OVERVIEW
OVERVIEW
Polyvalvular disease is a condition that involves simultaneous invasion of two or more heart valves. Common combined valve diseases include mitral stenosis combined with aortic stenosis, mitral stenosis combined with aortic valve closure insufficiency, mitral closure insufficiency combined with aortic stenosis, mitral closure insufficiency combined with aortic valve closure insufficiency, and rarely triple valve lesions.
Whether medical insurance
yes
Department
Cardiovascular Medicine, Cardiac Surgery
Synonyms
Combined Valve Disease
Clinical Symptoms
Exertional palpitations, shortness of breath, dyspnea, hepatomegaly, positive hepatic jugular venous reflux sign, abdominal effusion, and other signs of stagnation in the pulmonary circulation. Diastolic rumbling murmur or systolic blowing murmur can be heard in the auscultation area of mitral valve.
Hazards
It can lead to acute pulmonary edema, and the mortality rate is extremely high if not treated in time.
Complications
Acute pulmonary edema, heart failure, atrial fibrillation, thromboembolism, etc.
Examination
Physical examination, blood routine, X-ray film, echocardiography, electrocardiogram, etc.
Diagnosis
Diagnosis can be confirmed according to the location, nature and clinical manifestations of the heart murmur, combined with the results of X-ray and echocardiography.
Treatment principle
Apply cardiotonic, diuretic and vasodilator drugs to delay or relieve the development of heart failure, and to buy time and create conditions for surgical treatment.
Curative
It can relieve the symptoms and improve the prognosis.
Dietary recommendations
Ensure high-quality protein and vitamin intake, patients with cardiac insufficiency should limit the amount of water intake, and should not consume too much or long-term food that has an effect on anticoagulant therapy.
Etiology
Etiology
One kind of disease damages several valves at the same time, most commonly rheumatic heart disease; one valve damage leads to overloading of cardiac volume or pressure, which successively causes proximal valve function involvement.
Symptoms and Diagnosis
Typical symptoms
There may be exertional palpitations, shortness of breath, dyspnea, hepatomegaly, positive hepatic jugular venous reflux sign, abdominal effusion, and other manifestations of stagnation of the body-pulmonary circulation. Diastolic rumbling murmur or systolic blowing murmur can be heard in the auscultation area of mitral valve, and systolic or diastolic murmur can be heard in the auscultation area of aorta.
Diagnostic basis
Exertional palpitations, shortness of breath, dyspnea, hepatomegaly, positive hepatic jugular venous reflux sign, peritoneal effusion, and other manifestations of stasis in the body-pulmonary circulation.2 Diastolic rumbling murmur or systolic blowing murmur can be heard in the auscultation area of the mitral valve, and systolic or diastolic murmur can be heard in the aortic auscultation area.3 Electrocardiogram (EKG) shows hypertrophy of the left and right ventricles, and ST segment and T wave abnormalities.4 X-ray examination shows increased pulmonary hemorrhage, and left and right ventricles are both enlarged, and the left and right ventricles are both enlarged, X-ray may show increased pulmonary blood, enlarged left and right ventricles, and bulging pulmonary artery segments. Echocardiography can clarify the degree of damage to each valve and is an important means of confirming the diagnosis.
Treatment
Therapeutic approach
Internal medicine is the same as for single valve damage. Surgery is the mainstay of treatment. Multivalve prosthetic valve replacement has a high risk of death and a poor prognosis, and preoperative diagnosis and clarification are essential for therapeutic decision making. For example, severe mitral stenosis can mask coexisting aortic valve disease, and if surgery is performed to correct only the former, it will result in a dramatic increase in left ventricular load, causing acute pulmonary edema and increased operative mortality. In left heart prosthetic valve replacement, if the obviously affected tricuspid valve is not operated accordingly, the postoperative clinical improvement is not good. Mitral valve insufficiency secondary to aortic valve insufficiency can be relieved after aortic valve replacement in mild cases, while more severe cases require annuloplasty. Therefore, preoperative left and right heart catheterization and cardiovascular angiography should be used to confirm the diagnosis. In some cases, such as tricuspid valve damage, the diagnosis can only be confirmed during surgery.
Drug therapy
Cardiotonic, diuretic and vasodilator drugs should be used to slow down or relieve the development of heart failure, so as to buy time and create conditions for surgical treatment.
Surgery
If the symptoms cannot be controlled by active medical treatment, surgery should be performed as soon as possible, including valve balloon angioplasty, valve repair and prosthetic valve replacement.
Prognosis
Surgical treatment can improve long-term survival and prognosis, but the risk of multi-valve surgery is relatively high compared to single-valve surgery.
Nursing care
Daily care
1. Formulate an activity plan according to cardiac function and physical condition. 2. Maintain a relaxed mood and avoid over-excitement. 3. Prevent infections and consult a regular hospital in time when infections occur. 4. Women of childbearing age who have bioprosthetic valves should wait for at least 6 months after the valve replacement surgery to stop using anticoagulant medication and have their cardiac function recovered well before they can be considered pregnant.
Dietary management
1. Eat high-calorie, high-protein and light food. 2. Avoid oily and stimulating food. 3. Eat more fresh fruits and vegetables.