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Treatment of atrioventricular valve dysplasia (avd) abroad

Atrioventricular valve dysplasia (avd) is a slowing down or complete cessation of impulses conduction from the atria to the ventricles. Some people have it as a norm and it is not a reason to be concerned. Other patients might experience the atrioventricular block if they have heart disease.

 

In this case, change in the impulse conductivity leads to violations of hemodynamics and can cause sudden cardiac death.

 

Atrioventricular valve dysplasia

 

Causes of atrioventricular valve dysplasia (avd)

Atrioventricular valve dysplasia (avd) is not an independent disease. Illness is considered to be just a kind of cardiac conduction disorders. AV blockade can be acute, paroxysmal or permanent.

 

Acute AV blockade occurs within the time frame, but it is stable. Causes of the acute form of atrioventricular blockade are:

  • Myocarditis (heart muscle inflammation)
  • Myocardial infarction
  • Hypothyroidism (low level of thyroid hormone)
  • Drugs administration (beta-blockers, calcium blockers, morphine, cardiac glycosides, tricyclic antidepressants, cholinomimetics)

 

Paroxysmal form is a short-termarrhythmia episode that disappears by itself without any treatment, but then occurs again. Causes of the paroxysmal form of atrioventricular blockade are:

  • Vomiting
  • Myocardial ischemia
  • Sleep apnea syndrome
  • Postural block (occurs in the lateroprone position and disappears in the upright position and is determined by the increased tone of the vagus nerve)
  • Reflex reactions

 

Permanent form of the atrioventricular blockade occurs as a result of the chronic disease course:

  • Cardiosclerosis (after myocarditis or myocardial infarction)
  • Cardiomyopathy
  • Congenital failure of the atrioventricular node
  • Lenegre-Lev's disease
  • Artificial destruction of the atrioventricular node

 

Atrioventricular valve dysplasia symptoms

 

Atrioventricular valve dysplasia (avd) - Symptoms

Atrioventricular blockade can have different severity stages that determine the symptoms:

  • Stage 1 – all the impulses pass through  the atrioventricular node, but slower than normally
  • Stage 2 – not all the impulses pass from atria to the ventricles
  • Stage 3 – impulses don’t reach the ventricles at all

 

During the Stage 1 of the atrioventricular blockade a patient doesn’t feel anything. He might just have low heart rate. A disorder can be identified only with the help of electrocardiography (ECG). A patient doesn’t have any complaints.

 

During the Stage 2 of the atrioventricular blockade the following symptoms occur:

  • Low heart rate
  • Feeling of “a sinking heart”
  • Chronic fatigue
  • Dizzy spells
  • Headache
  • Reduced tolerance to physical stress (shortness of breath occurs)
  • Short episodes of loss of consciousness or seizures are possible

 

During the Stage 3 of the atrioventricular blockade the dissociation of the activity between atria and ventricles can be observed. Atria contracts as usual while the ventricular contractions rate is significantly reduced sometimes even less than 30 beats per minute. A patient has a strong shortness of breath. He may lose the consciousness as a result of the brain oxygen starvation.

 

Stage 3 of the AV blockade carries the risk of sudden cardiac death. Impaired heart conduction is accompanied by the heart failure among 90%, which is manifested by the corresponding symptoms (swelling of the legs, shortness of breath, sudden weakness).

 

Atrioventricular valve dysplasia diagnostics

 

Atrioventricular valve dysplasia (avd) - Diagnostics

ECG is the basic method of atrioventricular block diagnostics. A doctor can notice the following peculiarities while analyzing this kind of heart conductivity disorders:

  • Stage 1 – an increase in the heart cycle length and reduction of the heart rate
  • Stage 1 type 1 – gradual increase of the heart cycle length, then follows the loss of one of the ventricular contractions
  • Stage 2 type 2 – a steady heart cycle; the loss of one or several ventricular contractions can be observed form time to time
  • Stage 3 – atria and the ventricles contract in different time, independently from one another

 

Additional analytic methods that allow identifying the blockade stage are:

  • Transesophageal electrophysiological study
  • Intracardiac electrophysiological study

 

The latter methodis more informative. Electrodes are inserted to the patient through the femoral artery under the X-ray control. They are used for the stimulation.

 

A doctor reviewe the electrogram and analyses the stage of the AV blockade (distal or proximal) based on it. It is significant for the therapeutic tactics choice.

 

Atrioventricular valve dysplasia treatment abroad

 

Treatment of atrioventricular valve dysplasia (avd) abroad

On condition that there are no any symptoms and the risk of the complete atrioventricular blockade is absent, then the observation or the conservative treatment (prescription of the medications) is used. Otherwise, the basic method of treatment is the insertion of the temporary or permanent heart pacemaker.

 

Indications for the pacemaker implantation are:

  • Stage 3 of the distal blockade
  • Stage 2 type 2 of the distal blockade (there is a high risk of the complete AV blockade development)
  • Stage 3 of the proximal blockade if it is not combined with myocardial infarction
  • any stage 2-3 blockade accompanied by the hemodynamic impairments

 

Temporary pacemaker is implanted on condition that patient’s normal heart conductivity is prognosed to be restored completely. If chances for a positive dynamics are low (permanent form of the AV blockade), the permanent pacemaker has to be implanted.

 

Atrioventricular valve dysplasia prognosis

 

Atrioventricular valve dysplasia (avd) - Prognosis

Prognosis is positive for the Stage 1, Stage 2 type 1 of the atrioventricular blockade as they don’t have a tendency to further progress.

Less positive prognosis have Stage 2 type 2 and Stage 3 of the atrioventricular blockade. Their further progress threatens the patients’ life and therefore demands the surgical treatment.

 

Life and work prognosis for a patient is determined by the main disease and character of its clinical course.

 


 

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