Treatment of tricuspid valve insufficiency in children in Israel

The movement of blood flow from one chamber of the heart to another occurs in one direction. The reverse movement is prevented by valves (bicuspid and tricuspid), which close during systole. Incomplete closure of the atrioventricular orifice between the ventricular and atrial cavities leads to disruption of blood regulation, the severity of which varies from asymptomatic to severe.

Characteristic ailments: weakness, rapid heartbeat, pressing pain in the heart, shortness of breath, cyanosis.

In Israeli clinical treatment of children with tricuspid valve dysfunction is carried out in accordance with the established degree and is aimed at eliminating heart failure.

Statistics and prognosis for the treatment of tricuspid valve insufficiency in children in Israel

Defective valve function detected in the first years of life is most often a congenital anomaly (organic) and, as a rule, not isolated.

The acquired form (relative or functional, not associated with deformation of the valve leaflets) is caused by diseases that result in the development of rheumatic pathologies. Such a lesion is recognized in 15–30% of cases.

A child with severe tricuspid valve insufficiency, especially in combination with other severe myocardial pathologies, develops serious complications that require immediate treatment, which is successfully carried out in the best clinic in Israel, Hadassah . In addition, corrective or therapeutic measures are required for all types of congenital heart disease.

The prognosis of therapy depends on the severity of reverse blood flow (there are 4 degrees), damage to the myocardium itself, and the severity of associated complications. The rich experience and professional skills of the doctors at our medical center allow us to adequately assess the condition of a small patient and, if appropriate, select effective drug treatment. But the prospects of the technique are considered short-lived, since the medicinal effect can stabilize well-being, without excluding the progression of the disease. The mortality rate remains high.

Without timely assistance from cardiac surgeons, not only stagnation in the body, but also irreversible processes can develop.

Open heart surgery carries an increased risk but has a better prognosis. Mortality after surgery is 1–3%, and for plastic surgery this figure is lower than for prosthetics (about 14% of the total).

2.Why does mitral regurgitation occur?

The mitral valve is a kind of valve that separates the left atrium from the ventricle. Due to various factors that impair its functioning, the valve does not fit tightly enough to the walls of the ventricle. As a result, the two connecting plates - components of the valve - cannot effectively block the reverse flow of blood, placing additional stress on the heart to normalize the circulation of blood flow. This phenomenon does not pass without leaving a trace on the human body. The consequences of mitral valve regurgitation can include diseases such as arrhythmia, heart failure and endocarditis.

There are two main forms of mitral regurgitation: chronic and acute. Let us consider in more detail their differences and features of the course.

• Acute mitral regurgitation.
  Acute regurgitation of the mitral valve occurs against the background of various cardiac pathologies: dysfunction or rupture of the papillary muscles, acute rheumatic fever, infective endocarditis, rupture of the mitral valve leaflets, dilatation of the left ventricle. Acute regurgitation develops instantly. Due to possible severe bleeding caused by rupture of cardiac tissue, it can be life-threatening.
• Chronic mitral regurgitation.
  The causes of chronic regurgitation of the mitral valve are also associated with heart diseases - mitral valve prolapse, expansion of its ring. The chronic form of regurgitation is much more common than the acute form. It is characterized by slow and gradual development, so the disease is most often diagnosed in older people.

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Symptoms and diagnosis of tricuspid valve insufficiency in children in Israel

The etiology of tricuspid valve dysfunction differs into primary and secondary, that is, congenital (organic) and acquired (functional). In the first case, the valve leaflets are affected, they become deformed, wrinkled or calcified. In the second, the valve apparatus is damaged (papillary muscles, chordae tendineae, fibrous ring).

Signs of tricuspid insufficiency:

• blue-yellow complexion;
• puffiness;
• dyspnea;
• cardiopalmus;
• rapid fatigue with low load;
• pain and feeling of heaviness in the right hypochondrium;
• pulsation of neck veins;
• flatulence;
• nausea, vomiting.

In addition to external symptoms, the patient exhibits stagnation in the circulatory system, which is manifested by the accumulation of fluid in the pleural cavity, edema, ascites, and enlarged liver.

Before starting an instrumental or hardware study, the cardiologist conducts a physical examination, analyzes the nature of complaints of malaise and inquires about previous diseases.

The whole process takes from 3 to 7 days. The diagnostic findings brought with you are reviewed, after which an additional check is performed. The laboratories of the Hadassah MC are equipped with high-precision equipment, which eliminates false diagnoses. Often, previously identified pathology is not confirmed.

The following are prescribed for examination:

• Auscultation - listening allows you to determine the heart tone and the presence of arrhythmia.
• Electrocardiogram (ECG) - determines hypertrophy or overload of the right heart chambers, rhythm and conduction disturbances (AV block, tachycardia, atrial fibrillation), the size of the right atrium and ventricle.
• Phonocardiogram - reveals systolic murmur.
• X-ray - detects changes in the size of the atrium and vena cava.
• Echocardiography (EchoCG) is an ultrasound method for recognizing regurgitation, morphological and functional changes in the myocardium and valvular apparatus accompanying congenital heart disease.
• Computed tomography (CT) - the study allows you to study the organ from different angles, accurately visualizes all parameters, and, if necessary, displays a section in any plane.

The completeness of the clinical picture is complemented by the collection of tests (CBC, OAM, biochemical and immunological tests), which can indicate the inflammatory process, deviations from standard indicators in case of damage to internal organs, the content of antibodies and C-reactive protein.

After studying the results of the diagnostic course, the medical council draws up a treatment plan.

Characteristic symptoms

Manifestations depend on the stage of the pathological process. A hemodynamically insignificant variety has no signs at all.

Typical signs in other situations include:

• Liver lesions. They make themselves known in the later stages. They are determined by pain in the right hypochondrium, an increase in the size of the organ, and yellowness of the skin due to excess bilirubin. A gradual formation of insufficiency is possible.
• Abdominal pain of unknown localization. Wandering, radiating to the iliac regions. Acute discomfort is not typical, therefore it is impossible to confuse it with the clinical picture of appendicitis.
• Shortness of breath for no apparent reason. It develops first against the background of intense physical activity, then occurs in a state of complete rest. Significantly reduces quality of life.
• Polyuria. As a result of developing renal failure. At later stages (3-4), with primary damage to the excretory system, it is replaced by a reverse process. Daily diuresis is 500 ml or less.
• Tachycardia. The heart rate reaches 120-150 beats. They are full-fledged, regular. Type - sinus. Less often paroxysmal.
• Weakness, lack of ability to work.
• Feeling of constant cold. The patient freezes because the intensity of peripheral circulation decreases.
• Increased pressure in the veins. Objectively, the symptom is manifested by swelling of the cervical vessels, their intense pulsation, and visible tension. Not only the doctor, but also the patient himself or the people around him can determine the sign. However, blood pressure drops in most cases. Not significant, however, clinical significance is present.
• Swelling of the lower extremities. As a logical continuation of increasing renal failure.
• Breathing problems.

As a result, the patient has a whole range of symptoms from both distant organs and systems, and the cardiac structures themselves. The reason for all the sensations lies in the disruption of blood circulation, both in the large and in the small circle.

Modern methods of treating tricuspid valve insufficiency in children in Israel

The pediatric cardiology department at Hadassah is headed by Dr. Azariah Rein. After receiving higher medical education at the Hebrew University, he trained at the Shaare Zedek Clinic. After receiving his degree, he became a university professor in Jerusalem and Harvard. Permanent member of the Academic Council of Israel, engaged in scientific research.

Cardiac surgery is under the direction of Professor Eldad Erez, holder of two higher qualifications, specializing in the treatment of congenital defects in children. The future doctor of medicine's internship took place in Haifa and Beilinson, his residency in Atlanta (USA), where the doctor mastered the technology of heart transplantation. Erez teaches medical students in Tel Aviv and Jerusalem, and is the author of scientific works.

The first day after hospitalization in the hospital is reserved for examination, medical history, and documentation in Hebrew. Throughout the entire stay in the hospital, the little patient and his parents are accompanied by a Russian-speaking consultant.

Treatment for tricuspid valve insufficiency in children is selected strictly on an individual basis and depends on the degree of regurgitation of blood flow (1, 2, 3 or 4):

• 1 - subtle throw or touch of the tricuspid valve;
• 2 — reverse ejection is determined at a distance of 2 cm from the atrioventricular opening;
• 3 — return of blood from the right ventricle to a distance of more than 2 cm;
• 4 - regurgitation in the right atrium over a significant extent.

The first stage may be limited to medical observation or conservative therapy. Starting from the second, the nature of the intervention will depend on the intensity of casting, complications caused by the defect, and the presence of combined anomalies.

Elimination of the defect and the consequences of improper functioning of the heart is carried out through medication or surgery.

Drug therapy

The conservative approach includes drugs that ease the work of the heart and reduce pulmonary hypertension. This list includes diuretics, anticoagulants, b-blockers, glycosides, drugs that increase metabolism, and ACE inhibitors.

Surgical intervention

The main types of surgical techniques are repair of the patient's own valve or prosthetics using a bioprosthesis or a mechanical analogue.

Indications for prosthetics are considered to be severe changes in the valves. The material for the manufacture of a biological prosthesis is the aorta of an animal (pig). Unlike a mechanical one, a bioprosthesis significantly reduces the development of thromboembolism, but lasts only 10 years, requiring repeated replacement.

Preference is given to plastic correction, but only if no pronounced changes in the structure of the valves are detected. The obvious advantages of this procedure are minimal postoperative complications and a reduction in the rehabilitation period. In addition, restoration using one’s own, normally functioning tissues increases resistance to infections and eliminates the need for constant use of special medications.

1.What is mitral valve regurgitation?

​Mitral valve regurgitation

characterized by an unnatural flow of blood from the left ventricle into the left atrium during
systole
- contraction of the heart muscle.

When the heart valve is working properly, blood moves from the atrium to the ventricle. Against the background of rheumatic fever, dilation of the mitral valve ring, ischemic dysfunction of the papillary muscles and other unfavorable factors, the direction of blood flow changes in the opposite direction.

According to statistics, about 70% of the world's population is affected by mitral regurgitation. Minor manifestations of this pathological process can occur even in absolutely healthy people.

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Rehabilitation after treatment of tricuspid valve insufficiency in children

The recovery period takes place in the specialized rehabilitation department of the Hadassah MC. They use a modern approach and innovative technologies that promote a speedy recovery and return to a full life.

To prevent negative consequences upon discharge, Israeli cardiologists recommend following certain requirements:

• follow all doctor's instructions;
• refuse self-medication;
• exclude independent withdrawal of medications or changes in their dosage;
• After complete recovery, start hardening the child.

The equipment of the rehabilitation center allows both children and their accompanying persons to stay comfortably in our institution.

Forecast

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Depends on the stage and nature of therapy.

• At the first stage, the survival rate is 100%, especially if there is no progression of the condition.
• The second is associated with a probability of 85%.
• Third - 45%.
• The fourth or terminal puts an end to the patient, giving no chance. The median is 1-2 years, often even less.

When carrying out complex therapy, it is possible to stabilize the conditions of even the most severe patients, prolonging life for several years.

Favorable prognostic factors:

• Period of youth.
• Absence of somatic pathologies, bad habits, complications after the operation.
• Good family history.
• Response to treatment.
• Reduction of symptoms.

Determining the possible outcome falls on the shoulders of the cardiologist. In order to say anything concrete, you need to at least carry out a full diagnosis.

How much does it cost to treat tricuspid valve insufficiency in children in Israel?

Hadassah is considered one of the best medical institutions in Israel. The most effective methods for recognizing and combating children's heart defects are being developed and implemented here; qualified senior and mid-level physicians work here.

The administration of the medical complex has a competitive pricing policy, so our cost of stay is average across the country and is 20–30% lower than in Europe and America. In addition, all prices are controlled by the Israeli Ministry of Health.

How to get treatment in Israel

By choosing our multidisciplinary complex, you get the opportunity to visit the right specialists and undergo all types of diagnostics in one place. Our own developments and exchange of experience with foreign partners make our clinic one of the best in the world.

To avoid the costs of intermediaries, use our official website. You can submit a request to visit the children's cardio center by filling out an electronic form. A Russian-speaking representative of the international department will contact you within two hours and answer all questions.