Most often the calcification of the aortal valve developing more often at men on average and advanced age is the reason of the isolated aortal stenosis. Usually this heart disease arises in the presence of the expressed atherosclerotic process in an aorta. Quite often its emergence is promoted by such congenital anomaly as existence of commissures (commissures) between aortal semilunums. In this case forming of an inborn dvustvorchatost and/or incomplete disclosure of shutters against which owing to the long-term injuring influence of a turbulent blood flow there is fibrosis and calcification of the aortal valve that as a result gives a picture of an aortal stenosis is possible.
The isolated aortal stenosis of the rheumatic nature meets extremely seldom whereas the combination of this defect to defeat of the mitral valve is typical for rheumatism. Also cases of forming of an aortal stenosis at patients with an infectious endocarditis at which as the reason of narrowing of a valve opening the organization of vegetation with their subsequent calcification can serve are described.
Clinical picture of an aortal stenosis
Due to high compensatory opportunities of a left ventricle the aortal stenosis remains asymptomatic for many years. Complaints appear only at late stages and are connected, first of all, with an asthma at an exercise stress which fast fatigue and bad portability of loadings joins afterwards.
Often the stenokardichesky syndrome comes to light, and only at a half of such patients coronary atherosclerosis takes place, and in other cases stenocardia is caused by discrepancy between needs of the increased left ventricle for oxygen and its real delivery in the conditions of the raised systolic prelum of coronary arteries.
Patients to the expressed aortal stenosis at an exercise stress sometimes have short-term losses of consciousness which reason the vazodilatation in the conditions of the fixed cordial emission is. Disturbances of a heart rhythm can be other cause of syncopal states.
Skin at persons with an aortal stenosis pale, pulse small and slow. Systolic, diastolic and pulse pressure is reduced. In the field of the handle of a breast clear systolic trembling is defined. The apical beat raising. Limits of relative cordial dullness are displaced to the left.
The most characteristic auskultativny sign of an aortal stenosis is existence of rough systolic noise over all surface of the heart with a maximum in the second mezhreberye to the right of a breast which is well carried out on vessels, especially on the right carotid artery. Noise has the spindle-shaped form, its duration — not less than a half of a systole.
In certain cases in the second mezhreberye the short diastolic noise merging with the II tone that can be followed by decrease in intensity of the II tone is listened on the right. These sound phenomena are caused by development of relative aortal insufficiency owing to dilatation of a left ventricle.
Sometimes noise of an aortal stenosis has a maximum on a top. Occasionally he in general is listened only on a top! In this case differential diagnosis with mitral insufficiency which is carried out by means of the phonocardiogram — in a noise form, and ultrasonic research of heart with doppler sonography is necessary.
Treatment of an aortal stenosis
Conservative therapy consists in treatment of heart failure using cardiac glycosides. In treatment it is necessary to avoid purpose of nitrates, beta-blockers, verapamil, and also an artificial diuresis. Prevention of an infectious endocarditis is carried out. In case of pregnancy at patients with a heavy aortal stenosis or at increase of symptoms of heart failure its interruption in connection with high risk of development of complications during the periods of incubation of a fruit and childbirth is shown. In other cases preservation of pregnancy in the conditions of careful control of indicators of a hemodynamics is possible.
The indication to operational treatment is emergence of the first symptoms (short wind, anginous pains, syncopal states), rough changes of the aortal valve with increase of a systolic gradient over 50 mm of mercury., signs of dilatation of a left ventricle. It is desirable to perform operation before emergence of symptoms of a left ventricular failure. At an asymptomatic current of a heavy aortal stenosis supervision over the patient is shown. As a short-term palliative measure by preparation for prosthetics of the aortal valve or at impossibility of surgical treatment, for example, on late durations of gestation, balloon valvuloplasty and intra aortal balloon counterpulsation can be used.
In case of timely operational treatment of an aortal stenosis (at the kept function of a left ventricle) the survival during 5 flyings makes about 85%, 10-year-old — about 70%.