Fibrous dystrophy of the valve apparatus

The cause of fibrosis and how to diagnose it

An important role in the functioning of the heart valve apparatus is played by the valves, represented by loose connective tissue, consisting of dense collagen and continuously continuing into the tendon chords (according to Wikipedia). Under the confluence of a number of circumstances, the number of blood vessels supplying the valve structure is reduced. As a result, elastic fibers are replaced by dense fibrous tissue, which is characterized by sufficient strength. Having lost lability, the valves lose the ability to provide physiological hemodynamics. Most often, the mitral valve is susceptible to pathology, less often the aortic valve.

Classification of pathology:

• focal. There is a moderate damage to the structure of the valve apparatus;
• diffuse. The lesion area covers the valves and subvalvular space;
• cystic. It is characteristic of an advanced stage and is considered a separate pathology with the formation of cavities.

Fibrosis of the leaflets of the aortic and mitral valves is explained by the following reasons:

• age-related changes with the loss of natural collagen potential;
• rheumatic attack (especially repeated), for example, after past infections of the oropharynx. The damage is attributed to the formation of antibodies and cross-reactivity between group A streptococcal carbohydrates and cardiac valve glycoprotein. Studies have shown that nearly every 5-year-old child has a history of a throat infection. Perhaps the formation of chronic rheumatic heart disease with lesions in the form of post-inflammatory marginal fibrosis;
• Marfan's syndrome, dysplasia, in which the anatomical and functional features of the connective tissue are genetically abnormal;
• atherosclerosis of the aorta. Calcification of plaques and subsequently thickening of its wall;
• foci of necrosis (with a heart attack) or inflammation (with myocarditis) near the valve ring.

Diagnosis of fibrosis is not difficult. Initially, clinical blood and urine tests are prescribed, detecting the possible presence of inflammation. Biochemical research indicates changes in cholesterol, sugar, uric acid, total protein, creatinine levels.

Ultrasound of the heart reveals the degree of narrowing, valve insufficiency, assesses the contractile function of the myocardium, blood volume during systole.

Radiography determines myocardial hypertrophy, pulmonary congestion, calcification of valve fragments.

CT, MRI, CAG are performed if necessary, surgical intervention for the prosthetics of structures.

How does this process affect the patient's quality of life?

The symptomatology of the disease depends on which particular valve is affected by fibrosis, although some signs of pathologies may overlap. Most often, the patient does not present any complaints for a long time, his condition remains satisfactory. Deterioration of well-being is characteristic of a neglected process and the formation of complications.

If the leaflets of the mitral valve are sealed, it is noted:

• fatigue during routine physical activity, sports;
• shortness of breath at rest;
• episodes of cardiac arrhythmias in the form of extrasystole or atrial fibrillation;
• chest pain;
• periodic edema.

If the hardening of the mitral valve leaflets continues to progress in the absence or ineffectiveness of treatment, MVP occurs with varying degrees of regurgitation or without.

Fibrosis of the walls of the aortic valve causes:

• progressive shortness of breath;
• pain in the heart during exertion;
• dizziness and fainting when playing sports;
• heartbeat disorders.

Sometimes the life of a patient with valvular fibrosis is complicated by episodes of hemoptysis, asthmatic attacks, explained by hemodynamic disturbances.

In young patients, issues related to pregnancy and military service come to the fore. The first is solved individually, depending on the stage of the fibrotic process, the presence of stenosis and hemodynamic disturbances. A woman carrying a child is observed, in addition to an obstetrician-gynecologist, also by a cardiologist. Childbirth takes place by caesarean section.

The army and the possibility of playing professional sports depends on the decision of the medical commission. It is taken into account whether the pathology has led to a pronounced defect and the presence of concomitant diseases.

Treatment and follow-up of a patient with valvular fibrosis

Often on the forums you can read the question of whether fibrosis is treated with folk remedies. The answer is unequivocal: there are no such recipes. This process is quite difficult in therapy, even for modern medicine.

It is important to know that the appointment of medications is indicated only in the clinical picture of heart failure, in which they are used:

• cardiac glycosides - Celanide, Digoxin, Strofantin;
• diuretics - Trifas, Indap, Veroshpiron;
• if indicated, antihypertensive and antiarrhythmic drugs.

Medication only minimizes the symptoms caused by fibrosis without affecting the progression of the disease.

Radical treatment consists of the following methods:

• valve replacement in order to replace a diseased structure with a mechanical or biological analogue. As a rule, a median sternotomy with the use of a heart-lung machine is used;
• closed or open mitral commissurotomy with the task of dissecting pathological connections between the valve cusps;
• coronary artery bypass grafting;
• endovascular prosthetics. The essence of the method is to administer a catheter with an implant through the femoral vessels without general anesthesia. Indicated for patients with severe chronic diseases;
• valve transplant (relatively new technique).

Indications for fibrosis for surgery:

• neglect of the process;
• wrinkling of valves, tendon filaments;
• the presence of pronounced calcification.

After the operation, the patient should be under the dispensary supervision of a cardiologist. The patient is shown annual examinations and treatment in a sanatorium of a cardio or cardio-rheumatological profile.

Conclusions

Subjective symptoms, indicating a change in the work of the heart, always require a visit to a doctor. Preventive examinations are also important, allowing you to suspect in time the presence of pathological disorders in the structure of the myocardium. Especially in the case of loss of valves due to fibrous dystrophy, the ability to optimally perform their functions. In terms of the prognosis of the disease, it directly depends on the severity of the process, the age of the patient, the presence of other chronic diseases.