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در نارسایی دریچه آئورت ، خون در مسیر معکوس در طول دیاستول بطنی، از آئورت به بطن چپ جریان پیدا می کند.

علل نارسایی دریچه آئورت

نارسایی دریچه آئورت ممکن است در اثر بیماری اولیه دریچه ی آئورت یا ریشه ی ائورت (محل شروع سرخرگ آئورت) یا هر دو ایجاد شود. ناهنجاری برگچه های دریچه ی آئورت ممکن است ثانویه به بیماری روماتیسمی، ناهنجاری مادرزادی یا آندوکاردیت قبلی باشد. علاوه بر این نارسایی دریچه آئورت به طور شایع در نتیجه تنگی دولَتی و استحاله ای دریچه آئورت ایجاد می شود. اختلال در ریشه ی سرخرگ آئورت همراه با اتساع و حلقه ای بودن ریشه این سرخرگ ممکن است موجب جدا شدن و / یا افتادگی (پرولاپس) برگچه های دریچه آئورت شود. حدود نیمی از موارد نارسایی دریچه آئورت در اثر اتساع ریشه آئورت ایجاد می شوند که در بیش از۸۰ درصد بیماران مبتلا ه نارسایی دریچه آئورت علت شناخته شده ای ندارند، ولی بقیه موارد به دلیل افزایش سن و فشار خون بالا، سندرم مارفان، گسیختگی آئورت و سیفلیس به وجود می آیند. نارسایی دریچه آئورت در بعضی موارد در اثر مصرف داروهای مهار کننده بازجذب سروتونین، به ویژه داروهای حاوی ایزوتوپ های فن فلورامین یا دِکسفن فلورامین و آگونیست های دوپامین ایجاد می شود.

انواع نارسایی دریچه آئورت

نارسایی دریچه آئورت ممکن است حاد یا مزمن باشد.

نارسایی دریچه آئورت حاد

در نارسایی دریچه آئورت حاد، که در سوراخ شدن حاد دریچه ی آئورت در اثر آندوکاردیت روی می دهد، افزایش ناگهانی در حجم خون بطن چپ ایجاد می شود و در نتیجه افزایش بعدی در حجم خون موجب کاهش پیشرونده کارایی انقباض بطن چپ می شود و فشار پر شدن بطن چپ افزایش می یابد و این امر موجب افزایش فشار دهلیز چپ می شود و در نتیجه، بیمار مبتلا به نارسایی دریچه آئورت دچار تورم (اِدِم) ریه خواهد شد. نارسایی دریچه آئورت حاد شدید، یک اورژانس پزشکی است و در صورتی که فوراً برای بیمار مبتلا به نارسایی دریچه آئورت حاد با استفاده درمان جراحی، دریچه جدید گذاشته نشود به احتمال زیاد منجر به مرگ خواهد شد.

چنان چه نارسایی دریچه آئورت حاد ناشی از آندوکاردیت دریچه ی آئورت باشد، احتمال ضعیفی وجود دارد که دریچه ی جدید نیز به وسیله ی باکتری عامل آندوکاردیت دچار عفونت شود. معمولاً نارسایی احتقانی قلب شدید تظاهر می یابد و علایم نارسایی آئورت مزمن را به همراه ندارد.

نارسایی دریچه آئورت مزمن

در نارسایی دریچه آئورت مزمن که در صورت زنده ماندن بیماران مبتلا به نارسایی دریچه آئورت حاد ایجاد می شود، بطن چپ با اتساع و بزرگ شدن نا هم مرکز، خود را با بیماری تطابق می دهدو اضافه بار حجم جبران می شود. فشارهای پرشدن بطن چپ به حد طبیعی بر می گردند و بیمار دچار نارسایی قلبی آشکار نمی شود. در این مرحله جبران شده ممکن است بیمار مبتلا به نارسایی دریچه آئورت کاملاً بدون علامت باشد و فعالیت بدنی و ورزشی را به خوبی تحمل کند. سرانجام (معمولاً پس از یک دوره نهفته)، بطن چپ وارد مرحله جبران نشده می شود وفشارهای پر شدن آن افزایش می یابند. در حالی که در اکثر بیماران نشانه های نارسایی قلب ایجاد می شوند، بعضی از بیماران مبتلا به نارسایی دریچه آئورت به شکل بدون علامت این مرحله جبران نشده را تجربه می کنند.

درمان نارسایی دریچه آئورت

درمان صحیح نارسایی دریچه آئورت عبارت است از تعویض دریچه، قبل از این که بیمار به این مرحله جبران نشده وارد شود. وقتی نشانه های نارسایی دریچه آئورت مزمن و شدید ظاهر شوند عمدتاً ناشی از افزایش فشار های پر شدن بطن چپ هستند و عبارتند از: تنگی نفس در هنگام فعالیت، تنگی نفس در وضعیت خوابیده و تنگی نفس حمله ای شبانه.

بسیاری از بیماران مبتلا به نارسایی دریچه آئورت به دلیل هیپردینامیک بودن گردش خون دچار احساس ضربه زدن در قفسه سینه یا سر می شوند. چنان چه برون ده مؤثر قلب کاهش یابد بیمار در ابتدا دچار خستگی و ضعف می شود. ممکن است مانند نارسایی دریچه آئورت ، حتی در غیاب بیماری سرخرگ کرونر اپیکاردی ثانویه به افزایش فشارهای پر شدن بطن چپ و کاهش فشار عبور خون از سرخرگ کرونر آنژین صدری ایجاد شود. بیماری نارسایی دریچه آئورت با استفاده از علایم خاصی که در معاینه ایجاد می کند و اکوکاردیوگرافی تشخیص داده می شود.

درمان در نارسایی دریچه آئورت متوسط تا شدید عبارت است از تجویز داروهای گشادکننده رگ، مانند نیفدیپین یا داروهای مهار کننده آنزیم مبدل آنژیوتانسین (ACE). درمان جراحی تعویض دریچه در بیماران نارسایی دریچه آئورت علامتدار یا بیمارانی که شواهد اختلال عملکرد بطن چپ در آنها وجود دارند مورد استفاده قرار می گیرند. همان طور که گفته شد، در درمان نارسایی دریچه آئورت حاد نیاز به مداخله درمان جراحی فوری دارد و این بیماران اغلب دچار نشانه ها و علایم شوک قلبی می شوند و معمولاً رنگ پریده اند و اندام های انتهایی آن ها سرد است و نبض ضعیف و سریعی دارند. درمان طبی نارسایی دریچه آئورت حاد از تجویز داروهای گشادکننده رگ ها و داروهای مُدر، در صورت ثابت بودن فشار خون تشکیل می شود. در صورتی که بیمار مبتلا به نارسایی دریچه آئورت دچار عدم کفایت همودینامیکی باشد باید از داروهای مؤثر بر انقباض عضلات قلب و داروهای تنگ کننده رگ ها برای درمان استفاده کرد. در درمان نارسایی دریچه آئورت نوزادان و کودکان نیز بالون والوولوپلاستی می تواند مؤثر واقع شود.

برای مطالعه " درمان بدون جراحی تنگی دریچه آئورت " کلیک کنید .

منبع : کتاب بیماری های قلبی

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