Metrolina-tricuspid and Microline-aortic-tricuspid vices

Metrolina-tricuspid combinations were observed in children is not often. According to Century A. Chernogubov (1950), they are defined by 9.8%. The greatest difficulties arise in recognition of the defeat of valves, when there is a combination of mitral valve stenosis tricuspid valve (I. A. Cashiers and G. I. Cashiers, 1964; candidate of Joldak and E. wolf, 1964; L. M. fitileva, 1968; C., Shcherba, 1968; G. I. Cashiers, 1972; B. the Ionas, 1960; Lenzi e a, 1958; Moncada and E., 1963).
These difficulties, according to the authors, connected with the interference of the sound of the left and right sides of the heart. According to G. I. Tsukerman (1969), diastolic tricuspid noises are only 45% of patients and according to S., Shcherba - 98%. Melody same mitral stenosis, as a rule, difficulties in the diagnosis did not cause.
R. D. Bagirova (1975) reported 7 patients metrolina-tricuspid stenosis observed it BUT among patients who have been produced mitral comissurotomy. In these patients was determined before the operation "early" presistolic noise. Noise tricuspid stenosis were heard all over precardiac area. It was noted dominant pattern tricuspid stenosis. Melody same mitral valve manifested no noise, only three member rhythm.
In the diagnosis of such complex combinations of vices help data electrocardiographic studies. Picture tricuspid stenosis characterized by severe hypertrophy and dilation of the right heart L. A. Barsky and S., Shcherba, 1965; G. I. Dekhtyar, 1972; B. M. Sadovska, I. G. Nikitin, 1976; B. the Jonash. 1960; M. G. Santucci and, Bono, 1966).
Metrolina-aortic-tricuspid vices (triple defects) are observed more frequently than metrolina-tricuspid combination: according to I. A. Cashiers and G. I. Cashiers (1972)-by 10.9%. C. E. Nezlin in the Institute of cardiovascular surgery watched 32 patients with a similar combination. R. D. Bagirov described the combination metrolina-aortic-tricuspid stenosis in 3 patients.
Triple heart disease is a very serious illness. The clinical picture varies depending on the extent and nature of the defeat of each of the valves. In cases of triple Vice sooner develop severe hemodynamic disorders in which there is a decrease in minute volume of blood circulation. Early appear signs of hypertension in the pulmonary circulation, although less pronounced than in the "clean" mitral stenosis. Quite early develops signs of stagnation of blood in the pulmonary circulation. Children usually enter the hospital in a state of decompensation. The essential help in the diagnosis provide additional methods: electrocardiography, phonocardiography, x-ray, sometimes elektrokhimicheskoe study. In complex cases, for topical diagnostics blemish in the absence of contraindications recommended to resort to methods of cardiac catheterization and angiocardiography.
Forecast the combined heart defects in children less favourable than in isolated lesions valves.
Concerning the most favorable, in the opinion of pediatricians (A. N. Volovik, 1955; E. A. Gornitzka, 1964; O. D. Sokolov-Ponomareva, 1969), is a combination of the aortic and mitral regurgitation.
The most unfavourable is the combination of aortic vices with stenosis of the left atrioventricular holes, especially with the prevalence of the latter. This quite early develops decompensation blemish: expand right half of the heart and the blood pressure increases in the veins of the systemic circulation. Clinically develop cyanosis, dyspnea, enlarged liver and spleen, appear ascites, edema.
In cases of prevalence of aortic blemish leading in the development of decompensation is the weakening of the function of the left ventricle. Clinically, it appears first shortness of breath, stagnation in the lungs, and then join the signs of decompensation in a large circle circulation.
Extremely unfavorable prognostic are triple-defects - metrolina-aortic-tricuspid, especially at the prevalence of tricuspid stenosis.