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دریچه ی شریان ریوی، کمتر از سایر دریچه های قلبی تحت تأثیر روماتیسم قلبی و آندوکاردیتعفونی قرار می گیرد. شایع ترین ناهنجاری اکتسابی این دریچه شریان ریوی قلب ، نارسایی آن است که ثانویه به اتساع حلقه دریچه مزبور در نتیجه فشار خون  شدید ریوی به وسیله عمل جراحی یا تخریب آن در اثر آندوکاردیت باکترایی موجب نارسایی قلبی نمی شود مگر آنکه پرفشاری جدی ریوی نیز موجود باشد. انسداد در مسیر عبور خون از بطن راست ممکن است در قسمت بالای دریچه ای یا زیر دریچه ای یا به صورت مخلوطی از این موارد موجود باشد.

تنگی دریچه شریان ریوی قلب در چند قسمت از سرخرگ های ریوی محیطی از یافته های بیماری جنینی ناشی از سرخجه است. بیماری تنگی دریچه شریان ریوی قلب شایع ترین فرم انسداد مجزای بطن راست است.

تنگی دریچه شریان ریوی یا هیپر تانسیون ریوی عبارت است از افزایش ممتد فشار شریان ریوی (PAP) بیشتر از ۲۵ میلی متر جیوه در حالت استراحت (نرمال ۲۰-۱۰میلی متر جیوه) یا افزایش بیش از ۳۰ میلی متر جیوه در حالت فعالیت (نرمال ۳۰-۲۰ میلی متر جیوه ) این فشارها به صورت مستقیم و همانند فشار خون سیستمیک قابل اندازه گیری نیستند و باید در حین کاتتریزاسیون طرف راست قلب اندازه گیری شوند . در صورت نبود این اندازه گیری ها ، شناخت بالینی شرایط بیمار ، تنها شاخص هیپرتانسیون ریوی است .

تنگی دریچه شریان ریوی به دو فرم ( ایدیوپاتیک) اولیه و ثانویه تقسیم می شود . تنگی دریچه شریان ریوی ثانویه معمولا نتیجه بیماری قلبی یا ریوی است (مانند: بیماریهای مزمن انسدادی ریوی ، پلورال افیوژن ). علل تنگی دریچه شریان ریوی اولیه ناشناخته است . بیشتر در بالغین جوان ۴۰-۳۰ ساله رخ می دهد . در زنان بیشتراز مردان وجود دارد. شرایط پیشرونده منجر به نارسایی قلب راست و دیس پنه شدید می شود.

علایم تنگی دریچه شریان ریوی

بیماران مبتلا به تنگی دریچه شریان ریوی قلب خفیف معمولاً بدون علامت هستند و بیماری انها با افزایش سن پیشرفت نمی کند یا کمی تشدید می یابد. در تنگی های شدیدتر ممکن است بیماری با گذشت زمان افزایش یابد. خستگی، تنگی نفس، نارسایی بطن راست و سنکوپ ممکن است موجب محدود شدن فعالیت بیماران مسن تر مبتلا به تنگی دریچه شریان ریوی قلب شود. در انسداد شدید و تنگی دریچه شریان ریوی قلب ، ممکن است فشار خون سیستولیک در بطن راست بیشتر از بطن چپ شود.

در فرم متوسط تا شدید علامت اصلی و معمولا تنها علامت تنگی نفس است . تنگی نفس ابتدا هنگام فعالیت و بعدا در زمان استراحت نیز ظاهر می شود . درد زیر جناغ شایع است که در ۵۰ - ۲۵% بیماران دیده می شود . سایر علائم شامل  درد قفسه سینه مشابه آنژین ، تپش قلب ، ضعف عضلانی ، سرفه غیر موثر ، علائم نارسایی طرف راست قلب شامل ادم محیطی ،آسیت ، اتساع ورید های گردنی، احتقان کبد ،رال و سوفل قلبی ، کلابینگ می باشند .

تشخیص تنگی دریچه شریان ریوی

معمولاً با الکتروکاردیوگرافی (ECG) می توان میزان انسداد در مسیر برون ده بطن راست و تنگی دریچه شریان ریوی قلب را اندازه گیری کرد. اکوکاردیوگرافی دو بعدی فرم ظاهری دریچه ی ریوی را نشان می دهد و به وسیله ی سونوگرافی داپلر می توان گرادیان فشار جریان خروجی را تخمین زد.

درمان تنگی دریچه شریان ریوی

هدف از درمان تنگی دریچه شریان ریوی برطرف کردن اختلال قلبی یا ریوی است . اکثر بیماران با تنگی دریچه شریان ریوی اولیه در حال استراحت هیپوکسی ندارند اما در هنگام فعالیت به اکسیژن نیاز دارند. درمان شناخته شده ای برای تنگی دریچه شریان ریوی وجود ندارد . با درمان حمایتی و تجویز اکسیژن هیپوکسی کاهش پیدا می کند . در بیماران با نارسایی شدید بطن راست کاهش برون ده قلبی و سیر پیشرونده بیماری در حالت استراحت نیز به اکسیژن نیاز است . اکسیژن درمانی مناسب ، انقباض عروق را معکوس می کند و تنگی دریچه شریان ریوی را در زمان کوتاهی کاهش می دهد .

اغلب در درمان تنگی دریچه شریان ریوی قلب ،روش بالون والوولوپلاستی مؤثر واقع می شود. انسداد متوسط تا شدید ناشی از تنگی دریچه شریان ریوی قلب را می توان با درمان جراحی برطرف کرد. معمولاً تنگی های متعدد سرخرگ های ریوی محیطی غیر قابل جراحی هستند ولی تنگی دریچه شریان ریوی قلب یک شاخه ی منفرد یا تنگی واقع در محل دو شاخه شدن تنه ریوی اصلی با درمان جراحی قابل اصلاح است.

درصورت وجود مشکلات قلبی درمان شامل محدودیت مایعات ، داروهای مدر برای کاهش تجمع مایع است و گلیکوزیدهای قلبی (دیژیتال ها ) به منظور بهبود عملکرد قلب است . اساس درمان دارویی وازودیلاتورتراپی است وخط اول وازودیلاتورهای مورد استفاده کلسیم بلوکرها شامل نیفیدپین و دیلتیازم است . در هیپرتانسیون ریوی اولیه وازودیلاتورها از موفقیت متغیری بر خوردارند ممکن است به علت خطر آمبولی ریوی مزمن از ضد انعقادهایی مثل وارفارین استفاده شود .

آشنایی با تنگی دریچه ریوی در نوزادان (کلیک کنید)

منبع : کتاب بیماری های قلبی

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