Defects of the valve of a pulmonary artery
Acute insufficiency of the valve of a pulmonary artery happens at an infectious endocarditis. However relative insufficiency against pulmonary hypertensia and dilatation of the basis of a pulmonary artery meets more often. Cases of inborn defect are frequent.
Stenosis of the valve of a pulmonary artery, as a rule, inborn. Massive vegetations can be the cause of the acquired defect at an infectious endocarditis, and also a carcinoid syndrome.
Acute insufficiency of the valve of a pulmonary artery is shown by a volume overload of a right ventricle and acute insufficiency on a big circle of blood circulation.
Auskultativno at insufficiency is listened short diastolic noise in the second, third mezhreberye to the left of a breast which extends to an average third of a clavicle up, follows the II tone at once, merging with it. Cardiac sounds can be invariable.
The course of chronic insufficiency of the valve of a pulmonary artery — in the absence of pulmonary hypertensia, usually asymptomatic. At its existence conditions for an overload and dilatation of a right ventricle with development of the phenomena of stagnation in a big circle of blood circulation are created.
Patients with a stenosis of the valve of a pulmonary artery at early stages are disturbed by fatigue, faints, symptoms of right ventricular insufficiency develop afterwards.
The main auskultativny sign of a stenosis of the mouth of a pulmonary trunk — the rough long systolic noise with a maximum in the second, third mezhreberye to the left of a breast, a spindle-shaped form which is carried out on the left half of a neck. The II tone on a pulmonary artery is split and weakened.
Treatment of patients with defect, the valve of a pulmonary artery
Treatment of insufficiency of the valve of a pulmonary artery is directed to prevention of an infectious endocarditis and fight against right ventricular insufficiency — diuretics and venous dilators. Prosthetics of the valve is, as a rule, carried out only at the infectious endocarditis which is not giving in to conservative treatment and in the absence of pulmonary hypertensia.
The insignificant stenosis of the valve of a pulmonary artery does not demand treatment. At the expressed isolated stenosis means of the choice is balloon valvuloplasty. Existence of blood clots in proximal departments of a pulmonary artery demands purpose of thrombolytic means and carrying out an embolectomy.