Tricuspid valve. Insufficiency of tricuspid valve 1, 2, 3 degrees: signs and treatment

The main muscle of the human body is the heart. This is a complicated mechanism, the components of which are the valves. In the right half is the tricuspid valve. He shares the atrium and the ventricle. When his work fails, the blood flow in this part of the muscle is broken. As a result, a life-threatening condition arises. In medical practice, it is also known as "tricuspid valve failure." In today's article, the main causes, symptoms and methods of treatment of this disease will be considered.

Anatomic Help

The human heart is a muscular organ. Its cavity is divided into 2 atria and 2 ventricles. The communication between these structures occurs through the valves. They are responsible for the flow of blood in one direction.

In the right part of the heart, the cells are connected through the tricuspid valve. It consists of the following anatomical formations:

• Three valves (septal, anterior and posterior);
• A tendon stroke;
• Papillary muscles;
• Fibrous ring.

During the contraction of one atrium, the tricuspid valve opens. Gradually, the blood fills the ventricle. After this, the myocardium begins to alternately contract, while the valve flaps collapse under strong pressure. Such a well-functioning mechanism prevents reverse casting (regurgitation) of blood. Under the influence of certain factors, sometimes his work fails. In this case, they say that the tricuspid valve has a failure. However, it can no longer fulfill its functions fully.

With this pathology, the blood from the right ventricle returns to the atrium. A slight increase in the volume of the liquid practically does not affect the functioning of the main muscle of the body. With severe deficiency of the heart chamber, deformations are experienced, the pressure indices change drastically. It can increase up to 8 times in comparison with natural values.

Brief description of the disease

Tricuspid insufficiency is a heart disease that develops due to the inadequate closure of valve flaps, the reverse transfer of blood from the right ventricle to the atrium. Against the background of constant regurgitation diastolic volume and pressure in this structure of the heart increase. This entails hypertrophy and dilatation of its walls. As a result of disrupting the work of compensatory mechanisms, the patient develops stagnant phenomena in the body.

Tricuspid insufficiency is often accompanied by other congenital heart defects. For example, an open oval window or an atrial septal defect.

The main causes and forms of pathology

Insufficiency of the tricuspid valve always has a different course. To make an accurate diagnosis, you first need to determine the form of the pathological process. To this end, various criteria are used in medical practice: the period of occurrence, localization of the damaged site of the valve, severity of regurgitation.

Depending on the time of development, the disease in question can be of two kinds. As a rule, in all cases it is not acquired, but occurs after the inflammatory process. Congenital malformation is extremely rare and is developing in the womb. On its appearance affects the effect of negative factors on the body of a pregnant woman. It can be radiation, infectious disease or radiological exposure.

Based on the fact in which part the tricuspid valve is damaged, the insufficiency can be of two forms. The organic variant is accompanied by a physiological change in the leaflets. They are gradually deformed, covered with bloom. With the functional form of the disease, the valve does not completely close.

The development of acquired organic tricuspid insufficiency occurs under the influence of the following reasons:

1. Rheumatism is an inflammation that spreads to internal organs.
2. Carcinoid syndrome - damage to various organs caused by a small intestinal tumor. Pathogenic elements from the neoplasm get into the blood and begin to attack the endocardium. Then they penetrate into the pulmonary vessels.
3. Infective endocarditis is an inflammatory lesion of the heart membrane.
4. Mitral commissurotomy. This is an operation that is used to treat stenosis.

Acquired functional (relative) insufficiency of the tricuspid valve develops because of damage to the papillary muscles or enlargement of the fibrous ring. In the first case, the structures are responsible for maintaining the motor ability of the valves. With myocardial infarction, papillary muscles are damaged. This leads to a disruption in the functionality of the tricuspid valve.

Pathologies of the fibrous ring can cause various disorders. These include myocarditis, ruptured chords, tumors and tumors that prevent the flow of blood from the ventricle.

Stages of development of insufficiency

Based on the severity of the regurgitation process, it is common to distinguish several stages during the course of the disease:

• Degree 1. The return flow of blood retains its minimum values, is not accompanied by a hemodynamic disorder.
• Degree 2. At this stage, the pathology is accompanied by the advance of the back stream of blood to a distance that does not exceed 2 cm.
• Degree 3. The blood flow is advanced to the atrium for a distance of more than 2 cm from the valve surface.
• Degree 4. At the moment of regurgitation, the blood penetrates into the upper atrium zone, passing through the entire chamber.

About what symptoms are accompanied by each of the stages of the disease, will be described below.

Symptoms of tricuspid valve failure

At the initial stage, the heart defect practically does not manifest itself. Sometimes after physical exertion patients notice the appearance of a strong pulsation of veins on the neck. Detect the pathological process is possible only with the help of Doppler. Normal ECG does not show significant changes in the heart.

Insufficiency of the tricuspid valve of the 2nd degree is accompanied by an increase in the volume of the reverse blood flow. Right ventricular dysfunction leads to an increase in heart size. As a result, the clinical picture is complemented by the following symptoms:

• A decline in strength, a decrease in physical and mental activity;
• Frequent urination at night;
• Marked swelling of the lower extremities;
• dyspnea;
• Feeling of heaviness under the ribs;
• Dyspeptic disorders.

When listening to the heart, pansystolic noises and atrial fibrillation are determined.

As a result of the progression of the pathology, the number of symptoms manifested increases. Ignore their occurrence is not recommended. Better at the initial stage of the disease development, seek qualified medical help. Insufficiency of the tricuspid valve of the 1-2 degree can still be cured medically. The transition of the disease to the next stage always requires surgical intervention. Even after the operation, complications can not be ruled out.

Features of the disease in children

Newborn babies with severe regurgitation and the presence of concomitant cardiac pathologies are prone to rapid development of right ventricular failure. Very often it ends with a fatal outcome.

Acquired form of the disease develops against the background of complications of other diseases. Most often it's a streptococcal infection, which leads to rheumatic fever.

Among other causes of deficiency in childhood can be identified:

• Acute form of hypertension;
• Myocardial diseases;
• Traumatic injuries;
• Malignant neoplasms.

At the initial stage, the failure of the tricuspid valve in children is considered as an anatomical feature. The first degree of the pathological process does not require treatment. With age, the disease usually passes by itself.

Insufficiency of the mitral and tricuspid valve

Very often, the disruption of the valve on the right side is combined with the dysfunction of the structures of the left half. In this area, the main load is accounted for by the so-called mitral valve. Symptoms of the disorder are summarized. The combination of such violations negatively affects the work of the right ventricle, which is complicated by the onset of pulmonary hypertension. Patients diagnosed with "insufficiency of the mitral and tricuspid valve 1 degree" are recommended surgical intervention.

Methods of diagnosis

Early detection of the disease plays a direct role in the success of treatment, and also affects the life expectancy of the patient. Since the insufficiency of the tricuspid valve of the 1st degree proceeds almost asymptomatically, pathology is detected only after its transition to the next stage of development.

Diagnosis begins with interviewing the patient, studying his anamnesis and physical examination. Asking various questions to the patient, the doctor determines the clinical picture, the time of appearance of the first symptoms. He also needs to know what diseases preceded the failure. In case of external examination, cyanosis of the skin and puffiness are usually detected, and when listening, there is a violation of the heart rhythm.

As part of the diagnosis, several laboratory tests are required. Among them, the most informative characterizes the analysis of blood and the study of the patient's immunological status. According to the results of laboratory tests, it is possible to judge the presence of inflammatory processes in the body, concurrently occurring ailments.

To clarify the diagnosis, a doctor can use hardware survey methods. These include:

1. ECG. It is carried out with the purpose of revealing the increase in the volume of the atrium.
2. Phonocardiogram. Demonstrates the presence of systolic noises.
3. Spiral CT. Provides an informative image of the main muscle of the body.
4. Radiograph. Gives an idea of the size of the heart, reveals stagnant phenomena.
5. Coronary cardiography. It is used before an operative intervention and allows to estimate a blood flow.
6. Echocardiography. It shows the deformation of the leaves, the presence of new formations on them.

Based on the results of a complete examination, the doctor gets an idea of the state of the tricuspid valve. The inadequacy of this structure is well treatable only at the initial stage of development. More details of the treatment options for this disease will be discussed further.

Principles of treatment

Insufficiency of tricuspid valve 1 degree does not require therapy. If the disease passes to the next stage of development, the patient is treated. It can be both medicamental and operative. To help the latter resort to particularly serious cases, when the use of pills and injections does not work.

For the entire period of treatment the patient must adhere to the following rules:

1. Quit smoking completely.
2. Avoid hypothermia and stressful situations.
3. Follow the diet to reduce the burden on the heart.
4. Reduce the intensity and amount of physical activity.

Compliance with these recommendations increases the effectiveness of the therapy, as well as a kind of prevention of complications.

Medication

Moderate insufficiency of the tricuspid valve is not considered an indication for surgical intervention. In this case, the treatment is carried out with the help of medications. The standard therapy scheme involves the use of the following medicines:

1. Diuretics ("Britomar", "Hydrochlorothiazide"). Eliminate stagnant phenomena in the body, accelerate the process of removing the liquid.
2. Preparations of potassium ("Panangin", "Asparka"). Help the body not to accumulate excess fluid.
3. Venous dilators (Corvaton, Nitrosorbide). Reduce the burden on the heart by depositing blood.
4. Anticoagulants (Warfarex, Warfarin).
5. Cardiac glycosides (Digoxin, Korglikon). They help in the fight against arrhythmia.
6. Beta-adrenoblockers ("Diltiazem", "Carvedilol"). Reduce the frequency of contractions of the left ventricle.

The dosage and dosage regimen are determined on an individual basis, taking into account the severity of the disease.

Operative intervention

Insufficiency of the tricuspid valve of the 3rd degree is considered the main indication for surgical intervention. Also, surgery is recommended for patients with severe deformities of the valves or severe malfunctions in their operation.

With the preservation of the valve apparatus, annuloplasty is used. During the operation, the doctor applies U-shaped seams to the damaged area.

If the intervention turned out to be ineffective, there are obvious structural changes, the patient is put an artificial cap. After implantation, an anticoagulant therapy is required. When implanting a biological prosthesis, it is of a short-term nature. If it is made of medical alloys, treatment of a tricuspid valve deficiency takes a little longer.

Possible complications and prognosis for recovery

Lack of timely treatment can lead to progression of the disease. The pathological process in this case affects not only the tricuspid valve. Insufficiency gradually leads to the fact that the body begins to look for new compensatory mechanisms. Thus, he tries to cope with the existing violations. Depending on the neglect of the disease, the following disorders may occur:

• pneumonia;
• Increased liver size, cirrhosis;
• pulmonary embolism;
• Ascites.

If you believe the statistics, the listed complications develop in 90% of cases.

As for the prognosis for recovery, it depends solely on the degree of development of the disease. Insufficiency of the tricuspid valve of the 2 nd degree is well amenable to drug treatment, and the probability of occurrence of complications is practically zero. At the third degree of the pathological process, the five-year survival rate is about 60-70%. Such figures are typical for patients who have already undergone surgical intervention. With decompensated forms of insufficiency accompanied by chronic pulmonary diseases, the prognosis is disappointing.