Heart "valve" is sick, don't easily "abandon"

What is the connection between rheumatic heart disease and rheumatism in the traditional sense?

Rheumatic diseases are caused by streptococcus infection in the human body, resulting in secondary infections. Streptococcal infections are quite special. After the body produces antibodies, some bacteria can be suppressed, but for streptococcal humans, they may accidentally hurt their own tissues while destroying these foreign objects. In medical terms, it is called an autoimmune disease tendency. Rheumatic disease is actually such a disease. It destroys foreign tissues and destroys its own tissues due to the production of antibodies in the body. If this damage accumulates in the joints, we call it rheumatoid arthritis. When it accumulates in this heart, we call Rheumatic heart disease, and the most common one that accumulates in the kidney, is called glomerulonephritis. Therefore, rheumatic heart disease is actually an immune response caused by the human body after the secondary infection of the bacteria, but at the same time it destroys the bacteria and affects its own image and tissue.

What is rheumatic heart valve disease?

　　Rheumatic heart disease mainly includes rheumatic myocarditis, which destroys myocardial cells. The heart is composed of four chambers, just like four rooms; and there must be doors between the houses. The heart is between each room and between the heart and the large blood vessels of the body. It has a door to check. These doors are equivalent. To the valve. It basically functions as a one-way valve. Blood enters another room or big blood vessels from this room. Under normal circumstances, the door should be fully opened to allow the blood to flow smoothly. The door must be closed to prevent the blood from flowing back and back, which is the function of the heart valve.

　　Since it is the effect of a one-way valve, all of its lesions will be nothing more than two aspects. One is that it cannot be opened, and the blood will form an obstacle after passing. phenomenon. In rheumatic valvular disease, the most common is mitral valve disease. The left heart has two rooms, one is the left atrium, and the other is the left ventricle. The door between the left atrium and the left ventricle is the mitral valve. Rheumatic diseases are mainly stenosis, which means that the blood does not flow smoothly. It is mainly due to the invasion of rheumatic lesions, causing lesions to appear in the place where the two doors are combined. After the lesions, it gradually appears that the leaflets thicken and form some scars, which will cause the doors to stick together and fail to open. Will be blocked. At the same time, there are also incomplete closures, which are mixed and coexist on both sides.

　　Rheumatic valvular disease is clinically manifested mainly by stenosis and inability to circulate blood. The blood in the left atrium is blocked from entering the left ventricle. Just like the upstream, when the water flow in the upstream is blocked, it will accumulate in the upstream. For the heart, it causes blood in the atrium to accumulate here, because an increase in volume will cause the atrium to expand and also cause increased pressure in the atrium. The left atrium receives blood from the lungs. After inhaling oxygen through the lungs, the blood is oxygenated in the lungs. The oxygenated blood enters the left atrium, and then reaches the body through the left ventricle and aorta. When left atrium pressure is very high, blood access to the lungs can also be difficult. Therefore, patients with rheumatic valvular disease have a very big characteristic is that radon will appear after activity. This is because after the blood is blocked, in addition to the atrial blockage, the lungs will also be blocked by blood, and the oxygenation function will be reduced. Therefore, basically, the patient with rheumatic valvular disease has a decreased activity tolerance.

What are the clinical manifestations of rheumatic heart disease?

　　Rheumatic valvular disease is clinically manifested mainly by stenosis and inability to circulate blood. The blood in the left atrium is blocked from entering the left ventricle. Just like the upstream, when the water flow in the upstream is blocked, it will accumulate in the upstream. For the heart, it causes blood in the atrium to accumulate here, because an increase in volume will cause the atrium to expand and also cause increased pressure in the atrium. The left atrium receives blood from the lungs. After inhaling oxygen through the lungs, the blood is oxygenated in the lungs. The oxygenated blood enters the left atrium, and then reaches the body through the left ventricle and aorta. When left atrium pressure is very high, blood access to the lungs can also be difficult. Therefore, patients with rheumatic valvular disease have a very big characteristic is that radon will appear after activity. This is because after the blood is blocked, in addition to the atrial blockage, the lungs will also be blocked by blood, and the oxygenation function will be reduced. Therefore, basically, the patient with rheumatic valvular disease has a decreased activity tolerance.

What are the common treatments?

　Rheumatic valvular disease is divided into three levels of mild, moderate and severe. Generally speaking, patients with moderate or higher symptoms will have obvious symptoms, and our medication can only relieve the symptoms. For example, diuretics relieve the symptoms of palpitation or shortness of breath, but this does not relieve the degree of stenosis or the degree of insufficiency. So far the whole world has to be solved by surgery. This is the best treatment and the best long-term effect.

　There are two types of surgical treatment. The first is the replacement of the artificial valve. After the disease, we remove the diseased door and replace it with an artificial valve. This is the artificial valve replacement. Another approach is to preserve the patient's original valve structure. The door ca n’t open and stick together, we separate the sticking places; some places are thickened, which causes the leaf leaf movement to decrease. We remove the thickened places so that the door can return to the range of motion and solve the blood flow These abnormalities, so this method is called repair, professionally called plastic surgery.

What is the difference between mitral angioplasty and mitral valve replacement?　

 There are two types of surgical treatment. The first is the replacement of the artificial valve. After the disease, we remove the diseased door and replace it with an artificial valve. This is the artificial valve replacement. Another approach is to preserve the patient's original valve structure. The door ca n’t open and stick together, we separate the sticking places; some places are thickened, which causes the leaf leaf movement to decrease. We remove the thickened places so that the door can return to the range of motion and solve the blood flow These abnormalities, so this method is called repair, professionally called plastic surgery.

At present, what is the status of these two types of surgery in China?

  So far, rheumatic valvular disease is estimated nationwide, with an estimated 7 million or more patients with moderate lesions. The number of patients who should enter the scope of surgical treatment each year is estimated to be in the millions. During the treatment of rheumatic valvular disease in China, the proportion of artificial valve replacement is very high. Rheumatic valvular disease currently has a higher incidence in developing countries. For the promotion of valve repair in China, I think there are several reasons. First, we have not done enough in the methods and training of rheumatic valvular surgery, and we may have a wrong view of rheumatic valvular disease. For example, repair surgery, rheumatism will not occur after repair, although the valve is repaired, but there is continuous etiology damage, repair is equal to Bai Xiu, this concept is wrong.

　Technically speaking, valve repair surgery has higher requirements and learning curve for doctors than replacement surgery. Replacement surgery is relatively routine, and the conditions encountered in repair surgery are diverse. The degree of valve damage to patients varies, and there can be many types of lesions, requiring a doctor to have a special grasp and study of repair surgery techniques. In recent years, I have summarized some methods of rheumatic valvular disease repair, and made it easier to teach and easier to understand.

　Thirdly, we should educate and popularize patients on the concept, so that everyone knows why repairs are needed. From the perspective of the heart anatomy, the mitral valve device is very important for the function of the left ventricle. The heart has four rooms. Generally speaking, everyone's heart function is based on the left ventricle function as the most important platform. The mitral valve is the most important structure in the left ventricle, so when the prosthetic valve is replaced, it will destroy the structure. Since the prosthetic valve is a fixed suture frame after prosthetic valve replacement, the related motion will disappear. When this door is removed, even the building supporting it will be cut off. Therefore, the most important thing for artificial valve replacement is to damage the entire structure of the mitral valve device. The contraction function gradually goes down.