Rehabilitation after mitral valve replacement. Heart diseases that cause disability Artificial heart valve disability

for whom a long period is required; - biochemical blood tests (C-reactive protein, proteinogram, sialic acids, diphenylamic acid, fibrinogen, aminotransferases, etc.); - basic hemodynamic indicators and external respiration function at rest and with exercise; - ECG in dynamics, FCG, echocardiogram; x-ray of organs chest in dynamics; - blood culture (if necessary). Group III disability after heart surgery is established with persistent moderate limitation of life activity in any of its manifestations in the patient:

Is a disability group given after heart surgery?

After the operation, the patient quickly returns to his normal life. The rehabilitation period depends on the severity of coronary artery disease, the presence of concomitant pathologies and the individual characteristics of the body.

However, in reality, everything happens exactly the opposite.

But after heart bypass surgery, a person is not always able to fully restore health.

The intervention made significant adjustments and restrictions to a person’s lifestyle.

The patient refers to poor health and the occurrence of a number of complications after the surgical procedure.

Deterioration in the process of memory and thinking, in particular in the first six months after surgery. The appearance of postpericardiotomy syndrome.

It should be clarified that in the third stage of cardiac hypertension (its companion is high blood pressure), periodic crises occur that disrupt cerebral circulation, which often leads to paralysis.

2. People who have suffered a myocardial infarction and have severe coronary insufficiency, accompanied by serious changes in the functioning of the heart muscle and third-degree circulatory disorders.

In addition to loss of ability to work, great importance the sick person has the ability to self-care.

Assignment of disability is carried out on the basis of the presence of the following signs that determine the actual condition of the patient:

Depending on these factors, three disability groups are assigned: Legal issue

Is there any disability after heart surgery?

Until now, many people rely on outdated documents where certain diseases were prescribed for which a person is recognized as disabled.

The documents, which came into force back in 1959, state that patients with the following disorders have the right to register a disability.

However, following this list did not allow for a fair assessment of whether or not to give people a disability.

Group 3 - speaking in simple language, the “lightest” of all three possible, it is sometimes also called “working”. Patients with the established second group cannot work, serve themselves with the help of others, and can partially do it themselves.

The first disability group is the most “severe” in terms of the patient’s health. People are completely dependent on the help of others, their self-care and independent movement are limited.

My husband underwent heart surgery and the valve was replaced with an artificial one. They gave me disability group 3, working.

Any heart disease, and in particular attacks of palpitations, severe shortness of breath, is given a second one, but if there was also heart surgery, then this group should already be given a second one.

And those who give the third group even for heart disease, this is no longer according to the rules (in other words, bribes are required). I know such cases.

The decision of the VTEK depends on the indications.

Most likely they will give you a second one first, and then they may give you a third one for health reasons.

The decision is made by the ITU commission (Bureau of Medical and Social Expertise).

Mechanical heart valve after surgery

Not treating stagnant manifestations contributes to the development of diseases of all human organs, ultimately leading to death.

Based on this, valve pathology is very dangerous problem requiring cardiac surgery. The following types of surgical intervention are distinguished: Plastic surgery consists of restoring the valve on a support ring.

Surgery is used for heart valve insufficiency. Prosthetics involves complete replacement of the valve. The mitral and aortic heart valves are often replaced.

The operation is prescribed in case of severe valve damage with the development of heart disease, which has a significant impact on hemodynamics. The development of valve defects occurs due to rheumatism.

Heart valve replacement significantly prolongs the life of a patient with heart disease and improves its quality. There are biological (tissue) and mechanical valves (ball, disc, bicuspid). Biological ones are more susceptible to wear, but less likely to lead to the development of embolism. Artificial valves differ from a healthy native valve in their hemodynamic characteristics. Therefore, patients with artificial heart valves are classified as patients with abnormal valves. After heart valve replacement, they should be monitored by a therapist, cardiologist and other specialists due to the constant use of anticoagulants, the possibility of dysfunction of the prosthesis, the presence of heart failure in some of them, etc.

Keywords: artificial heart valves, prosthetic heart valves, antithrombotic therapy, residual heart failure, prosthetic thrombosis, prosthetic dysfunction, prosthetic valve endocarditis, echocardiographic diagnosis.

introduction

Radical correction of valvular heart defects is possible only with the help of cardiac surgery. Studies of the natural history of mitral heart disease have shown that it leads to the development of heart failure, disability and rapid death of patients, and the average life expectancy of patients with aortic stenosis after the onset of coronary symptoms or attacks of syncope was approximately 3 years, from the onset of manifestations of congestive circulatory failure - about 1.5 years. Surgical treatment of valvular heart defects is effective means choice designed to improve the patient’s condition, and often to save him from death.

Surgical operations for heart valve diseases can be divided into valve-sparing and heart valve replacement, i.e. replacing the valve with an artificial one. The installation of an artificial heart valve, as R. Weintraub aptly put it (R. Weintraub, 1984), is a compromise in which one pathological valve is replaced by another, because the prosthesis being installed has all the features of an abnormal valve. There is always a pressure gradient on it (hence, there is a moderate stenosis), hemodynamically insignificant regurgitation that occurs when the valve is closed or on a closed valve, the substance of the prosthesis is not indifferent to the surrounding tissues and can cause thrombosis. Therefore, cardiac surgeons are striving to increase the proportion of reconstructive operations on valves, ensuring the future life of patients without possible specific “prosthetic” complications.

In connection with the above, patients who have undergone valve replacement surgery are proposed to be considered as patients with abnormal heart valves.

Despite this, heart valve replacement is effective way prolongation and radical improvement of the quality of life of patients with heart defects and remains the main method of their surgical treatment. Already in 1975 D.A. Barnhorst et al. analyzed the results of replacement of the aortic and mitral valves with prostheses of the Starr-Edwards type, which they began in 1961. Although the survival rate of patients after implantation of an aortic prosthesis by 8 years after surgery was 65% compared to 85% in the population, and the expected survival rate after mitral replacement was 78 % compared to 95% in the population, these indicators were significantly better than in non-operated patients.

Implantation of an artificial valve actually lengthens the life expectancy of a patient with valvular heart disease: after mitral valve replacement, survival by 9 years was 73%, by 18 years - 65%, while with the natural course of the defect, 52% of patients had already died by five years. With aortic replacement, 85% of patients survive by the age of 9, while drug therapy supports life by this period in only 10%. Further improvements in prostheses and the introduction of low-profile mechanical and biological artificial valves have further increased this difference.

indications for valve replacement

Indications for valve replacement developed by domestic authors (L.A. Bockeria, I.I. Skopin, O.A. Bobrikov, 2003) and are also presented in the recommendations of the American Heart Association (1998) and European recommendations (2002):

Aortic stenosis:

1. Patients with hemodynamically significant stenosis and new or existing clinical symptoms (angina pectoris, syncope, heart failure) of any severity, because the presence of clinical symptoms in patients with aortic stenosis is a risk factor for significant

reducing the life expectancy (including sudden death).

2. Patients with hemodynamically significant stenosis who have previously undergone coronary artery bypass grafting.

3. In patients without clinical symptoms with severe aortic stenosis (aortic valve opening area<1,0 см 2 или <0,6 см 2 /м 2 площади поверхности тела, пиковая скорость потока крови на аортальном клапане при допплер-эхокардиографии >4 m/s) cardiac surgery is indicated for:

a) the occurrence of the specified clinical symptoms during a test with increasing physical activity (such patients go into the category of patients with clinical symptoms), an indicator such as an inadequate rise in blood pressure during physical activity or its decrease is less important;

b) patients with moderate and severe valve calcification with a peak blood flow velocity on the valve >4 m/s with its rapid increase over time (>0.3 m/s per year);

c) patients with reduced systolic function of the left ventricle of the heart (left ventricular ejection fraction<50%), хотя у бессимптомных пациентов это бывает редко.

Transluminal valvuloplasty It is rarely performed in adult patients with aortic stenosis. Aortic insufficiency:

1) patients with severe aortic insufficiency 1 and symptoms at the level of III-IV functional classes according to NYHA with preserved (ejection fraction > 50%) and reduced systolic function of the left ventricle of the heart;

2) with symptoms at the level of NYHA functional class II and preserved systolic function of the left ventricle of the heart, but with rapidly progressing dilatation and/or a decrease in the ejection fraction of the left ventricle, or a decrease in the tolerance of dosed physical activity during repeated studies;

1 By severe, hemodynamically significant, we mean aortic insufficiency, manifested by a well-audible protodiastolic murmur and tonogenic dilatation of the left ventricle. In severe aortic insufficiency, the area of ​​the initial part of the regurgitation jet when examined in color Doppler scanning mode at the level of the short axis of the aortic valve with the parasternal position of the ultrasound sensor exceeds 60% of the area of ​​its fibrous ring, the length of the jet reaches the middle of the left ventricle or more.

3) patients with functional class II and higher of angina according to the Canadian classification;

4) with asymptomatic severe aortic insufficiency in the presence of signs of progressive dysfunction of the left ventricle of the heart during an echocardiographic study (the end-diastolic size of the left ventricle is more than 70 mm, the end-systolic size is >50 mm or more than 25 mm/m 2 body surface area, with the ejection fraction of the left ventricle<50% или быстрое увеличение размеров левого желудочка при повторных исследованиях);

5) patients with asymptomatic hemodynamically insignificant aortic insufficiency or with clinical symptoms with severe dilatation of the aortic root (>55 mm in diameter, and with a bicuspid valve or Marfan syndrome - >50 mm) should be considered as candidates for cardiac surgical treatment, incl. for aortic valve replacement, most likely together with reconstruction of the aortic root;

6) patients with acute aortic insufficiency of any origin. Mitral stenosis:

1) patients with clinical symptoms of III-IV functional classes according to NYHA and a mitral orifice area of ​​1.5 cm 2 or less (moderate or severe stenosis) with fibrosis and/or calcification of the valve with or without calcification of subvalvular structures, for whom open commissurotomy cannot be performed or transluminal balloon valvuloplasty;

2) patients with clinical symptoms of functional classes I-II with severe mitral stenosis (mitral orifice area 1 cm 2 or less) with high pulmonary hypertension (systolic pressure in the pulmonary artery more than 60-80 mm Hg), for whom open surgery is not indicated commissurotomy or transluminal balloon valvuloplasty due to severe valve calcification.

Asymptomatic patients with mitral stenosis most often undergo open commissurotomy or transluminal valvuloplasty.

Mitral regurgitation: cardiac surgical treatment of hemodynamically significant mitral insufficiency of non-ischemic origin - mitral valve repair, replacement with or without preservation of the subvalvular valves is indicated:

1) patients with acute mitral regurgitation with corresponding symptoms;

2) patients with chronic mitral regurgitation with symptoms at the level of III-IV functional classes with preserved systolic function of the left ventricle (ejection fraction >60%, end systolic size<45 мм; за нижний предел нормальной систолической функции при митральной недостаточности принимаются более высокие значения фракции выброса, потому что при несостоятельности митрального клапана во время систолы левого желудочка только часть крови выбрасывается в аорту против периферического сопротивления, а остальная уходит в левое предсердие без сопротивления или с меньшим сопротивлением, из-за чего работа желудочка значительно облегчается и снижение его функции на ранних стадиях не приводит к значительному снижению этих показателей);

3) asymptomatic patients or with mild symptoms with chronic mitral regurgitation:

a) with the ejection fraction of the left ventricle of the heart< 60% и конечным систолическим размером >45 mm;

b) preserved left ventricular function and atrial fibrillation;

c) preserved left ventricular function and high pulmonary hypertension (systolic pressure in the pulmonary artery >50 mm Hg at rest and more than 60 mm Hg during an exercise test).

In case of mitral insufficiency, preference is given to valve plastic surgery; in case of severe calcification (II-III degree) of the leaflets, chords, papillary muscles, mitral valve replacement is performed. 1

1 Hemodynamically significant mitral regurgitation is manifested by a well-audible holosystolic murmur and tonogenic dilatation of the left ventricle of the heart on echocardiography. In case of severe mitral regurgitation, when studying the regurgitation jet in continuous wave Doppler mode, its spectrum will be completely opaque throughout the entire systole; high-speed turbulent flows will be detected when examining in color Doppler mode already above the mitral leaflets in the left ventricle; Severe mitral regurgitation is indicated by the presence of retrograde flow in the pulmonary veins and increased pressure in the pulmonary artery.

Tricuspid valve defect rarely isolated, more often occurs in combination with mitral or as part of a multivalve lesion. When it comes to choosing a method of surgical treatment for the tricuspid valve, the prevailing opinion is that tricuspid replacement is undesirable. It has been shown that replacement of the tricuspid valve with a mechanical prosthesis significantly more often leads to complications in the immediate and long-term period than is the case with mitral and/or aortic valve replacement. When this valve is replaced, there is a rapid change in the hemodynamics of the right ventricle with a significant decrease in its filling, a decrease in the size of its cavity and, as a consequence, restriction of the movements of the obturator element of artificial valves of old designs. The low linear velocity of blood flow through the right atrioventricular opening is a factor that increases the possibility of thrombus formation on a mechanical prosthesis. All this leads to its dysfunction and thrombosis. In addition, suturing in the area of ​​the septal leaflet of the tricuspid valve is fraught with damage to the His bundle with the development of atrioventricular block. Therefore, in the surgical treatment of tricuspid defect, preference is given to plastic surgery.

Indications for prosthetics of the tricuspid valve are pronounced changes in its leaflets, most often with its stenosis and in cases of previously ineffective annuloplasty; in other cases, plastic surgery should be performed. When replacing a tricuspid valve with an artificial one, biological and mechanical bicuspid prostheses are used, because the blood flow through them is central, their obturator elements are quite short. However, we observed a patient who developed thrombosis of a biological artificial valve in the tricuspid position several years after the operation.

At multivalve lesion Indications for surgery are based on the degree of damage to each valve and the patient's functional class. It is considered optimal to refer patients with functional class III to a cardiac surgeon.

For infective endocarditis Valve replacement is almost always performed. Implantation of artificial valves is indicated for:

1) lack of effect from antibiotics within 2 weeks;

2) severe hemodynamic disturbances and rapid progression of heart failure;

3) repeated embolic events;

4) the presence of an intracardiac abscess.

Contraindication replacing the valve with an artificial one can only be a terminal stage of the disease with degenerative changes internal organs, although each case should be carefully reviewed in conjunction with a cardiac surgeon, because Often, after surgery, these changes turn out to be reversible, as well as diseases that definitely shorten life expectancy, such as oncological processes, etc. Coronary angiography should be performed before valve surgery in persons with symptoms suggestive of coronary heart disease over 35 years of age and in the absence of such symptoms in men over 40 years of age and in women over 60 years of age.

The age of patients is a negative prognostic factor, however, valve replacement operations have now been mastered in patients of any age, and the perioperative mortality of these operations is constantly decreasing. The need for implantation of artificial valves in the elderly is dictated by an increase in the number of people over 60 years of age with damage to the valve apparatus. Rheumatism is most often cited as the cause of valve damage in the elderly, degenerative damage to the valve apparatus is detected in more than 1/3 of patients, and coronary heart disease.

The complexity of surgical treatment of heart disease in older age groups is determined by the presence of concomitant non-cardiac diseases and cardiac damage. Despite this, many researchers recognize that valve replacement surgery, primarily the aortic valve, in patients over 70, and even over 80 and 90 years old, is the operation of choice, providing acceptable operative mortality and a significant improvement in their quality of life in the long-term postoperative period. It is believed that patients in this age group should receive biological prostheses, since the dangers of anticoagulant therapy have been shown in patients over 65 years of age who have had mechanical prostheses installed. It appears that elderly patients should undergo prosthetic surgery as early as possible, before heart failure develops.

The indication for valve replacement is hemodynamically significant valvular heart disease with gross changes in the valve apparatus, infective endocarditis, in which valve-sparing operations are impossible.

types of artificial valves

Currently, it is possible to observe patients who have mainly three models of mechanical artificial valves and various biological prostheses installed. Mechanical artificial valves:

1. Ball (valve, ball) prostheses: in our country these are prostheses AKCH-02, AKCH-06, MKCH-25, etc. (Fig. 12.1, see inset).

Prostheses of this model were used mainly in the 70s, and nowadays they are practically not installed. However, there are still quite a lot of patients who have undergone prosthetic replacement with these valves. For example, we are currently observing a 65-year-old patient who had a ball aortic valve prosthesis installed more than 30 years ago. In these artificial valves, a closure element in the form of a ball of silicone rubber or other material is enclosed in a cage, the arms of which may be closed at the top, but on some models they are not closed. There are 3 small “feet” on the valve seat, which create some clearance between the obturator element (ball) and the seat and prevent jamming, but as a result there is minor regurgitation on such an artificial valve.

The disadvantages of artificial valves of this design were the presence of a stenotic effect, high inertia of the obturator element, blood turbulence that arose on them, and a relatively high incidence of thrombosis.

2. Disc hinged artificial valves began to be created in the mid-70s and were widely used in our country in the 80s and 90s (Fig. 12.2, see inset).

These are prosthetic valves such as Bjerka-Schaley, Medtronic-Hull, etc. In the USSR and then in Russia, one of the best valves of this design is EMICS, which has shown its wear resistance, reliability, low thrombogenicity and low pressure drop values ​​when implanted in both the mitral and aortic

position. The locking element of such prostheses is a disk made of substances that ensure its wear resistance (polyurethane, carbonite, etc.), which is overturned by the blood flow between the U-shaped limiters located on the prosthesis frame and closes, preventing regurgitation, at the moment the blood flow stops. Currently, there are a large number of patients with prosthetic valves of these designs.

3. Bicuspid hinged low profile prosthetic valves: The most commonly used representative of prostheses of this design is the St valve. Jude Medical (St. Jude valve), developed in 1976 (Fig. 12.3, see inset). The valve consists of a frame, two leaflets and a cuff. The design of the prosthesis provides a large opening angle of the valves, at which three holes are created. The St. Jude valve allows for nearly laminar flow and creates almost no resistance to flow. During the closure of the valves, there is almost no regurgitation, but when the valves of the prosthesis are closed, a minimal gap remains through which minor regurgitation occurs. In Russia, a bicuspid prosthesis is currently used, produced by the MedInzh plant (Penza), which has the same name.

4. Biological artificial valves: biological valve prostheses (Fig. 12.4, see inset) are divided into allogeneic (obtained from the dura mater of corpses) and xenogeneic (from pig aortic valves or the pericardium of calves taken from the slaughterhouse). There are also reports of prostheses made from the patient’s own tissue (pericardium, pulmonary valve) (autotransplantation).

In addition, the biological material of such prostheses is most often strengthened on a supporting frame; currently there are so-called frameless bioprostheses that provide a smaller pressure drop (gradient) on them.

Recently, for aortic valve replacement, a so-called homograft is used, when the pulmonary artery valve of the same patient is installed in the aortic position, and in its place a biological prosthesis is installed - the Ross operation.

The most important component of the creation of bioprostheses is the development of conservation methods, which determines the duration of their work, resistance to the introduction of microorganisms and the development of infective endocarditis. Freezing (cryopreservation) and treatment with glutaraldehyde, papain with additional immobilization with diphosphonates and heparin are used.

dynamic monitoring of the patient after valve replacement

Dynamic observation Patient care after valve replacement should begin immediately after discharge from the cardiac surgery hospital. Dispensary observation is carried out for the first 6 months - 2 times a month, the next year - 1 time a month, then 1 time every 6 months - a year, it is advisable to conduct an echocardiographic study at the same time.

A general practitioner who is approached by a patient with an artificial heart valve (or artificial valves) faces a number of tasks (Table 12.1).

Table 12.1

The need for interaction of patients after heart valve replacement with a general practitioner

1. To monitor the state of the blood coagulation system in connection with the constant use of indirect anticoagulants.

2. For dynamic monitoring of the function of prosthetic valves for early diagnosis of its disorders and identification of complications in the long-term period after prosthetics.

3. To correct conditions directly related to the presence of a valve prosthesis.

4. For timely detection of a new defect of an unoperated valve in a patient with a prosthetic valve (or aggravation of a previously existing moderate valve defect).

5. To correct circulatory failure and heart rhythm disturbances.

6. For the treatment of diseases not related to prosthetics or indirectly related to it.

7. For early (if possible) diagnosis of complications arising in the late postoperative period.

Continuous antithrombotic therapy

First of all, a patient who has undergone valve or valve replacement surgery is forced to constantly take antithrombotic drugs, in the vast majority of cases - indirect anticoagulants. Almost all patients with mechanical prosthetic valves should take them. The presence of bioprote-

In many cases, it also does not exclude the need to take oral anticoagulants, especially in those patients who have atrial fibrillation.

Until relatively recently, it was mainly the drug phenylin, which has a relatively short duration of action. Over the past few years, patients have been prescribed the indirect oral anticoagulant warfarin (Coumadin).

It is now recognized that the laboratory indicator that evaluates the hypocoagulant effect of an oral anticoagulant is the international normalization ratio (INR 1). Oral anticoagulants do not act on an already formed blood clot, but prevent its formation. The dose of warfarin is selected according to the recommendations of the All-Russian Association for the Study of Thrombosis, Hemorrhage and Vascular Pathology named after A.A. Schmidt - B.A. Kudryashov for treatment with oral anticoagulants (2002). INR levels that need to be maintained in patients during various periods after prosthetics are presented in Table 12.2 (recommendations of the American Society of Cardiology). It should be noted that for 3 months after surgery, until epithelization of the prosthesis has occurred, the INR should be maintained between 2.5 and 3.5 for any model of installed artificial valve.

After this period, the level of the selected normalization ratio will depend on the model of the prosthesis, its position and the presence or absence of risk factors.

Table 12.2 does not provide data on tricuspid valve replacement with mechanical prostheses. As already mentioned, the risk of thrombosis in the presence of a tricuspid artificial valve is high, therefore, if the patient has a mechanical prosthesis in the tricuspid position, the INR should be maintained at a level of 3.0 to 4.0. The same level of hypocoagulation should be achieved

Type of prosthetics
First 3 months after surgery
Three months after prosthetics
PAK with a bicuspid prosthesis St. Judah or Medtronic Hall
PAK with other mechanical prostheses
PMC with mechanical prostheses
PAK with bioprosthesis	80-100 mg aspirin
AVR with bioprosthesis + risk factors
PMC with bioprosthesis	80-100 mg aspirin
PMC with bioprosthesis + risk factors

Note. AVR - aortic valve replacement, MVR - mitral valve replacement. Risk factors: atrial fibrillation, left ventricular dysfunction, previous thromboembolism, hypercoagulability

to avoid with multivalve prosthetics. For the MedEng bicuspid prosthetic valve in the aortic position, in the absence of risk factors, primarily atrial fibrillation, the INR can apparently be maintained at 2.0-3.0.

It should be said that maintaining the desired level of hypocoagulation is not always an easy task for the doctor and the patient. The initial selection of the drug usually occurs in the hospital. In developed countries, personal dosimeters are available for further monitoring of INR. In Russia, the patient determines it in outpatient medical institutions, which often leads to increased intervals between measurements. Therefore, both the doctor and, importantly, the patient should remember the signs of excessive hypocoagulation in order to promptly reduce the dose of warfarin: bleeding gums, nosebleeds, micro- and gross hematuria, prolonged bleeding from small cuts during shaving. It should be remembered that the effect of warfarin is enhanced by aspirin, nonspecific anti-inflammatory

Bodies, heparin, amiodarone, propranolol, cephalosporins, tetracycline, disopyramide, dipyridamole, lovastatin and other drugs, which should be contained in the instructions for their use. The effectiveness of indirect anticoagulants is reduced by vitamin K (including in multivitamin pills!), barbiturates, rifampicin, dicloxacillin, azathioprine and cyclophosphamide and many foods containing vitamin K: cabbage, dill, spinach, avocado, meat, fish, apples, pumpkin . Therefore, instability of the INR at already selected doses of warfarin can sometimes be explained by many circumstances. We must also not forget about errors in determining the INR. In addition, apparently, among the Russian population, the mutation of the CYP2C9 gene, which determines high susceptibility to warfarin, is quite common, which requires the use of lower dosages (Boitsov S.A. et al., 2004). In cases of immunity to warfarin, it is possible to use other drugs of this group (Sincumar).

If the INR is excessively increased - more than 4.0-5.0 - without signs of bleeding, the drug is discontinued for 3-4 days until

Table 12.3

Changing antithrombotic therapy before elective noncardiac surgery or surgery

The patient is taking anticoagulants. No risk factors	Stop taking the indirect anticoagulant 72 hours before the procedure (minor surgery, tooth extraction). Resume on the day after the procedure or surgery
Patient taking aspirin	Stop 1 week before surgery. Resume on the day after surgery
High risk of thrombosis (mechanical prostheses, low ejection fraction, atrial fibrillation, previous thromboembolism, hypercoagulability) - the patient is taking indirect anticoagulants	Stop taking anticoagulants 72 hours before surgery. Start heparin when the INR drops to 2.0. Stop heparin 6 hours before surgery. Start heparin within 24 hours after surgery. Start indirect anticoagulant
Surgery complicated by bleeding	Start heparin when danger of bleeding subsides, APTT<55 с

the required INR level (2.5-3.5), then begin taking it at a dosage reduced by half. If there are signs of increased bleeding, Vicasol is prescribed once at a dose of 1 mg orally. At higher INR values ​​and bleeding, Vicasol 1% solution 1 ml, fresh frozen plasma and other hemostatic agents are administered intravenously.

Tactics for the use of anticoagulants when it is necessary to perform a planned non-cardiac surgical procedure or operation

The tactics for using anticoagulants if necessary during a planned non-cardiac surgical procedure or operation are presented in Table 12.3.

There is also an opinion that during tooth extraction it is impossible to completely cancel anticoagulants, because the risk of thromboembolism significantly exceeds the risk of bleeding.

Factors that increase the risk of thromboembolism during non-cardiac surgical procedures and manipulations are presented in Table 12.4.

It is clear from the table that a higher risk is created by artificial valves of the old design (valve prostheses), and there are more possibilities of thrombosis with mitral and tricuspid replacement than with aortic replacement. A high risk of thrombotic complications exists in patients who have previously experienced thromboembolism in the presence of atrial fibrillation. What matters is the type of operation or procedure, the organ that is being intervened.

All of the above applies to elective non-cardiac surgery and procedures. In cases where urgent surgical intervention or urgent tooth extraction (large molar), biopsy, etc. is necessary, the patient must be prescribed 2 mg of Vikasol orally. If the INR remains high the next day, the patient is again given 1 mg of Vikasol orally.

The vast majority of patients with artificial heart valves are forced to take indirect anticoagulants for life. The level of hypocoagulation should be determined by the INR value in the range of 2.5-3.5.

Clinical and operational factors	Low risk	High risk
Clinical factors
Atrial fibrillation
Previous thromboembolism
Signs of hypercoagulability
LV systolic dysfunction
> 3 risk factors for thromboembolism
Mechanical prosthesis model
Valve
Rotary disc
Bivalve
Type of prosthetics
Mitral
Aortic
Tricuspid
Type of non-cardiac surgery
Dental/ophthalmological
Gastrointestinal/urinary tract
Pathology variant
Malignant neoplasm
Infection

tasks of a cardiologist and therapist

The tasks of a cardiologist and/or therapist includes regular auscultation of the heart and listening to the melody of the prosthesis. This makes it possible to timely identify dysfunction of the artificial valve and/or the appearance of a new defect in the non-operated valve. The patient's last

with a prosthetic valve occurs quite often. Most often, severe tricuspid regurgitation or senile calcification of the native aortic valve develops in elderly patients in the long-term period after implantation of a mitral prosthesis.

When deciding on prevention of rheumatic fever We are guided by the fact that the majority of patients with artificial valves installed for rheumatic heart disease are over 25 years old, and we believe that such patients should not undergo it. If such a need arises (for example, in young patients undergoing surgery against the background of acute rheumatic fever), then such prophylaxis should be carried out with retarpen 2.4 million units once every 3 weeks.

Prevention of infective endocarditis. Much more important given that patients with artificial valves are at high risk of developing infective endocarditis. Situations in which there is a particularly high risk of infective endocarditis and the prophylactic doses of antibiotics that must be used during these procedures are presented in Table 12.5.

Table 12.5

Prevention of infective endocarditis

I. For dental procedures and operations, operations in the oral cavity, upper gastrointestinal tract and respiratory tract:

1. Amoxicillin 2 g orally 1 hour before the procedure, or

2. Ampicillin 2 g IM or IV over 30 minutes. before the procedure, or

3. Clindamycin 600 mg orally 1 hour before the procedure, or

4. Cephalexin 2 g orally 1 hour before the procedure, or

5. Azithromycin or clarithromycin 500 mg 1 hour before the procedure.

II. During procedures and operations on organs genitourinary system and lower gastrointestinal tract:

1. Ampicillin 2 g + gentamicin 1.5 mg per 1 kg of body weight IM or IV within 30 minutes. from the start of the procedure and 6 hours after the first injection, or

2. Vancomycin 1 g over 1-2 hours IV + gentamicin 1.5 mg/kg body weight IV, end of infusion within 30 minutes after the start of the procedure.

Before tooth extraction, an antibiotic in the indicated dosage should be prescribed 1-2 hours before the procedure. Antibiotics should be prescribed to this entire group of patients for any injury or severe acute respiratory infections. At the same time, we should not forget that endocarditis of the artificial heart valve may begin with an incomprehensible fever, and in such a situation, before using antimicrobial drugs, a blood test should be taken for culture to identify microflora.

The task of a doctor observing a patient with artificial heart valves includes regular auscultation for timely detection of changes in the melody of the prosthetic valve, i.e. its possible dysfunction or the emergence of a new defect of the unoperated valve.

Treatment of residual heart failure

Implantation of an artificial valve brings significant clinical improvement to patients with heart disease. The vast majority of patients after surgery belong to functional classes I-II. However, some of them still experience shortness of breath and congestion of varying severity. This applies primarily to patients who have atriomegaly, atrial fibrillation, low ejection fraction and dilatation of the left ventricle, tricuspid regurgitation after surgery. More often, moderate heart failure occurs after prosthetics mitral valve, not aortic. Therefore, up to 80% of patients with an artificial mitral valve take digoxin (0.125 mg/day) and usually a small daily dose of a diuretic (0.5-1 tablet of Triampur). It should be said that average age patients in the long-term period after valve replacement are 50-60 years old, and therefore most of them already have hypertension, coronary heart disease, etc., requiring the use of appropriate medications.

Patients with normally functioning artificial valves, with sinus rhythm, non-dilated heart chambers, normal FI, I-II FC	Patients with normally functioning prosthetic valves with persistent or transient AF, with atriomegaly and/or LV dilatation and/or low FI
When prescribing a motor regimen, patients with abnormal valves with minor stenosis are considered	When prescribing a motor regimen, patients with FC II-III CHF are considered
Preliminary tests are prescribed to exclude ischemic heart disease - VEM in normal mode or treadmill - Bruce protocol	Tests are prescribed to determine PF limited by CHF systems: VEM, protocol with rapidly increasing PF or treadmill - Naughton protocol
Walking at a normal and then at an energetic pace for 25 to 40-50 minutes. per day, swimming at a moderate speed) 3-5 times a week	Walking at a heart rate of 40% of the threshold 3-5 times a week for 20 minutes, then gradually the load level increases to 70% of the threshold, and the duration of the load is up to 40-45 minutes per day

Note. FI - left ventricular ejection fraction, FC - functional class, VEM - bicycle ergometry, AF - atrial fibrillation, CHF - chronic heart failure, FN - physical activity, PFN - exercise tolerance

may not be limited (see Table 12.6). They should not participate in competitive sports and endure extreme loads for them (we must also not forget that the vast majority take indirect anticoagulants), but they need physical rehabilitation. Before prescribing physical exercise, it is advisable to conduct a physical stress test in such patients to exclude coronary artery disease (bicycle ergometry, treadmill according to the standard Bruce protocol).

With an enlarged left atrium and/or reduced left ventricular systolic function, the appropriate recommendations for patients with heart failure should be followed. In this case, with moderate changes in these indicators and slight fluid retention, we recommend that patients walk at a normal pace 3-5 times a week with a gradual increase in load.

With a significant decrease in the ejection fraction (40% and below), walks at a slow pace are suggested. It is advisable to conduct a preliminary study of the level of exercise tolerance on a bicycle ergometer or treadmill (modified Naughton protocol). With a low ejection fraction, they start with 20-45 minute loads at a level of 40% of the maximum tolerated load power 3-5 times a week and try to bring it very gradually to a 70% level.

Specific complications after heart valve replacement

An important component of monitoring a patient with artificial valves is the identification of specific long-term complications. These include:

1. Thromboembolic complications. Unfortunately, none of the prosthesis models guarantees against thromboembolism. It is believed that mechanical prostheses such as St. have an advantage. Judas and biological. Thromboembolism is any thromboembolic event occurring in the absence of infection after full recovery from anesthesia, starting in the postoperative period, which leads to any new, temporary or permanent, local or general neurological impairment. This also includes embolisms in other organs of the large circle. Most thromboembolic complications occur in the first 2-3 years after

operations. As artificial valves and anticoagulation therapy improve, the incidence of these complications decreases and ranges from 0.9 to 2.8 episodes per 100 patient-years for mitral replacement and from 0.7 to 1.9 episodes per 100 patient-years for aortic replacement.

In severe embolic events, for example in acute cerebrovascular accident, low molecular weight heparins are added “on top” of indirect anticoagulants.

2. Wear of the prosthetic valve- any dysfunction of the prosthesis associated with the destruction of its structure, leading to its stenosis or failure. Most often this occurs during the implantation of biological prostheses due to its calcification and degeneration. Dysfunctions associated with wear of ball, long-term aortic prostheses occur less frequently.

3. Thrombosis of a mechanical prosthesis- i.e. any blood clot (in the absence of infection) on or near a prosthetic valve that obstructs blood flow or causes dysfunction.

4. Specific complications also include the occurrence of paraprosthetic fistulas, which may occur due to infective endocarditis of the prosthesis or for other reasons (technical

technical errors during surgery, gross changes in the fibrous ring of the affected valve).

In all cases of prosthetic dysfunction, the clinical picture of the corresponding valve defect develops acutely or subacutely. The therapist’s task is to identify clinical changes in a timely manner and listen to new sound phenomena in the melody of the prosthesis. In patients with mitral prosthesis dysfunction, the functional class quickly increases to III or IV due to new dyspnea. The rate of increase in symptoms may vary; quite often, dysfunction due to thrombosis of the mitral prosthesis began long before treatment. On auscultation, a clearly audible mesodiastolic murmur appears at the apex, in some patients a rough systolic murmur appears, and the melody of the working prosthesis changes.

Aortic replacement- clinical symptoms increase at different rates, shortness of breath and pulmonary edema occur. During auscultation of the heart, rough systolic and protodiastolic murmurs of varying intensity are heard. Sometimes vague symptoms end in the sudden death of the patient.

The clinical picture of artificial tricuspid valve dysfunction has its own characteristics: patients may not notice changes in their health for a long time, and there are often no complaints. Over time, weakness appears, palpitations during physical activity, pain in the right hypochondrium, weakness and even fainting with little physical activity. The degree of prosthetic dysfunction does not always correlate with the severity of symptoms. In an objective study of patients with thrombosis of the tricuspid prosthesis, the most consistent sign is some degree of liver enlargement. Swelling appears and increases.

Treatment of prosthetic valve thrombosis with thrombolysis is possible only if it occurs in the near future after replacement or in patients with contraindications for reoperation. All cases of prosthetic dysfunction should be consulted with a cardiac surgeon to decide on reoperation.

5. Infective endocarditis of the prosthetic valve in terms of frequency of occurrence it ranks second after thromboembolic complications and remains one of the most dangerous complications of cardiac surgery. From the tissues adjacent to the prosthesis, microorganisms that cause endocarditis penetrate into the synthetic

coating of the artificial valve and become difficult to access by antimicrobial agents. This causes difficulties in treatment and high mortality. Currently, there is an early one, which occurs up to 2 months after prosthetics (some authors increase this period to 1 year), and a late one, which affects the artificial valve after this period.

Most often, the clinical picture consists of fever with chills and other manifestations of severe intoxication and signs of artificial valve dysfunction. The latter may be a consequence of the appearance of vegetations, paravalvular fistula, or thrombosis of the prosthesis. The presence of fever, especially resistant to antipyretic drugs and antibiotics, especially accompanied by a clinical picture of a septic condition in a patient with an artificial valve or valves in the heart, must necessarily include infective endocarditis in the differential diagnosis. A change in the auscultatory melody of a valve prosthesis due to its dysfunction may not occur immediately, so echocardiographic examination, especially transesophageal echocardiography, becomes of great diagnostic importance.

Treatment of infective endocarditis of prosthetic heart valves remains challenging. In each case of this disease, the cardiac surgeon must be immediately notified. The possibility of surgical treatment should be discussed from the moment of diagnosis - most patients with late infective endocarditis of the prosthetic heart valve should undergo surgical treatment.

Antimicrobial therapy In most cases, infective endocarditis of an artificial valve is prescribed before obtaining data from a microbiological study.

Currently, most researchers working on this issue recommend vancomycin in combination with other antibiotics in various regimens for empirical treatment as a first-line drug (Table 12.8).

The duration of therapy with vancomycin with rifampicin is 4-6 weeks or more; aminoglycosides are usually discontinued after 2 weeks. Careful monitoring of renal function is recommended.

lin-resistant staphylococci, Staphylococcus aureus and gram-negative bacilli. Before starting empirical therapy, blood is drawn for microbiological testing.

Clinically significant mechanical hemolysis practically does not occur in modern models of valve prostheses. Mild increases in lactate dehydrogenase appear to be associated with mild hemolysis in some patients. However, when dysfunction of artificial valves occurs, overt hemolysis sometimes occurs.

Complications of a prosthetic valve include: thromboembolism in the systemic circulation, thrombosis and dysfunction of the prosthesis, paraprosthetic fistulas, wear of the prosthesis, infective endocarditis.

Determination of disability group

In the vast majority of cases, such patients are assigned disability group 2 without a work recommendation, i.e. without the right to work. At the same time, a survey of patients who underwent surgery to replace a heart valve with an artificial one showed that the majority of them consider the results of cardiac surgery to be positive. It is believed that the number of such patients who are assigned a disability group is unreasonably high. On

1 year immediately after heart valve replacement surgery (and in some categories of patients - within 1.5-2 years) the disability group should be determined, because the myocardium recovers after surgical trauma within approximately 1 year.

In addition, a disability group should be established in case of loss or reduction of qualifications and/or inability to perform work in the specialty that the patient had before the operation. It should be taken into account that some patients, before valve replacement surgery, had been on disability for a long time, sometimes since childhood, and did not work, and they do not have professional training. The causes of persistent disability in patients after cardiac surgery may not be associated with low tolerance to physical activity, but, for example, be the result of cognitive disorders and a decrease in mnestic functions due to long-term operations using artificial circulation. In addition, such patients are often reluctant to be given work by the administration of the institutions in which they are trying to get a job. Therefore, for a large proportion of patients who have undergone valve replacement, a disability pension is a measure of social security.

Echocardiography of normally functioning artificial valves and ultrasound diagnosis of their dysfunction

Echocardiography is the primary tool for assessing the condition of prosthetic heart valves. There are a number of limitations when visualizing a prosthetic heart valve using transthoracic ultrasound. For example, in the presence of a mitral valve prosthesis, a full examination of the left atrium is not possible during echocardiography in a four- and two-chamber apical position due to the appearance of an acoustic shadow created by the prosthesis (Fig. 12.5).

Nevertheless transthoracic echocardiography the most accessible and widely used method, which, with certain experience of the researcher, makes it possible to identify artificial valve dysfunction in real time. Transesophageal echocardiography can be a clarifying method. The ultrasound technician must be familiar with the picture of a normally functioning prosthetic valve. The locking elements must move

Rice. 12.5. Echocardiography B-mode. Apical four-chamber position. Normally functioning mechanical bicuspid mitral valve prosthesis, atriomegaly. Acoustic shadow from the prosthesis in the left atrium

move freely, with normal amplitude. When echocardiography in B-mode of the valve prosthesis (Fig. 12.6 and 12.7), the elements of the ball (rather than the entire ball) and the cells of the prosthesis are more often visualized. When examining a patient with a hinged disc prosthesis in B-mode, you can see the hemming ring of the prosthesis and the locking element (Fig. 12.8).

With high-quality visualization of a mechanical bicuspid prosthesis in B-mode, the sewing ring of the artificial valve and both leaflets are clearly visible (Fig. 12.9). And finally, echocardiography of a biological artificial valve in B-scan mode allows you to see the supporting frame of the prosthesis, its struts and thin shiny leaflets, which normally close tightly and do not prolapse into the cavity of the left atrium (Fig. 12.10).

An important role is played by assessing the range of motion of the obturator element of a mechanical prosthesis. With the normal function of a mechanical artificial valve, the amplitude of movement of the ball in the valve prosthesis and the disc locking element should not be less than 10 mm and that of the bicuspid valve leaflets should not be less than 5-6 mm. To measure the amplitude of movement of the obturator elements, M-mode is used (Fig. 12.11).

Rice. 12.6. Echocardiography, B-mode. Apical four-chamber position. Normally functioning mechanical mitral valve prosthesis. The upper part of the prosthesis cage and the upper part of the ball surface are visible

Rice. 12.7. Echocardiography, B-mode. Parasternal short axis artificial aortic valve. A normally functioning mechanical valve prosthesis is visualized in the lumen of the aortic root.

Rice. 12.8. Echocardiography, B-mode. Apical four-chamber position. Normally functioning mechanical disc hinge mitral valve prosthesis. The sewing ring and the locking element are visible in the open position

Rice. 12.9. Echocardiography, B-mode. Apical four-chamber position. Normally functioning mechanical bicuspid mitral valve prosthesis. The sewing ring and two flaps of the locking element are visible in the open position

Rice. 12.10. Echocardiography, B-mode. Apical four-chamber position. Normally functioning biological mitral valve prosthesis. Prosthesis struts and two closed thin flaps are visible

Rice. 12.11. Echocardiography, M-mode. Normally functioning mechanical bicuspid mitral valve prosthesis. In the apical four-chamber position, the cursor is parallel to the obturator element

Figure 12.11 clearly shows that the movement of the disk of the mechanical hinged mitral valve prosthesis is free, its amplitude exceeds 1 cm. The third component of assessing the function of the prosthesis is a study using Doppler echocardiography. With its help, the pressure gradient on the artificial valve is measured and the presence of pathological regurgitation is excluded or detected. Table 12.9 shows the normal limits for pressure drops on prosthetic valves of various models depending on their position.

From Table 12.9 it is clear that the average gradient on a normally functioning mitral valve prosthesis of any design should not exceed 5-6 mm Hg, and the peak aortic gradient should not exceed 20-25 mm Hg. If the prosthesis is dysfunctional, the gradient on them can increase significantly.

Below we provide illustrations of dysfunctions of artificial valves identified using transthoracic echocardiography (Fig. 12.12-12.19).

Thus, patients with prosthetic heart valves represent a special group of patients with abnormal heart valves. Interaction with them requires special skills, both from the clinician and from the echocardiographer.

Rice. 12.12. Echocardiography, M-mode. Thrombosis of a mechanical bicuspid mitral valve prosthesis. In the apical four-chamber position, the cursor is positioned parallel to the obturator element. It can be seen that the speed and amplitude of the disc movements are significantly reduced

Rice. 12.13. Echocardiography, M-mode. Severe dysfunction of the mechanical disc hinge prosthesis of the tricuspid valve due to its thrombosis. In the apical four-chamber position, the cursor is positioned parallel to the obturator element. Virtually no disc movement

Rice. 12.14. Echocardiography, B-mode. Parasternal long axis of the left ventricle. Severe dysfunction of the mechanical disc hinge mitral prosthesis - separation of the sewing ring from the fibrous ring is clearly visible

Rice. 12.16. Echocardiography, B-mode. Parasternal short axis of the left ventricle at the level of the mitral artificial valve. Massive calcification of the biological prosthesis is visible

Rice. 12.17. Echocardiography, B-mode. Apical four-chamber position with scanning plane deviation. The same patient as in Fig. 12.16. The arrow indicates a fragment of a ruptured mitral bioprosthesis leaflet.

Rice. 12.18. Echocardiography, B-mode. Parasternal long axis of the left ventricle. In the mitral position, the frame struts of the mitral biological prosthesis are visualized. Calcification and separation of part of the bioprosthesis leaflet

For what heart diseases is a disability group given? This issue worries residents of Russia, since 30% of the population suffers from one or another type of cardiovascular pathology. Dysfunction of the circulatory system affects a person’s physical capabilities, including his ability to work.

Who is given disability?

Disability is due to pathologies that cause dysfunction of vital organs. The list of such heart diseases includes:

1. Myocardial infarction. Violations lead to insufficient blood supply to organs and tissues, which provokes functional disorders of the heart and death of its tissues. As a result of diseases, a person is physically unable to perform labor activity. Smoking and coronary heart disease contribute to the progression of the disease.
2. Stage 3 hypertension. Accompanied by high blood pressure and crises, which affect the blood supply to the brain and lead to paralysis.
3. Severe heart disease and circulatory disorders of the last stage.

In addition, disability is granted to people who have undergone complex heart surgery - bypass surgery, valve replacement, etc.

Disability groups

Disability is assigned based on the following characteristics that determine the general state of health:

• injuries and organ damage circulatory system resulting in the inability to perform basic everyday activities;
• loss of a person’s ability to move independently;
• congenital defects in the structure of the heart, which led to the impossibility of working;
• identifying a person’s need for rehabilitation and special care.

There are 3 disability groups:

• Group 1 – patients need constant care from other people;
• Group 2 – people partially lose their physical abilities. Assigned for moderate heart disease. These patients are able to care for themselves if favorable conditions are created for them;
• Group 3 – people are able to take care of themselves, but have restrictions on working in their specialty.

Groups for IHD

People with coronary artery disease have contraindications to work:

associated with the maintenance of an electromechanical installation;

associated with an increased danger to the lives of other people (driver, train driver);

passing in extreme conditions(miners, builders).

Disability groups for ischemic heart disease are presented in the table

Degree of disability due to hypertension

People with hypertension also have the right to receive disability if we are talking about complicated forms of the pathology. Receiving benefits is indicated for stage 3 hypertension, accompanied by frequent crises, impaired cerebral blood supply, and damage to internal systems and organs.

For angina pectoris, temporary disability is usually prescribed:

• for FC 1 (functional class) – up to 10 days;
• for FC 2 - up to 3 weeks;
• for FC 3 – up to 5 weeks.

Groups for CHF (chronic heart failure)

Depending on the severity, chronic failure is classified into 4 functional classes.

There are 2 degrees of CHF. At 1st degree, the symptoms of the disease manifest themselves dimly and occur at the moment a person commits physical activity. The main signs of the disease: an increase in the size of the liver, attacks of suffocation and a displacement of the left border of the heart.

In case of stage 1 CHF, there are clear signs of circulatory disorders: weakness, rapid heartbeat, inability to remain in a supine position, expansion of the borders of the liver.

Disability in chronic heart failure is correlated as follows:

• CHF 1st degree FC 1,2,3 – disability is not established;
• CHF 1st degree FC 4 – 3rd group;
• CHF 2 degrees FC 1 – 3 group;
• CHF 2 degrees FC 2,3,4 – group 2.

Disability after heart surgery

Disability is issued after heart surgery. The group is determined depending on the complexity of the intervention and how the patient himself underwent the operation.

After bypass

After the intervention, patients are temporarily unable to work. A medical examination decides to assign a disability group to a person. Group 1 is prescribed to people who have suffered severe CHF and need care. Group 2 is given to people who underwent rehabilitation after CABG with complications. Disability group 3 is assigned to people with an uncomplicated rehabilitation period who have 1-2 functional classes of heart failure and angina pectoris.

After valve replacement

Heart disease eventually causes heart failure. Replacing a valve cannot with 100% certainty solve all the problems a person has. The issue of assignment of disability is considered in each individual case based on the results of diagnostic measures: stress test, pharmacological tests, echocardiography and others. Based on the results of the examination, specialists identify the degree of “wear and tear” of the heart. The presence of symptoms of CHF is a reason for transferring a person to light work or establishing a disability group for him.

After ablation

Previously, after cardiac ablation, disability group 2 was assigned for up to 1 year. Modern intervention techniques have made RFA surgery and recovery easier.

Currently, the decision to assign disability after RFA is based on the degree of circulatory impairment. With a NC of 0.1 degree, disability is not issued. For NK of 2nd degree, disability group 2 is assigned, for NK of 3rd degree - 1st group.

Registration of disability

Registration of disability requires time and medical examination. To get a group, you need to visit a cardiologist and leave with him a statement of intention to obtain disability. The doctor performs an examination, enters data into the patient’s medical record and gives referrals to specialists in other fields. A complete examination to make an accurate diagnosis is performed in an inpatient setting.

After a complete diagnosis, you can collect a package of documents:

• referral to a commission;
• passport;
• a copy of the work book;
• medical card;
• an extract from the institution at the place of examination;
• statement.

Survey

In case of cardiovascular diseases, disability is issued for a temporary period. Patients regularly need to be examined once a year for groups 1 and 2 and once every 6 months for group 3. For disabled children, a second commission is assigned depending on the severity of the pathology.

A person may be refused to extend his disability. This decision must be appealed to the ITU Bureau within a month.

Advice! There is the possibility of an independent review that is not associated with ITU. If the results of the ITU and the independent examination do not correspond, they file a claim in court to resolve the controversial issue.

Amount of disability benefits

In case of cardiovascular diseases associated with impaired functioning of internal organs and a person’s loss of ability to work, disability is prescribed. The disability group depends on the severity of the pathology and concomitant diseases. ITU gives a disability group after studying all necessary documents. A person needs to be examined regularly to renew benefits and allowances.

Disability due to a pacemaker for pensioners, if we are talking only about pacemaker implantation, is also assigned in rare cases. ITU experts can legally refuse to assign a disability if they find that a person’s life is not absolutely dependent on the work of the ECS (the act states that there are minor restrictions). In any case, ITU experts never, on their own initiative, propose conducting an appropriate survey, and they do not have the necessary equipment.

Is a disability group given after heart surgery?

ITU Appeal the decision ITU decision My disability is lifted, a year after heart surgery to replace a valve, my health is not very good, but they say that they will remove it, and the attending physician cannot do anything. read answers (1) Tags: Heart surgery Replacement Procedure Required Is a 7 month old child disabled after heart surgery due to a secondary ASD?read answers (1) Tags: Is there a disability? Heart surgery My daughter had heart surgery, a congenital defect, in the first month of life, can I receive any money? , how long?read answers (3) Tags: State pension provision Federal law Cash My child underwent heart surgery, in the first month of life, a defect, now we are 4 months old, can I get any cash payments? read answers (1) Tags: Cash payment Payment I have an aortic artificial heart valve.

Medical and social examination

Why is a pacemaker disabled? Disability for a pacemaker is granted only if body functions are severely impaired and there is an unfavorable work prognosis (the possibility of continuing professional activity– i.e. After surgery, the patient has restrictions on working with a pacemaker that did not exist before). If there are no such violations and forecasts, then disability will not be assigned.
To obtain a disability group when installing a pacemaker, you should contact the medical and social examination committee (MSE, previously called the medical and labor expert commission, VTEC). When deciding whether disability is appropriate, the commission must be guided by data on the degree of dependence of the patient on the operation of the device.
If the postoperative epicrisis says: “discharged with improvement...” (and this is usually the case), then assignment to a group will be denied.
The severity of heart rhythm disturbances before and after implantation of the stimulator, the frequency and severity of attacks of concomitant diseases will be assessed. If you have a pacemaker, they may give you the following groups disability: 3 temporary, 3 permanent, 2 temporary, 2 permanent.

Only a medical commission can give an exact answer as to what disability group is assigned if an ECS is installed. Group 3, 0th and 1st degrees are workers, 2nd and 3rd degrees are not workers, but without a ban on work (the employee has the right to continue working). An employer may request an Individual Rehabilitation Program for a disabled person, but the employee may not provide it - in this case, the employer is not responsible for restrictions in work functions.

This is especially true for readers of the next thread who are interested in whether it is possible to work as a driver with a pacemaker. The same applies to group 2.

Heart diseases that cause disability

Tags: Congenital heart defect Lawyer Disability Less than a month ago I underwent surgery to replace the mitral valve plus concomitant diseases, today I was with the doctors and they said that the commission to read the answers (1) Tags: Federal Law of the Russian Federation Social guarantees Establishing disability Is a child (10 months old) entitled to disability after radical surgery heart surgery, diagnosis of congenital heart disease Tetralogy of Fallot. read answers (1) Tags: Is the Ministry of Health of Russia entitled to disability Heart surgery Will a child be given disability after abdominal heart surgery if everything is fine after the operation? read answers (1) Tags: Resolution Government of the Russian Federation Establishing a disability group Registration of a disability group My child had open heart surgery (ASC), and was always given disability for a year after the operation. But the ITU refused me.

How to get group 3 disability: list of diseases and pension amount

Info

In case of persistent circulatory failure of the second degree, patients can work from home. Persons of mental work can sometimes perform work in much easier conditions.

When circulatory disorders reach stage III, patients cannot perform professional work, and sometimes require constant care. Criteria for determining the disability group. In the absence of significant morphological changes and circulatory disorders, the range of professions available to patients is very wide, and all of them can be employed either in their main profession without reducing their qualifications, or through retraining.

In the presence of significant morphological changes in the myocardium in combination with significant rhythm disturbances or sluggish rheumatism, the range of professions available to patients is limited, and most of them have limited ability to work (group III disabled people).

Rehabilitation after mitral valve replacement

Attention

How to get disability after pacemaker implantation?

1. Determine the degree to which your life and health depend on the operation of the pacemaker - this can be done by checking the operation of the IVR.
2. You must take a referral for an MSE from the cardiologist you are seeing (local specialist) (reporting symptoms: shortness of breath, dizziness, darkening of the eyes, etc.).
3. The certificate of absolute dependence must be copied - you keep the original and give a copy to the ITU.

There is no need to make a fuss or argue anywhere or with anyone. If they do not make contact voluntarily, then statements are written in two copies - one to the chief doctor, the second (with a note of acceptance) again to yourself.

Responsible people lose the desire to argue and swear if they see in front of them a more or less prepared citizen who is aware of his rights.

Mitral regurgitation

Telephone consultation 8 800 505-91-11 Free call Boy before heart surgery, i.e. until the age of 15 he received a disability pension, but after the operation it was decided to deprive him of his disability pension. read answers (1) Tags: Responsible person Heart surgery My daughter was given disability until she was 18 after open heart surgery (OHS), they are inviting me in a month for control examination.

Disability after heart surgery

For this purpose, the following have been proposed: determination of the titer of antistreptolysin and antihyaluronidase, the presence of C-reactive protein, fibrinogen, diphenylamine index, protein and lipoproteins by electrophoresis, as well as formol, cadmium and sublimate tests, etc. These tests are not specific for the rheumatic process, but in the aggregate help determine the presence of an active process.
The presence and degree of impaired blood circulation are established by a detailed clinical examination of the patient. Labor forecast, indicated and contraindicated conditions and types of work. The labor prognosis of patients with isolated insufficiency is generally favorable. This is explained by the fact that circulatory disturbances with this defect rarely occur, and if they occur, they progress slowly and have the character of right ventricular failure, which is easily amenable to therapeutic intervention.

An employer may request an Individual Rehabilitation Program for a disabled person, but the employee may not provide it - in this case, the employer is not responsible for restrictions in work functions. This is especially true for readers of the next thread who are interested in whether it is possible to work as a driver with a pacemaker. The same applies to group 2. Discussions on the topic Is disability allowed when installing a pacemaker - there are many on other diseases, but the situation with pacemakers is well described. Legal advice on assigning a disability group after surgery to install a stimulator is not very meaningful material, because The specialist was clearly too lazy to answer.

Medical and social examination

Treatment prescribed for acquired defects can be conservative or surgical. Conservative treatment includes the prevention of complications, relapses of the underlying disease that caused the acquired defect, and correction of heart function. If the ongoing therapeutic treatment does not bring the desired result, the patient is advised to consult a cardiac surgeon for timely surgical treatment.

Acquired heart defects are dangerous for the development of progressive heart failure, lead to disability, and can often be fatal. Registration of disability Whether disability is due to a heart defect is decided by a medical and social expert commission, abbreviated as ITU. The commission consists of several specialists.

Heart diseases that cause disability

24-hour legal advice by phone GET FREE CONSULTATION WITH A LAWYER BY PHONE: MOSCOW AND MOSCOW REGION: ST. PETERSBURG AND LENIGRAD REGION: REGIONS, FEDERAL NUMBER: Is disability given after heart surgery? The heart is the most important organ human body. It delivers blood to all tissues and organs, so it bears enormous loads. Poor nutrition, stress, increased fatigue, poor ecology, constant nervous tension lead to the fact that the heart cannot stand it and gets sick.

Diseases of this organ often require careful treatment and surgery. Disability is often awarded after heart surgery and heart diseases.

Is disability allowed after heart surgery?

UPS), in a month you are invited for a follow-up examination. Do they now want to remove the disability? read the answers (1) Topic: Get a disability group My child has a congenital heart defect after the operation we will be put on disability. I want to know which group will be and how much they will pay. read the answers (1) Less than a month ago I had surgery to replace the mitral valve valve plus concomitant diseases today, the doctors said that the commission was to read the answers (1) Topic: Is a disability group eligible? Is a child (10 months) eligible for disability after radical heart surgery, diagnosed with congenital heart disease Tetralogy of Fallot. read answers (1) Topic: Child's disability They will Is there a disability for a child after abdominal heart surgery, if everything is fine after the operation? read the answers (1) My child had open heart surgery (ASS), and was always given disability for a year after the operation.

Do heart defects give you disability and how to apply for it?

Coronary heart disease, smoking and obesity also contribute to the progression of myocardial infarction. 2. Stage 3 hypertension. The disease is characterized by high blood pressure, the presence of crises, leading to disturbances in the supply of blood to the brain, which often lead to paralysis. 3. Severe heart defects, as well as irreversible circulatory disorders of the 3rd degree.

Attention

In addition, patients who have undergone a number of severe forms of heart disease and operations, for example, coronary bypass surgery, can count on registration of disability. If you want to receive disability due to heart disease, you need to contact your doctor to express this desire. Registration of disability after bypass surgery After cardiac bypass surgery, temporary disability is observed.

Therefore, the patient is issued a sick leave certificate for up to 4 months.

Disability after heart surgery

Info

All over the world the most common cause diseases of the heart and blood vessels are the cause of death. Both adults and children suffer from these diseases. Heart disease is a serious, often incurable disease. Symptoms that indicate the presence of a disease such as heart disease cannot be ignored.
It is important to diagnose the disease in time and begin treatment as early as possible. What is a heart defect called? A heart defect is a pathological disorder in the structure and functioning of the heart that leads to heart failure.
Topic: Free medications Child on disability, 2 years old, two heart surgeries, after the first operation Sildenafil was prescribed for health reasons until the 3rd planned operation read answers (1) Topic: Heart surgery Recently underwent a complex heart surgery (aortic valve replacement)., and Now I found out that I have some benefits, how can I find out more about this? read the answers (1) Topic: Heart surgery I had heart surgery and after the operation I developed epilepsy, what disability group should I be given? Thank you. read the answers (1) Topic: Copyright and related rights After heart surgery ACS, disability was not given at work, they say that you can’t work in your specialty, you need to resign of your own free will. read the answers (2) Topic: After the operation My daughter is 4 years old, she has CHD, secondary ASD. We were put on a waiting list for surgery.

What is the law for disability when replacing a heart valve?

Achieving a complete recovery is only possible through surgery. The consequence of the development of such a serious disease as heart disease is a gradual disruption of the functions of other human organs to varying degrees. To maintain health and avoid the development of more severe complications, correct knowledge about the dangers of heart disease is necessary.
Modern medicine has so much high level development that even in the most difficult cases of organ disease can, if not completely cure, then provide a person decent life. Congenital heart defects Congenital pathologies of cardio-vascular system are caused by various reasons.

Next, patients are sent for a medical and social examination, which decides whether to assign a disability after heart bypass surgery and which group. Disability group I is assigned to people with severe chronic heart failure who require care from others. Disability group II can be assigned to patients with a complicated postoperative period.

Important

Disability group III can be assigned to patients uncomplicated by the course of the postoperative period, as well as with or without grade 1-2 angina pectoris, heart failure. Work in professions that do not pose a threat to the patient’s cardiac activity may be permitted. At the same time, prohibited professions include working in the field, with toxic substances, at heights, and as a driver.

The heart is a vital organ that performs the main function in the circulatory system, ensuring the movement of blood through the vessels thanks to its rhythmic contractions. When pathological defects are observed in the condition of the heart, the first thing the body experiences is insufficient blood supply. If the degree of blood supply disturbance is high enough, then the person is given a disability.
Heart defects are divided into:

1. Congenital. Disturbances in the structure of the heart organ occur even before a person is born.
2. Purchased. Heart pathology develops during a person’s life, for example, in the case of complications after an illness.

Heart defects are chronic diseases that gradually progress. Various therapeutic methods alleviate the condition of patients, but do not bring complete recovery. Therapy does not eliminate the cause of the disease.
Disability is a medical and social category, and not a purely medical one. From a practical point of view, the issue of assigning disability to a person after surgery to implant a pacemaker is decided on the basis expert assessment preservation of labor functions by the patient. Those. education, specialty, place of work and working conditions, self-care opportunities and the degree of disability reduction must be taken into account.

Formally, on the basis of Government Resolution No. 123 of February 25, 2003 “On approval of the regulations on military medical examination” in accordance with Art. 44 people after installation of an artificial heart pacemaker are equivalent to patients with ischemic disease with a significant degree of dysfunction. And such patients should be given a disability group without conditions. Legal grounds According to clause 13 of the Decree of the Government of the Russian Federation of April 7, 2008.

Their task is to study the documents provided by the patient, assess the patient’s health and make a decision on disability. To register a disability, the patient must inform the attending cardiologist about his decision to receive a disability group. The attending physician makes his own assessment of the patient’s condition and refers him to other specialists, who also make appropriate entries in the patient’s card. Often, a complete examination of the patient with all necessary laboratory tests is carried out in a hospital. After undergoing a complete diagnosis, the patient must collect a package of all necessary documents to submit them to the ITU for a final conclusion.