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Endocardiac calcification

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Endocardiac calcification
Diagnosis
Treatment of endocardiac calcification

Endocardiac calcification is a pathological adjournment of calcium in various intracavitary structures of heart — the fibrous bases of valves, shutters of valves, chordal threads and pristenochny sclerous thickenings of an endocardium. The greatest clinical value has calcification of valve structures of heart (calcification of valves).

Calcification of valves of heart is the frequent pathology getting great value in development and progressing of heart diseases.

Despite considerable distribution of calcification and its quite often heavy manifestations, this pathology in most cases during lifetime of patients is not distinguished and quite often is only a section find. At the same time masks of calcification of valves of heart are wrong diagnoses of rheumatism, a cardiosclerosis, idiopathic hypertensia, etc. Therefore clinical studying of calcification — an actual problem.

Special researches show that calcification of valves of heart can be distinguished during lifetime of patients. At the same time its timely diagnosis allows to avoid diagnostic mistakes in many cases and to carry out by the patient adequate treatment

Calcification of valves of heart should be subdivided on primary and secondary.

Primary — essential (idiopathic), with an unspecified etiology, apparently, nonspecific character. At the same time the expressed dependence of primary calcification on age of patients is noted.

Primary calcification of heart as age degenerative process — a heavy sign of aging of heart. Especially often this pathology occurs at women of senile age and is described sometimes as "an illness of elderly women".

Secondary calcification results from inflammatory process — usually known etiology, and also at dystrophy of valves because of their congenital anomaly of development.

The reasons of primary endocardiac calcification are finally not studied, but they are not specific and are not connected with any specific nosological form.

Calcification of fabrics is a result of any their destruction, both inflammatory, and noninflammatory, especially at blood supply disturbance. Most often calcification develops in the necrotic centers. At the same time physical and chemical properties of fabric with accumulation of an alkaline phosphatase and other enzymes catalyzing education and loss of salts of calcium in the necrosis centers change.

Blood clots, focal necroses of vascular walls and other impractical fabrics are exposed to calcification. Calcification is promoted by a lipoidosis of fabrics with decomposition of ethers of cholesterol on free cholesterol and fatty acids which react with calcium ions, turning them into compounds of lime.

The lipoidosis, fibrosis and calcification appear in places of the greatest load of heart valves in the field of their basis and in adjacent sites of shutters. The lipoidosis often precedes calcification, and acts not as the calcification reason, and as its prestage indicating a fabric degeneration.

Calcification can form also without participation of lipids — as a result of change of physical and chemical properties of fabric and blood with loss of calcium on the collagenic fibers which underwent dystrophy. Pathological process of calcification can be similar to a physiological osteogenesis. At primary calcification of the aortal valve morphologically it was possible to note bone sites even with formation of marrow.

Calcification of valves of heart is an age degenerative process which is noted by 40 — 50 years of life and further spontaneously progresses. Progressing of calcification is promoted by primary deformation of the valve as a result of its sklerozirovaniye with a lipoidosis, fibrinferments and local disturbance of a hemodynamics.

The clinical picture of calcification of mitral and aortal valves is not specific, diverse, a little studied and usually proceeds behind a mask of other "usual" cardiovascular pathology. There are no pathognomonic manifestations of calcification of valves.

Signs of secondary (rheumatic) and primary (not rheumatic) calcification of the mitral valve according to morphological data

Signs

Rheumatic calcification

Nerevmatnchesky calcification

Involvement of shutters of the valve

More often both

To thicket of one

Calcium localization:

 

 

macroscopically

In shutters, throughout, is closer to commissures

In the basis of shutters is closer to
to fibrous ring

microscopically

Mainly in a spongy layer it is (more superficial)

Mainly in a fibrous layer it is (deeper)

Merge of shutters
on commissures

It is expressed

It is not expressed

Warts on shutters

Often on edge of the valve

No

Change of chords

Are shortened, thickened, soldered to shutters

Are not changed

Calcification in the field of a valve ring

It is not expressed

It is sharply expressed

Mitral stenosis

Often

Seldom

Combination of defects
different localization

Often, especially mitral with
aortal

Seldom: the isolated aortal stenosis is characteristic

 



 
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