pulmonary valve insufficiency
Introduction
Introduction to pulmonary valve insufficiency Pulmonary valve insufficiency, the most common cardiovascular disease, because the root extension of the pulmonary trunk caused by pulmonary hypertension causes the annulus to expand, such as rheumatic mitral valve damage, Aishengmanger syndrome, etc., rarely seen as a special hair Sexual or Marfan syndrome pulmonary artery dilatation. Pulmonary valve regurgitation is often associated with other cardiovascular diseases, especially those with pulmonary hypertension. Separate congenital pulmonary regurgitation is rare, and the degree of regurgitation is often mild and often asymptomatic. Early clinical symptoms of pulmonary valve regurgitation are palpitations, shortness of breath, prone to respiratory infections, edema in heart failure, paroxysmal dyspnea, liver enlargement, oliguria, and arrhythmia. Mild congenital valvular disease can be observed and followed up, and early rheumatic valvular disease can also be treated with drugs. Once the clinical symptoms are obvious and the heart function is reduced, surgery should be considered. basic knowledge The proportion of illness: 0.15% Susceptible people: no special people Mode of infection: non-infectious Complications: pulmonary hypertension
Cause
Causes of pulmonary valve regurgitation
Pulmonary artery dilatation (30%):
The most common disease is due to the expansion of the trunk of the pulmonary artery secondary to pulmonary hypertension, causing the annulus to expand, seen in rheumatic mitral valve disease, Eisenmenger syndrome and so on.
Primary damage (35%):
Rare causes include idiopathic and Marfan syndrome and primary pulmonary valve damage, primary lesions of the pulmonary valve are rare, can occur in infective endocarditis, pulmonary stenosis or tetralogy of Fallot, carcinoid Syndrome and rheumatic heart disease.
Prevention
Pulmonary valve insufficiency prevention
Pulmonary valve regurgitation is often associated with other cardiovascular diseases, especially those with pulmonary hypertension. Separate congenital pulmonary regurgitation is rare, and the degree of regurgitation is often mild and often asymptomatic. Seek medical attention in case of symptoms, determine the cause as soon as possible, and determine the treatment. Once rheumatism is extremely likely to aggravate the condition, it should be actively prevented. When jaundice occurs due to liver function damage caused by liver sputum, it should be checked in time to determine the nature of the lesion. When surgery is required, you should have a good time.
Complication
Pulmonary valve regurgitation complications Complications pulmonary hypertension
Pulmonary valve insufficiency results in excessive right heart volume overload. If there is no pulmonary hypertension, it can be asymptomatic for many years. If there is pulmonary hypertension, it will accelerate the occurrence of right heart failure. The main complications are pulmonary hypertension and right heart failure. And often secondary to left heart failure. At this time, the cardiac output is reduced, the systemic circulation is congested, and the venous pressure is increased, often accompanied by edema of the lower extremities, and systemic edema may occur in severe cases.
Symptom
Pulmonary valve regurgitation symptoms Common symptoms Palpitation heart sound abnormal heart murmur Heart tremor pulmonary murmur Heart expansion activity after shortness
In most cases, the clinical manifestations of primary disease are prominent, and the performance of pulmonary valve insufficiency is concealed, only occasionally found during auscultation. The signs are as follows:
First, blood vessels and heart beats
Pulmonary valve regurgitation The second intercostal space of the left sternal border and the enlarged systolic pulsation of the pulmonary artery may sometimes be accompanied by systolic or diastolic tremor. The lower left sternal border and the right ventricular high dynamic systolic pulsation.
Second, heart sounds
In patients with pulmonary hypertension, the second heart sound pulmonary valve component is enhanced. The second heart sound is broadly split. The increase in right stroke volume results in a sudden expansion of the enlarged pulmonary artery to produce a systolic jet sound, which is most pronounced in the second intercostal space on the left sternal border. The fourth intercostal space on the left sternal border often has the third and fourth heart sounds in the right ventricle, which is enhanced when inhaling.
Third, the heart murmur
Secondary to pulmonary hypertension, after the second heart sound in the first intercostal space on the left sternal border, immediately through the beginning of the early diastolic sigh-like high-profile descending murmur, enhanced during inhalation, known as GrahamSteell murmur. Due to the expansion of the pulmonary artery and the increase in the right stroke volume, there is a systolic jet murmur after the jet is injected between the intercostals of the left sternal border.
Examine
Pulmonary valve insufficiency examination
Laboratory and other inspections:
First, X-ray examination of the right ventricle and pulmonary trunk expansion.
Second, ECG pulmonary hypertension has right ventricular hypertrophy.
Third, echocardiography Doppler is extremely sensitive to the diagnosis of pulmonary valve regurgitation, which can be semi-quantitative. Two-dimensional echocardiography helps to identify the cause.
Diagnosis
Diagnosis and diagnosis of pulmonary valve insufficiency
Differential diagnosis
1. Atrial septal defect: signs of mild pulmonary stenosis, ECG findings and atrial septal defect have similarities.
2. Congenital primary pulmonary artery dilatation: The clinical manifestations and ECG changes of this disease are similar to those of light pulmonary stenosis, and the differential diagnosis is difficult. Right heart catheterization failed to find systolic pressure gradient or other abnormal pressure in the right ventricle and pulmonary artery, and there was no shunt, and X-ray showed that the total dry arc of the pulmonary artery was dilated, which is conducive to the diagnosis of this disease.
3. Fallot tetralogy: severe pulmonary stenosis with atrial septal defect, and patients with right-to-left shunt cyanosis (Faler's triad), need to be differentiated from the tetralogy of Fallot.
