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Combining aortic heart disease clinically features with characteristis for each of the components of its valvular lesions. In order to determine the prevalence of vice, the clinical data and the results of all paraclinical methods must be carefully analyzed. Determination of dominant species lesions is essential, since this depends on the indications for surgery and the nature of the surgery. Sometimes invasive methods are used in order to clarify the nature of the predominant lesions.
Tricuspid valve (insufficientia valvulae tricuspidalis) occurs relatively frequently. Different organic and relative failure. The latter is more common. Usually defect occurs in combination with mitral or aortic malformations. Relative tricuspid regurgitation observed in a significant expansion of the right ventricle and in increase its cavity. During systole of the right ventricle, some part of the blood from the cavity comes back into the right atrium. Stagnation of blood in the cavity of the right atrium is transmitted to the system of hollow veins. On examination of patients, there are revealed acrocyanosis, swelling of the neck veins and their systolic pulsation - positive venous pulse, a small icterus sclera and skin due to functional failure congestive liver. There is a pulsation in the epigastrium due to dilatation of the right ventricle. Sometimes there is a ripple of the liver.
In auscultation, there is determined systolic murmur, with its epicenter at the base of the xiphoid process. This noise is amplified in the height of inspiration (symptom Rivero - Korvallo), which distinguishes it from the noise mitral valve. During inhalation, blood flow through the right half of the heart accelerates and the amount of regurgitation increases. On the ECG signs of right ventricular hypertrophy, the PCG at the base of the xiphoid process distinct systolic murmur, beginning immediately after the I tone.On the top of inspiratory, noise amplitude increases. In the diagnosis, there are held differential diagnosis of adhesive pericarditis.
Stenosis of the right atrioventricular opening (tricuspid stenosis, stenosis ostii atrioventricularis decxtra, stenosis tricuspidalis) in almost pure form does not occur. Usually associated with mitral valvular disease. Clinical picture of the disease in most cases determine combined with it evils. On examination, there are revealed cyanosis, significantly extended and throbbing neck vein congestion in the systemic circulation, hypertrophy of the right atrium. In auscultation, there is reduction of the intensity of Eaton's lack of stagnation in the pulmonary circulation. At the base of the xiphoid process, there is auscultated diastolic murmur, recorded and PCG as presystolic diamond-shaped noise. The noise is amplified in the height of inspiration, especially in the position of the patient on the right side. Typically there was no significant pulmonary congestion, which is confirmed radiographically. On the ECG, there are signs of hypertrophy of the right atrium.
Congenital heart disease. Most patients with congenital heart defects are detected in childhood, because this raises a distinct sound and symptoms appear early hemodynamic instability. In some cases, due to the low intensity of vice it takes a long time hidden. Only in adulthood can be the first signs of decompensation, which forces the patient to see a doctor. As a result, a comprehensive survey noise, regarded earlier as inorganic, associated with the presence of congenital heart disease.
Classification of congenital heart and vessels.
1.Vices with discharge of blood from right to left: the triad of Fallot, Tetralogy of Fallo, pentad of Fallo, a discharge of the aorta and the pulmonary artery from the right ventricle, tricuspid atresia (with the usual discharge of large vessels), malformations of the right ventricle (hypoplasia, defects in muscle), transposition of the great vessels , atresia of the aortic arch malformations left heart syndrome (atresia or hypoplasia of the aortic, left ventricular diverticulum), truncusarteriosus (true and false), Common ventricle, Arteriovenous aneurysm (systemic and pulmonary). Vices with the initial discharge of blood from left to the right. Open ductusarteriosus, aortopulmonary fistula, primary and secondary atrial septal defect atrium. Total LyutembasheThree auricles heart syndrome Common atrioventricular canal defect septal sinus of Valsalva aneurysm is a breakthrough in the pulmonary circulation.
3. Malformations of the right half of the heart. Pulmonary stenosis (valve, infundibulyarny, on valve) Disease Ebstein Primary pulmonary hypertension
IV. Vices of left heart anomalies of the aortic arch of the aorta Coarctation of aortic stenosis of coronary artery anomalies of mitral valve stenosis
V. Other abnormalities
Anomalies of the heart and the provisions of its individual chambers (dextrocardia, dekstroversiya with reverse arrangement of the internal organs, etc.)
Congenital with discharge of blood from right to left are called vices "blue type", and the dumping of left to right - vices "pale type." Principle for syndromic congenital heart disease can be divided into pure gateways (aortic stenosis, coarctation of the aorta, pulmonary stenosis), net discharges (patent ductus arteriosus, atrial septal defect and ventricular septal), a combination of discharges and the gateway (triad and tetralogy of Fallo, transposition of the main vessels).
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