The aortic valve insufficiency

The clinic. Many children with aortic valve insufficiency long time did not make any complaints, feel good and cope with physical stress, and some of them even successful in doing sports.
Patients with severe aortic insufficiency complain of shortness of breath and palpitations that occur only at first heavy physical activity, in the future they occur in a small physical stress. Shortness of breath in such patients is the first sign of failure left heart.
Sometimes children complain of pain in the heart, which may be the result of insufficient supply of oxygen hypertrophied left ventricle due to the deterioration of coronary blood flow in it. Can be complaints of General weakness and fatigue.
When a small failure of the aortic valve is the only objective symptom blemish is the presence of diastolic aortic noise (A. N. Volovik, 1948; V.S. Nesterov, 1974; C. the Ionas, 1960); in severe aortic insufficiency has a number of characteristic features, due hemodynamic disturbances.
Physical development of children, as a rule, does not suffer. In some cases, there is a pale skin, due to reflex spasm of small arteries (O. D. Sokolov-Ponomarev, E. A. Nadezhdina, 1969). When there is a sharp deficiency of the aortic valve during the inspection draws the attention reinforced ripple arteries of the neck ("dance of carotid").
Observed in adults, symptoms such as rhythmic swaying head (symptom Musset), narrowing missed during systole and the expansion of its diastole, pulsation of the liver, spleen, rhythmic expansion of the uvula and tonsils (symptom Muller), the children are not observed (A. N. Volovik, 1955; O. D. Sokolov-Ponomarev, E. A. Nadezhdina, 1969).
Palpation of the pulse often even in a small degree of defect can detect the change. He felt as pulsus celer et altus (fast and high). Such character of the pulse due to the strong ejection of blood left ventricle during systole and regurgitation some blood during diastole. A number of patients can be observed so-called capillary pulse - pathological surge arterioles, clearly visible in the form of alternating red and white waves on a hole nail after a light pressure on the free edge. At insufficiency of the aortic valve discovered characteristic changes in blood pressure: the maximum pressure may be normal or slightly increased due to the increase in stroke volume, hypertrophy of the left ventricle, and the minimum is reduced, and the degree of reduction of diastolic blood pressure proportional to the degree of failure, aortic valve, as it is determined by the degree of regurgitation of blood. In severe aortic insufficiency minimum pressure may drop to zero. Pulse pressure as a result of this increased significantly.
In healthy people with each pulse wave on large arteries heard one tone when pressing artery stethoscope is one stenotic noise. In severe aortic insufficiency in children rarely possible to determine dual tone-Traub, due to a sharp systolic extension and fast losing the arterial wall, and dual noise Durose.
When viewed from the heart can sometimes be seen strong surge in the apex; palpation - reinforced shifted down apical impulse, which is determined in the fifth, less frequently, in the fifth-sixth intercostal space. Palpation of the apex of the heart the impression that dense ball rolls and strikes at hand. Borders of relative cardiac dullness expanded left and down, and, as a rule, this extension is small. Auscultation of the heart I tone at the top is usually weakened, due to the lack period closed valves, II tone of the aorta with mild aortic insufficiency is not modified, with heavy - weakened.
Main primary symptom of the failure of the aortic valve is the diastolic noise arising from the regurgitation of blood through the damaged aortic valve. The noise starts immediately after II tone gradually decreasing towards the end of diastole. Best of all he heard in the third and fourth intercostal space to the left of the sternum (L. M. fitileva, 1962; B. X. Vasilenko, 1972; N. M. Korenskaya, 1972). A number of patients noise are well heard and in the apex of the heart, rarely manage to listen to it in the second intercostal space to the right of the sternum. Usually it happens in severe aortic insufficiency. Diastolic aortic noise is often gentle, quiet, "flowing", which creates difficulties for his capture; therefore, it must listen in silence. Sometimes the noise is best detected when listening to the patient in the standing position with tilted forward the torso.
Often in the second intercostal space to the right of the sternum systolic hum, due to the relative narrowing of blood in the mouth due to the fact that deformed thick leaf aortic valve during systole not fit to the aortic wall (C. S. Nesterov, 1974) or the relative narrowing blood mouth with the expansion of the ascending aorta (Century Ionas, 1960).
At insufficiency of the aortic valve systolic murmur may listens and above the apex of the heart. It can be either wired noise from the aorta, and the noise of the relative failure of the mitral valve in the result of the expansion of the cavity left parts of the heart with severe aortic blemish.
Sometimes over the top able to listen gentle, soft, short presistolic noise, first described in 1862 Flint and called noise of flint. Noise flint different from presistolic noise mitral stenosis by freedom from pervasive character. Concerning the mechanism of the origin of the noise, there are different points of view. Most clinicians explain its appearance relative narrowing of the left venous holes in the enlarged left ventricle (C. E. Nezlin, 1968). Others believe that the noise of flint arises due to the fact that when regurgitation of blood from the aorta to the left ventricle is blocking access from the wall of the ventricle front, aortic door of the mitral valve, causing narrowing of the mitral orifice. In children noise of flint in aortic insufficiency are heard rarely.