis depends on the degree of narrowing of the lumen of the artery - a decrease in the diameter of the vessel up to 30% does not complicate the patient's life.

At this stage, regular examinations and observation by a cardiologist are shown.

The disease progresses slowly, so the symptoms of increasing heart failure are not noticeable to others and the patient (14-18% of patients die suddenly, without obvious signs of narrowing).

But in most cases, difficulties arise after the closure of the vessel by more than 50%, the onset of angina attacks (a type of coronary disease) and sudden fainting. Heart failure progresses rapidly, becomes more complicated and greatly reduces the patient's life expectancy (from 2 to 3 years).

Congenital pathology ends with the death of 8-10% of children in the first year of life.

Timely surgical treatment improves the prognosis: more than 85% of those operated on live up to 5 years, more than 10 years - 70%.

Source: http://okardio.com/bolezni-sosudov/aortalnyj-stenoz-551.html

Aortic stenosis: symptoms, treatment, prevention

The human heart is a complex and delicate, but vulnerable mechanism that controls the work of all organs and systems.

There are a number of negative factors, starting with genetic disorders and ending with an unhealthy lifestyle, that can cause malfunctions in this mechanism.

Their result is the development of diseases and pathologies of the heart, which include stenosis (narrowing) of the aortic orifice.

general information

Aortic stenosis (aortic stenosis) is one of the most common heart defects in modern society. It is diagnosed in every fifth patient over the age of 55, with 80% of patients being men.

In patients with this diagnosis, there is a narrowing of the aortic valve opening, which leads to a violation of the blood flow going to the aorta from the left ventricle. As a result, the heart has to exert considerable effort to pump blood into the aorta through a smaller opening, which causes serious disruption.

Causes and risk factors

Aortic stenosis can be congenital (occurs as a result of abnormalities in fetal development), but more often it develops in the course of a person's life. The causes of the disease include:

• heart diseases of a rheumatoid nature, which usually occur as a result of acute rheumatic fever due to infections caused by a certain group of viruses (group A hemolytic streptococci);
• atherosclerosis of the aorta and valve - a violation that is associated with lipid metabolism disorders and the deposition of cholesterol in the vessels and valve cusps;
• degenerative changes in the heart valves;
• infective endocarditis.

Risk factors for the development of the disease include an unhealthy lifestyle (in particular, smoking), kidney failure, calcification of the aortic valve and the presence of its artificial substitute - the biological tissue from which they are made is largely susceptible to the development of stenosis.

Classification and stages

Aortic stenosis has several forms, which are distinguished according to different criteria (localization, degree of blood flow compensation, degree of narrowing of the aortic orifice).

• according to the localization of the narrowing aortic stenosis may be valvular, supravalvular, or subvalvular;
• by degree of compensation blood flow (according to how the heart manages to cope with the increased load) - compensated and decompensated;
• according to the degree of narrowing aorta allocate moderate, expressed and critical forms.

The course of aortic stenosis is characterized by five stages:

• I stage(full refund). Complaints and manifestations are absent, the defect can be determined only through special studies.
• II stage(hidden insufficiency of blood flow). The patient is worried about mild malaise and fatigue, and signs of left ventricular hypertrophy are determined radiologically and by ECG.
• III stage(relative coronary insufficiency). There are chest pains, fainting and other clinical manifestations, the heart increases in size due to the left ventricle, on the ECG - its hypertrophy, accompanied by signs of coronary insufficiency.
• IV stage(severe left ventricular failure). Complaints of severe malaise, congestion in the lungs and a significant increase in the left heart.
• V stage, or terminal. Patients have progressive insufficiency of both the left and right ventricles.

For more information about the disease, see this animation:

Is it scary? Danger and complications

Quality and life expectancy of a patient with aortic stenosis depends on the stage of the disease and the severity of clinical signs. In people with a compensated form without severe symptoms, there is no direct threat to life, but the symptoms of left ventricular hypertrophy are considered unfavorable prognostically.

Full compensation can be maintained for several decades, but as the stenosis develops, the patient begins to feel weakness, malaise, shortness of breath and other symptoms that increase over time.

In patients with the "classic triad" (angina pectoris, syncope, heart failure), life expectancy rarely exceeds five years.

Besides, in the last stages of the disease there is a high risk of sudden death- Approximately 25% of patients diagnosed with aortic stenosis die suddenly from fatal ventricular arrhythmias (usually these include people with severe symptoms).

The most common complications of the disease include:

• chronic and acute insufficiency of the left ventricle;
• myocardial infarction;
• atrioventcular blockade (comparatively rare, but can also lead to sudden death);
• swelling and congestion in the lungs;
• systemic embolism caused by pieces of calcium from the valve can cause strokes and visual impairment.

Symptoms

Often, signs of aortic stenosis do not manifest themselves for a long time. Among the symptoms that are characteristic of this disease, there are:

• Shortness of breath. Initially, it appears only after physical exertion and is completely absent at rest. Over time, shortness of breath occurs at rest and intensifies in stressful situations.
• Chest pain. Often they do not have an exact localization and appear mainly in the region of the heart. The sensations can be pressing or stabbing in nature, last no more than 5 minutes and are aggravated by physical exertion and stress. Pain of an angina pectoris (acute, radiating to the arm, shoulder, under the shoulder blade) can be noted even before the onset of pronounced symptoms and are the first signal of the development of the disease.
• fainting. Usually observed during physical exertion, less often - in a calm state.
• increased palpitations and dizziness.
• severe fatigue, decreased performance, weakness.
• Feeling of suffocation which may be exacerbated by lying down.

When should you see a doctor?

Often the disease is diagnosed incidentally(during preventive examinations) or in the later stages due to the fact that patients attribute symptoms to overwork, stress or adolescence.

It is important to understand that any signs of aortic stenosis (palpitations, pain, shortness of breath, discomfort during physical exertion) are a serious reason for consulting a cardiologist.

Diagnostics

Diagnosis of defect stenosis is complex and includes the following methods:

• Collection of anamnesis. Analysis of patient complaints, past illnesses and family history (cases of heart disease or sudden death in close relatives).
• External inspection. Patients have pallor and cyanosis of the skin, heart murmurs and wheezing in the lungs, and the peripheral pulse on the radial arteries is weak and rare.
• Auscultation aortic stenosis. The method consists in listening to the tones and rhythms of the heart - with aortic stenosis, the II tone is usually weakened or completely absent, and systolic and diastolic murmurs are also noted.
• General blood analysis. It is carried out in order to determine the level of red blood cells, platelets, white blood cells, as well as the level of hemoglobin.
• General urine analysis. It makes it possible to identify violations that can affect the course of the disease.
• Electrocardiography. A method for assessing the electrical activity of the heart, which allows to identify violations of its work.
• echocardiography. Ultrasound examination, which determines the degree of narrowing of the aorta and the most significant indicators of the work of the heart.
• Coronary angiography with aortography. An invasive procedure that involves penetrating the vessels of the arms and legs to examine the vessels of the heart and aorta.
. The exercise tests include a walking test, an exercise bike test, and a treadmill test.

Treatment Methods

There is no specific therapy for aortic stenosis, so Treatment tactics are selected based on the stage of the disease and the severity of symptoms.. In any case, the patient should be registered with a cardiologist and be under strict supervision. It is recommended to undergo an ECG every six months, give up bad habits, diet and a strict daily routine.

Patients with stage I and II disease are prescribed drug therapy aimed at normalization of blood pressure, elimination of arrhythmia and slowing down the progression of stenosis. It usually includes taking diuretics, cardiac glycosides, drugs that lower blood pressure and heart rate.

Radical methods of the initial stages of aortic stenosis include cardiac surgery. Balloon valvuloplasty(a special balloon is inserted into the aortic opening, after which it is mechanically inflated) is considered a temporary and ineffective procedure, after which a relapse occurs in most cases.

In childhood, doctors usually resort to valvuloplasty(surgical valve repair) or Ross operations(transplantation of the pulmonary valve to the position of the aorta).

At stages III and IV of aortic stenosis, conservative drug treatment does not give the desired effect, so patients undergo aortic valve replacement. After the operation, the patient should take blood thinners throughout life that prevent the formation of blood clots.

If it is impossible to carry out surgical intervention, they resort to pharmacological therapy in combination with phytotherapy.

Prevention

There are no ways to prevent congenital aortic stenosis or its intrauterine diagnosis.

Preventive measures of acquired vice are in a healthy lifestyle, moderate physical activity and timely treatment of diseases that can provoke narrowing of the aorta (rheumatic heart disease, acute rheumatic fever).

Any heart disease, including aortic stenosis, is potentially life threatening. To prevent the development of cardiac pathologies and defects, it is very it is important to take responsibility for your health and lifestyle, as well as regularly undergo preventive examinations that can detect diseases at an early stage of their development.

If the opening of the aorta near the valve begins to narrow, this leads to impaired blood flow within the left ventricle. The pathology is called aortic stenosis, and the disease can be diagnosed not only in adults, but also in newborns. If you have increased fatigue, fainting, dizziness and asthma attacks, you should think about it. It may be time to seek help from a cardiologist.

Classification of aortic stenoses

Pathology of the aortic valve belongs to the group of defects of the cardiovascular system. This is a sluggish disease, the consequences of the development of which can manifest themselves in years. If we talk about the origin of the disease, then doctors distinguish congenital stenosis of the aortic orifice and an acquired variety of this pathology.

Depending on the localization, the disease happens:

• supravalvular;
• subvalvular;
• valvular.

Treatment will directly depend on. Cardiologists have found that the symptoms of the disease depend on the degree of its severity. Hemodynamic disorders in the body are conditionally divided into degrees (or stages), which determine the level of damage to the aortic valve.

There are five of these stages:

1. Full refund. At this stage, stenosis of the aortic orifice is detected by auscultation, since the narrowing of the vessel is extremely small. The patient cannot do without the dynamic observation of a cardiologist, but surgery is not yet required.
2. Latent heart failure. The patient complains of shortness of breath, fatigue, dizziness. Symptoms of aortic valve disease are confirmed by X-ray and ECG data. Surgical correction is recommended.
3. Relative coronary insufficiency. Shortness of breath increases, fainting and angina pectoris occur. Surgery is required.
4. Severe heart failure. There are nocturnal asthmatic attacks, at a calm state the patient complains of shortness of breath. Operations affecting the area of ​​the aortic valve are contraindicated. Potentially helps cardiac surgery, but the effect of it is small.
5. terminal stage. Pathology progresses inexorably, edematous syndrome and shortness of breath are pronounced. By applying medication, doctors achieve a short-term improvement in the situation. Surgical correction is strictly contraindicated.

Aortic stenosis in young children

If the pathology manifests itself in newborns, it is based on a hereditary factor. If the heart valves were susceptible to diseases in the baby's family members, this significantly increases the likelihood of illness. Babies who have had bacterial endocarditis or rheumatic fever are also at risk of getting aortic stenosis.

We list other possible causes of the manifestation of pathology in newborns:

• aortic valve defects (hereditary);
• improper closure;
• infections (we already mentioned them).

Symptoms in newborns resemble those in adult patients.

At first, the child is asymptomatic, but then you will find the following manifestations:

• increased physical fatigue;
• fainting (occur with strong tension);
• irregular heartbeat;
• chest tightness;
• pressure;
• compression;
• pain;
• dizziness;
• arrhythmia (rarely);
• asymptomatic sudden death.

Diagnosing an ailment in newborns is quite difficult, but over time, the signs of the disease appear brighter. For older patients, the doctor recommends to refrain from excessive exertion and avoid sports. Treatment consists of taking antibiotics (during surgery or visits to the dentist).

The main causes of the disease

Acquired aortic stenosis occurs due to rheumatic lesions of the aortic valves. The deformed valve flaps begin to gradually coalesce and thicken, then they become rigid. The valve ring narrows.

Here are some other possible reasons:

• aortic valve calcification;
• infective endocarditis;
• systemic lupus erythematosus;
• Paget's disease;
• renal terminal insufficiency;
• rheumatoid arthritis.

Narrowing of the aortic orifice may be hereditary (in newborns). The aortic valve can be bicuspid - another developmental anomaly in babies. Often the symptoms of the disease are diagnosed before the age of 30.

The formation of stenosis is accelerated in several cases:

• hypercholesterolemia;
• smoking;
• arterial hypertension.

Symptoms - what should be feared?

Symptoms of stenosis appear depending on the stage of the disease - we wrote about this above. Discomfort gradually increases - this is due to the constant narrowing of the aorta. In newborns and adult patients, a number of common symptomatic manifestations can be distinguished:

• shortness of breath (at first occurs during physical exertion, then it is constantly observed);
• muscle weakness;
• fast fatiguability;
• sensation of a "loud" heartbeat;
• fainting (with coronary insufficiency);
• angina attacks;
• dizziness;
• pulmonary edema and (severe cases).

Sometimes aortic stenosis is accompanied by numerous complications.

Here they are:

• ischemia;
• infective endocarditis;
• AV blockade;
• arrhythmias;
• gastrointestinal bleeding;
• myocardial infarction.

Pathology of the aortic valve is also right ventricular. This is a very dangerous kind of disease, since in 10% of cases sudden death occurs. Right ventricular stenosis is diagnosed mainly in the elderly.

How is pathology diagnosed?

A set of diagnostic measures aimed at identifying the affected aortic valve always begins with palpation. Doctors check the peripheral pulse and pressure, detect systolic trembling.

Other diagnostic methods are also used:

• . There is clearly a weakening of the second tone. A systolic murmur (scraping and rough) is heard, which in elderly patients may radiate to the upper cardiac regions.
• ECG. The left ventricle is hypertrophied, but this sign is not observed in 15% of cases. There are changes in the tooth, and sometimes intraventricular blockade. Daily monitoring of the aortic valve can detect painless myocardial ischemia and cardiac arrhythmia.
• X-ray examination. Changes in the size of the heart and post-stenotic aortic expansion are visible. If the defect develops for a long time (this does not apply to newborns), the radiograph shows the presence of calcifications.
• Echocardiography. The two-dimensional aortic valve diagnostic mode allows to detect thickening and thickening of its leaflets.
• Coronary angiography. Usually combined with aortography, a special invasive procedure in which vascular penetration occurs (a solution with a reagent is injected into the artery).

In addition to the above instrumental studies, general blood and urine tests are done, an anamnesis (including family history) is collected and analyzed, a test is carried out aimed at studying physical activity (treadmill, walking, exercise bike).

Based on the above studies, the doctor prescribes a treatment corresponding to the current stage of the defect.

Treatment options for aortic stenosis

Treatment of a damaged aortic valve includes conservative and surgical methods. At the same time, patients with an asymptomatic course of the disease are under vigilant medical supervision. Every six months or a year, these patients undergo echocardiography sessions, and take antibiotics before visiting the dentist. Pregnant women with stenosis need to control hemodynamic parameters. Termination of pregnancy may be required only in the most advanced cases.

Conservative treatment pays special attention to neutralizing the effects of arrhythmia and normal blood flow.

Here is a complete list of the phenomena that need to be dealt with:

• normalization of blood pressure;
• elimination of arrhythmias;
• slowing down the development of heart failure;
• prevention of coronary artery disease.

The pulmonary circulation is prone to stagnation, so treatment begins from this area. The patient is prescribed diuretics (Furosemide is the most common), while the collection of subjective, instrumental and clinical data continues. When detected, the intake of cardiac glycosides (for example, Digoxin) begins. Prescribed by doctors and potassium supplements.

In order for the hypertrophied myocardium to relax a little, B-blockers are recommended. The second option is calcium blocker antagonists. The nitrate groups, on the other hand, are contraindicated because cardiac output and cardiac output decrease. As the defect develops, conservative treatment begins to be combined with surgical correction, but more on that below.

Surgical intervention

Drug treatment is relatively effective only in the early stages of pathology. Surgical intervention is the main means of combating the disease. Such treatment directly depends on contraindications and the degree of violations received by the patient. The most common are balloon plasty and valve replacement. There are three main indications for surgery:

1. Satisfactory myocardial function.
2. Hypertrophy of the left ventricle (the dynamics of development can be traced on the cardiogram).
3. Abnormal systolic pressure gradient.

With artificial prosthetics of a damaged valve (changes are insignificant), the volume of surgical correction is minimized. The valve leaflets, which are in the process of splicing, are artificially separated.

In some cases, the tricuspid valve is replaced - then the patient is connected to an artificial blood supply. The aorta is dissected, the affected valve is removed, after which an implant is introduced into the patient's body.

The valve prosthesis is checked for several indicators.

Here they are:

• functionality;
• integrity;
• compliance with the size of the hole;
• no air bubbles.

After surgical correction, the patient undergoes a long course of rehabilitation. There is a risk of infective endocarditis, so doctors use a wide range of antibiotics. Thromboembolism is also a danger. This complication must be fought with antiplatelet agents and anticoagulants (Heparin, Aspirin).

Prevention

Congenital stenosis cannot be corrected - there are simply no preventive measures here. As for the acquired form of this terrible pathology, prevention should begin with the identification of diseases that served as a background for stenosis of the aortic mouth.

You need to be warned:

• atherosclerosis;
• rheumatism;
• infective endocarditis.

Some heart diseases are the result of a sore throat. Do not allow the deposition of cholesterol plaques on the walls of your blood vessels - this way you will prolong your life and get rid of numerous problems in old age.