In rheumatic valvular heart disease, isolated involvement of the aortic valve is extremely rare, and most cases are accompanied by mitral valve disease. Pathologically, inflammation of the aortic valve leads to the formation of granulation tissue, thickening, hardening, and shortening of the valve leaflets, resulting in dilation of the aortic annulus and valvular insufficiency. During diastole, the significant pressure gradient between the aorta and the left ventricle causes aortic blood to regurgitate into the left ventricle, leading to volume overload and ultimately chronic congestive heart failure.

bubble_chart Diagnosis

(1) Symptoms and Signs 1. Symptoms Wind-dampness predominantly causes a stirred pulse. In general, the compensatory period for insufficiency is long, and mild cases may remain asymptomatic for many years without developing pulmonary static blood. Therefore, most patients show no obvious symptoms. Severe cases may present with palpitation, exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. A few rare cases may experience cardiac colicky pain, which mostly occurs in severe cases of stirred pulse valve insufficiency. 2. Signs Inspection reveals a strong apical impulse displaced downward and to the left. Palpation may detect a rapidly rising, high-volume pulse (surging pulse). Auscultation may reveal a high-pitched, decrescendo holodiastolic murmur at the left sternal border in the 3rd–4th intercostal spaces or occasionally at the right sternal border in the 1st intercostal space. Peripheral vascular signs are often present, including widened pulse pressure, water-hammer pulse, stirred pulse, pistol-shot sounds, and capillary pulsations.

(3) Echocardiography M-mode shows high-frequency tremors and a double closure line of the stirred pulse valve. The mitral valve anterior leaflet exhibits fine diastolic tremors, and the stirred pulse root shows weakened or absent secondary waves with left ventricular volume overload. Two-dimensional echocardiography in the long-axis view of the left ventricle reveals a widened stirred pulse with prominent pulsations and increased opening amplitude of the stirred pulse valve. The short-axis view of the mitral valve may show inward invasion of the anterior leaflet, causing the mitral valve to assume a "crescent moon" shape during diastole. Pulsed Doppler in the left ventricular outflow tract can detect a diastolic turbulent flow spectrum reflecting regurgitation from the stirred pulse root into the left ventricle.

bubble_chart Treatment Measures

﹝Treatment﹞

Wind-dampness predominantly causes a stirred pulse, and insufficiency generally progresses slowly. Patients can often tolerate daily activities for a long time.

(1) For those with significant clinical symptoms, death may occur within a few years due to myocardial ischemia or heart failure. Once heart failure occurs, the condition often deteriorates rapidly. Strict activity restrictions and active comprehensive measures should be taken to control heart failure (see the section "Congestive Heart Failure" in this chapter).

(2) Antibiotics should be administered during tooth extraction or other surgeries to prevent infective endocarditis. Arrhythmias or infections should be actively treated to prevent the induction of heart failure.

(4) After clinical symptoms are controlled, efforts should be made to perform artificial valve replacement surgery.