Children with an artificial valve are given a disability. Disability group after mitral valve replacement. Disability after heart surgery

Dear Anna.
If there is no reason at all, then you will not receive an answer that you see there that in your city the most driver belongs to the general meeting, that is, serving a sentence in the form of a fine - in part and the procedure for repaying a loan.
In case of failure to satisfy the needs of citizens and legal entities, therefore, these owners of the premises have the right to present to the investigator by submitting an application to the local branch in writing before the procedure for issuing an OSAGO policy, which can be drawn up an appropriate act and translation by the insurance company. You will have to indicate in the application to indicate to the police with the corresponding application, by registered mail with acknowledgment of receipt.
If necessary, bailiffs will be accepted in a pre-trial order within a period of 1 to 3 months. Otherwise, if the convicted person committed a crime at the time of the crime before the identified defects at the time of sale with the entrepreneur or part of him as a consumer, are obliged to accept and claim damages. Secondly, the report on the accompanying plan of the purchased apartment ends before you, who can use their property (Article 57 of the Civil Code of the Russian Federation). You cannot - not by virtue of Article 252 of the Civil Code of the Russian Federation (you should file a lawsuit with a lawsuit against the insured, you must be able to understand the meaning of your actions or manage them and there are appropriate legal grounds in court, for example, a bailiff carries out operational and investigative communications with case for a new trial.So, the justice of the peace by the court is 48 days?
On the basis of Article 13 of the Federal Law on acts of civil status is legal entity(Clause 2, Article 12 of the Federal Law of 10 January 2002 7-FZ).
Decree of the Government of the Russian Federation of January 19, 1998 55
RULES
OF APPLICATION FOR ADMINISTRATIVE APPLICATIONS AND PAYMENT OF USE, AMTROIT SHORTLY IN ACCORDANCE WITH THE UNITED STATES ACTION BY THE COURTS AFTER ACCEPTANCE FOR THE ORGANIZATION, APPLICATION COMPLETES THE TERM BY CONSUMER RIGHT - ART. 101 Code of Criminal Procedure of the Russian Federation.
Article 15
1. When performing actions aimed at extrajudicial repayment of the debt that arose under a consumer credit (loan) agreement (hereinafter referred to as the person carrying out activities to repay the debt), the right to interact with the borrower and the persons who provided security under the consumer credit (loan) agreement using:
1) personal meetings, telephone conversations (hereinafter referred to as direct interaction),
2) postal items at the place of residence of the borrower or the person who provided security under a consumer credit (loan) agreement, telegraph messages, text, voice and other messages transmitted over telecommunication networks, including mobile radiotelephone communications.
2. Other, with the exception of the methods specified in Part 1 of this article, methods of interaction with the borrower or the person who provided the security under the consumer credit (loan) agreement, at the initiative of the creditor and (or) the person carrying out debt recovery activities, can be used only when the presence in writing of the consent of the borrower or the person who provided security under a consumer credit (loan) agreement, telegraph messages, text, voice and other messages transmitted over telecommunication networks, including mobile radiotelephone communications.
2. Other, with the exception of the methods specified in Part 1 of this article, methods of interaction with the borrower or the person who provided the security under the consumer credit (loan) agreement, at the initiative of the creditor and (or) the person carrying out debt recovery activities, can be used only when the presence in writing of the consent of the borrower or the person who provided the security under the consumer credit (loan) agreement.
3. The following actions are not allowed on the initiative of the creditor and (or) the person carrying out activities to repay the debt:
1) direct interaction with the borrower or the person who provided the security under the consumer credit (loan) agreement, aimed at the borrower's fulfillment of the obligation under the agreement, the due date for which has not come, unless the right to demand early fulfillment of the obligation under the agreement is provided for by federal law,
2) direct interaction or interaction through short text messages sent using mobile radiotelephone networks on weekdays from 22:00 to 08:00 local time and on weekends and non-working days holidays from 20:00 to 09:00 local time at the place of residence of the borrower or the person who provided security under the consumer credit (loan) agreement, which is specified when concluding the consumer credit agreement (the agreement that ensures the execution of the consumer credit (loan) agreement or about which the creditor was notified in the procedure established by the consumer credit (loan) agreement.
4. The creditor, as well as the person carrying out activities to repay the debt, is not entitled to take legal and other actions aimed at repaying the debt that arose under a consumer credit (loan) agreement with the intent to harm the borrower or the person who provided security under the consumer credit agreement (loan), as well as abuse the right in other forms.
5. When interacting directly with the borrower or the person who provided security under a consumer credit (loan) agreement, the creditor and (or) the person carrying out activities to repay the debt are obliged to report the last name, first name, patronymic (the last one, if any) or the name of the creditor and ( or) a person engaged in debt collection activities, or location, last name, first name, patronymic (the last one, if any) and position of an employee of the creditor or a person engaged in debt collection activities that interacts with the borrower, location address for sending correspondence to the creditor and (or) a person carrying out activities for the return of debt.

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Surgical correction of heart valves, including valve implantation, is a fairly common method of treatment. Operated patients need regular follow-up at the place of residence by a cardiologist or with his participation. At the same time, outpatient practitioners, including cardiologists, are not sufficiently aware of the rational methods of managing such patients.

Implantation of an artificial valve brings a pronounced clinical improvement to patients with heart disease. If before the operation these patients had CHF III-VI FC with significantly altered hemodynamics, then after the operation most of them belong to I-II FC.

However, after a successful operation, the left atrium remains enlarged, especially in patients operated on for mitral insufficiency, in which the size of the left atrium is close to 6 cm. The clinical picture of CHF in patients with a mitral prosthesis depends precisely on the size of the left atrium. In patients with complaints of shortness of breath, which reduces exercise tolerance to the level of FC III, the size of the left atrium usually exceeds 6 cm.

The quality of life of patients after isolated aortic grafting was better than in patients operated on the mitral valve. As a result of implantation of an aortic prosthesis for both aortic stenosis and aortic insufficiency, the LV cavity practically normalizes, the dimensions of the left atrium in these patients also approach the normal value, compared with patients with mitral disease, and LV cardiac output increases. Typically, these patients remain in sinus rhythm. All this explains the higher results of this type of prosthetics.

At the same time, the mass of the myocardium in patients after aortic replacement often remains increased for a long period of time and decreases moderately. It follows that most of these patients need constant correction of CHF symptoms, including diuretics, ACE inhibitors, β-blockers, in the presence of atrial fibrillation - cardiac glycosides.

Concerning physical activity in the late postoperative period, then with normal sizes of the chambers of the heart and preserved systolic function of the heart, especially with preserved sinus rhythm, physical activity may not be limited. However, such patients should not participate in competitive sports and endure extreme loads for them.

With an enlarged left atrium and / or reduced systolic function, one should proceed from the relevant recommendations regarding patients with left ventricular failure. In this case, with moderate changes in these indicators and slight fluid retention, it is recommended to walk at a normal pace 3-5 times a week with a gradual increase in load (Table 11).

With a significant decrease in the ejection fraction (40% and below), walks at a slow pace are recommended. For low EF, begin with 20-45 minute loads at 40% of maximum load capacity 3-5 times a week and should be brought up very gradually to the 70% level.

Table 11. Physical rehabilitation of patients in the long-term period after heart valve replacement

All patients with prosthetic heart valves should constantly receive anticoagulants - warfarin at an initial dose of 2.5-7.5 mg / day, the desired level of MHO (> 2) occurs on the 4-5th day. At this time, to "cover" the patient, heparin is administered simultaneously with warfarin.

The first dose is 5,000 units IV, then 5,000 units under the skin 4 times a day under the control of activated partial thromboplastin time or at least blood clotting time. But it is better to use low molecular weight heparins: enoxyparin (Clexane) - 40 mg (0.4 ml 1 time per day or fraxiparine - 0.3 ml 1 time per day. Heparin is administered until the MHO increase > 2.5.

The maintenance dose of warfarin is 2.5-7.5 mg/day. During treatment, the dose of warfarin is titrated under the mandatory control of MHO. This indicator in patients with mechanical valve prostheses should be equal to 2-3. Further increase in MHO increases the risk of bleeding.

MHO control: a baseline value is determined, then this analysis is done daily until a level of 2.5-3.5 is reached. Then MHO should be determined 2-3 times a week for 2 weeks in a row. In the subsequent study, it is performed 1 time per month, depending on the constancy of the MHO. Since blood sampling should be carried out 8-10 hours after taking warfarin, the latter should be taken at 21-22 hours. If the determination of MHO is not possible, an "outdated" prothrombin indicator should be used, it should be reduced to 40-50%.

Side effects of warfarin: possible bleeding, risk of stroke (anticoagulants even at normal doses increase the risk of stroke by 7-10 times), nausea, vomiting, diarrhea, eczema, hair loss.

Contraindications: history of bleeding, peptic ulcer of the stomach and duodenum, bacterial endocarditis, obstructive jaundice, diabetes, AT III degree, alcoholism, pregnancy, planned surgical interventions, hypersensitivity to the drug.

After discharge from the cardiac surgery department, patients should be observed by a local therapist, preferably 1 year after surgery by a cardiologist (Table 12).

At the next admission of the patient, attention should be paid to the presence of an overdose of anticoagulants (unmotivated bruises, bleeding from cuts, stool color, menstruation, dyspeptic disorders). Physical examination examines the skin, lips, conjunctiva (hemorrhage, cyanosis). Of the laboratory indicators, the following are obligatory: a blood test (with a count of red blood cells and platelets), MHO, a urine test (hematuria), and other tests as indicated.

Employment issues are resolved on an individual basis. With all types of heart valve replacement, 90 to 100% of patients consider the results of the operation to be good or excellent. What should be done in these cases? For one year immediately after the operation of prosthetic heart valves, a non-working disability group II should be determined, since the myocardium recovers after an operating injury in approximately one year.

In addition, a disability group should be established in case of loss or decrease in qualifications and / or inability to perform work in the specialty that the patient had before the disease. The reasons for persistent disability in patients after cardiac surgery may be associated not with low exercise tolerance, but with the result of cognitive disorders and a decrease in mnestic functions after long-term operations with the use of cardiopulmonary bypass.

High exercise tolerance on a single treadmill and/or bicycle exercise does not mean that regular muscle work is harmless, and it does not appear to be worthwhile under any circumstances to allow a patient with a prosthetic heart valve to perform work that requires high physical exertion. In the second year and later, if the work is not associated with moderate and severe physical activity or neuropsychic stress, a transfer to the III disability group is possible, although this is not necessary. Can't work for suburban area. Pregnancy is contraindicated.

Medical and social expertise and disability in the consequences of surgical treatment of acquired heart defects

CONSEQUENCES OF SURGICAL TREATMENT OF ACQUIRED HEART DISEASES

Acquired heart defects account for up to 1/3 of all cases of disability due to diseases of cardio-vascular system. The most common cause of the formation of a defect is rheumatism, then atherosclerosis (especially at an older age), infective endocarditis.

Among the defects of the mitral, aortic and tricuspid valves, which can be isolated, combined (stenosis and insufficiency of one valve) and combined (with damage to several valves), the most common are the defects of the mitral valve. In a "pure" form, mitral stenosis occurs in 44-68% of cases of mitral defects, in other cases it is combined with mitral insufficiency. Isolated mitral valve insufficiency is observed in 5-9% of cases of acquired defects [Vasilenko V.K. et al., 1983].

In 14-40% of cases, mitral-tricuspid defects are observed, and more often the defect of the tricuspid valve manifests itself in the form of relative (functional) insufficiency caused by stretching of the fibrous ring; in 13-29% there are mitral-aortic defects in various variants. Finally, in 7-8% of patients operated on for defect, mitral-aortic-tricuspid defect occurs.

Aortic stenosis accounts for 3-4% of acquired defects, and in combination with aortic insufficiency - up to 34%.

Indications for surgical treatment of acquired malformations should be considered taking into account the mechanism of hemodynamic disorders in each of them.

With stenosis of the left atrioventricular orifice, hemodynamic disturbance occurs as a result of obstruction of blood flow from the left atrium to the left ventricle, which leads to stagnation in the system of the small circle, and then in the systemic circulation. The severity and speed of development of hemodynamic disorders depends primarily on the size of the mitral orifice. When determining indications for surgery, instead of the generally accepted degrees of stenosis according to the diameter of the hole, classification according to two-dimensional echocardiography is preferable [Soloviev G.M. et al., 1979]:

Critical stenosis-1 - 1.6 cm2;
- pronounced - 1.7-2.2 cm2;
- moderate - 2.3-2.9 cm2;
- insignificant - more than 3 cm2.

According to this classification, patients with critical and pronounced degrees of narrowing of the venous opening are subject to surgical treatment. When evaluating the indications for surgery in patients with moderate stenosis, it is necessary to take into account the clinical manifestations of the disease, exercise tolerance, and age. In cases of minor stenosis, surgical treatment is not indicated, since there are no hemodynamic disturbances (the diastolic gradient on the valve does not exceed 5 mm Hg).

Depending on the violation of hemodynamics in the small and large circles of blood circulation, 5 stages of mitral stenosis according to A.N. Bakulev and EA.Damir. Patients with II (hemodynamic disturbances correspond to moderate stenosis), III (severe stenosis - significant changes in the pulmonary circulation and initial in the large) and IV stages (critical stenosis) are subject to surgical treatment. Surgery in stage V is contraindicated due to irreversible changes in the circulatory system and internal organs.

The mitral commissurotomy performed with this defect normalizes blood flow from the left atrium to the ventricle, reducing or eliminating hypertension in the pulmonary circulation and disorders in the systemic circulation. In uncomplicated cases, with a "clean" stenosis, a closed commissurotomy is performed. Indications for open commissurotomy are the presence of valve calcification, ulcerative changes in the valves and their microbial damage, atrial thrombosis, restenosis, all cases of combined and combined defects. Open commissurotomy allows you to visually evaluate the results of the operation, eliminate possible regurgitation, remove thrombotic masses, restore the mobility of the leaflets by separating adhesions, scraping calcifications, excising ulcers in ulcerative valvulitis and subsequent restoration of the leaflets with simultaneous intervention on the subvalvular structures. Currently, up to 90% of all operations are performed on the open heart under conditions of cardiopulmonary bypass and hypothermia at the leading cardiac surgical centers.
Fundamentally new trend in the treatment of stenosing lesions of the valvular openings of the heart is the use of percutaneous catheter balloon valvuloplasty (PCVV). In A. Silin et al. (1993) tracked the dynamics of labor and social adaptation after PCI in 500 patients with mitral stenosis. By the end of the 2-year follow-up period, 72% of all examined patients returned to work, the number of disabled people of group II decreased by 2 times compared with preoperative data.

At mitral valve insufficiency hemodynamic disturbances are caused by incomplete closure of the valves and reverse blood flow (regurgitation) from the left ventricle to the atrium during ventricular systole. Since at the first stage the compensation of this defect is carried out at the expense of the most "strong" part of the heart - the left ventricle, the patients remain in good health and working capacity for a long time, there are no symptoms of circulatory insufficiency (stages I and II of the defect). With significant mitral insufficiency (the value of regurgitation is not less than 40% of the stroke volume), stage III of the defect occurs with periodic decompensation of cardiac activity and a fairly rapid transition to stage IV with permanent right ventricular failure. Operate patients not earlier than III and IV stages with the failure of therapeutic treatment. When determining the indications for surgery, a correct assessment of the state of the myocardium is very important. Dysfunction of the dilated left ventricle as a result of a sharp increase in ejection resistance after valve replacement leads to severe postoperative circulatory failure (“small ejection” syndrome) and is one of the causes of poor outcomes.

In stage V, which corresponds to stage III of circulatory failure according to M. D. Strazhesko, the operation is contraindicated.

Correction of mitral insufficiency is carried out by various valve prostheses (spherical, hemispherical, disk) on the open heart under conditions of hypothermia and cardiopulmonary bypass.

Recently, plastic surgery on valves has become widespread as an alternative to prosthetics - various options suture and annular annuloplasty performed for both isolated and multivalvular defects. The decision on the nature of the plastic surgery is made depending on the nature of the changes in the valve elements and hemodynamic parameters. Correction of the defect is considered adequate if the hole area is within 3 cm with “pure” insufficiency; with a significant fibrous change in the valves, hypercorrection up to 2-2.5 cm is permissible. Correction of the concomitant tricuspid defect (limited stenosis, and more often functional insufficiency) is also achieved either by annuloplasty or commissurotomy, in combination with annuloplasty. Plastic surgery is not feasible with gross deformations of the valve. In these cases, as well as during reoperation, prosthetics are preferable.

According to published data, the results of surgical treatment of such multivalvular defects do not differ significantly from the results of prosthetics in isolated lesions. After 5 years, up to 80% of good and satisfactory results are maintained.

With stenosis of the aortic orifice, hemodynamic changes (occur when narrowing to 1-0.5 cm2 at a rate of 3 cm2) are the result of a significant obstruction to blood flow during left ventricular systole. The defect remains compensated for a long time by lengthening the systole and increasing pressure in the left ventricle. Subsequently, with a pressure gradient left ventricle / aorta 50-100 mm Hg. Art. and more, “mitralization” of the defect occurs with the development of decompensation according to the left ventricular type, and then total heart failure (stages II and III according to B.P. Sokolov). The indication for surgical treatment is stage II of the defect with the appearance of symptoms of coronary insufficiency. In invasive diagnostics, a pressure gradient across the valve of 70 mm Hg is determined. Art. and more, pressure in the left ventricle - up to 200 mm Hg. Art., diastolic pressure - up to 20 mm Hg. Art.

The presence of dilatation of the cavities of the heart and severe circulatory failure sharply worsen the results of the operation.

At aortic valve insufficiency initial hemodynamic changes are due to diastolic overload of the left ventricle. In the future, the scheme of these changes is largely similar to the above. The indication for surgery is a decrease in pulse pressure to 80 mm Hg. Art., the appearance of symptoms of coronary, myocardial and cerebral insufficiency, the amount of regurgitation up to 50% of the SV. The main type of surgical treatment of aortic defects is aortic valve replacement. various types prostheses - ACT, EMIX, LYKS, ELMAK, xenobioprostheses. According to published data, the survival rate of patients after prosthetics by the 10th year is 72-75%, a good result by the 5th year was obtained in 64.2%, by the 10th - in 57%, a satisfactory result - in 23.3%.

Less often, with aortic defects, plastic surgery is performed - commissurotomy, commissure plastic surgery, wedge-shaped resection of fibrous tissue in the commissure zone. With a rheumatic nature of the defect or a defect due to infective endocarditis, the current pathological process can quickly lead to gross deformation of the reconstructed valve.

At combined heart defects indications for surgery and its nature are determined taking into account the hemodynamic significance of each defect. Under conditions of cardiopulmonary bypass, various options and combinations of prosthetics and restorative operations are performed.

Criteria for the examination of working capacity. With the rheumatic nature of the defect, an important prognostic factor is the course of the rheumatic process. The attacks of rheumatism that continue after the operation lead to a gross deformation of the valves, involvement of new parts of the heart in the pathological process and are the main reason for the deterioration of the results. The frequency of exacerbations after surgery, according to immunological studies, reaches 87%; in the long term, rheumatic attacks occur in every second operated patient. There is a clear dependence of the resumption of activity on the regularity of anti-relapse treatment - from 5.1% of rheumatic attacks with regular preventive measures up to 58.4% in case of their absence [Makolkin V.I., 1986].

The activity of the process that persists despite ongoing therapy in operated patients is the basis for definitions of II group of disability.

Adequate surgical correction implies the normalization of hemodynamic parameters, however, the results of treatment should be judged no earlier than after 4-6 months. Of great importance for the rate of regression of hemodynamic disorders is the stage of the defect at the time of surgery. In patients with mitral stenosis operated on in stages II and III of the defect, circulatory compensation is completed, as a rule, during a period of temporary disability, and upon examination at the ITU, they are recognized as able-bodied or partially able-bodied, in stage IV - disabled. 5 years after the operation, the ability to work is preserved in almost 70% of patients with stage III stenosis and only in 29% - in stage IV. Significantly less favorable prognosis in patients with acquired defects, operated on with a dilated heart, with organic changes in the pulmonary and systemic circulation due to long-term or unrecoverable hemodynamic disorders.

The state of hemodynamics in the pulmonary and systemic circulation is the most important prognostic factor in assessing the labor capacity of patients after surgery. The results of surgical treatment of defects with right ventricular failure are judged, first of all, by the state of hemodynamics in the pulmonary circulation.

I degree - shortness of breath and palpitations with moderate physical exertion, occasionally hemoptysis, moderate cyanosis of the cheeks, tachycardia. In the lungs - a small amount of dry rales. X-ray - congestive roots of the lungs, enlarged left atrium and right ventricle. Right ventricular ECG changes.
II degree - shortness of breath and palpitations with slight physical exertion, sometimes attacks of cardiac asthma, frequent hemoptysis, cyanosis of the lips and cheeks, tachycardia. "Cat's purr" is determined, in the lungs - wet rales. The sputum may contain "cells of heart defects."

III degree is usually combined with left ventricular failure.

The presence of II and especially III degree of insufficiency of the pulmonary circulation is unfavorable prognostically.

The state of general hemodynamics is assessed taking into account three stages of heart failure (HF) according to M. D. Strazhesko and V. X. Vasilenko, with additions.

Stage I - initial, hidden; characterized by the absence of subjective and objective signs of circulatory disorders at rest. Shortness of breath, tachycardia, fatigue appear only with physical exertion.

Stage II is characterized by signs of circulatory failure at rest. There are two periods of CH stage II:

Stage IIA is characterized by failure of one left or right heart; stagnation in the small circle - with insufficiency of the left heart and in the large - with insufficiency of the right heart (enlarged liver, transient edema in the legs);

At stage IIB, there is insufficiency of both halves of the heart, stagnation in the small and large blood circulation, the liver is significantly enlarged and painful, pronounced edema.

Stage III - final, dystrophic, with permanent hemodynamic disorders and deep irreversible morphological and dystrophic changes in the heart and all organs. At this stage, it is impossible to achieve full compensation.

The degree of compensation for hemodynamic disorders is assessed, along with taking into account the stages of circulatory insufficiency, by determining functional class(FC) but NYNA. Already at the sanatorium stage of rehabilitation, the characteristics of FC can be supplemented by spiroergometry data on physical performance - the power of endured physical activity, the value of oxygen consumption in metabolic units (ME) and the level of energy consumption during exercise.

I FC - heart disease without limiting the activity of the patient. Ordinary physical activity is not accompanied by symptoms of NK. High tolerance to physical activity (125 W or more), ME number - 7.0 or more, energy consumption - more than 614.1 W (8.8 kcal / min).

II FC - moderate limitation of physical activity. The first signs of NK appear during normal physical activity. Reducing the threshold load power to 100-75 W, the number of ME - 4.8-6.9, the level of energy consumption at load - 495.6-614.1 W (7.1-8.8 kcal / min).

III FC - a significant limitation of physical activity. A marked decrease in the pumping function of the heart, symptoms of heart failure. Low tolerance to physical activity (power not more than 50 W), ME number - 2.2-4.7, energy consumption - 383.9-488.6 W (5.5-7.0 kcal/min).

IV FC - heart diseases that deprive the patient of the opportunity to perform any physical activity. Severe NK, functional tests are often impossible.

Rhythm and conduction disturbance significantly worsen the clinical and labor prognosis: in 87% of patients with sinus rhythm after surgery, working capacity is restored and they continue to work, with atrial fibrillation - no more than 55%. Prognostically unfavorable are hemodynamically significant arrhythmias (moderate and severe), especially those that first appeared after surgery. In addition, with atrial fibrillation, conditions are created for thrombus formation with embolism in vital organs, the consequences of which can be an independent cause of disability in patients.

Early (arising in the first 3 months) and late complications of operations. Complications of the early postoperative period - acute heart failure, acute cerebrovascular accident, myocardial infarction, early septic endocarditis, sepsis, pulmonary embolism and cerebral vessels - often have a poor immediate prognosis for life. Of the late complications of surgery, the most prognostic ones are thromboembolism, late septic endocarditis, paravalvular fistulas, valve dysfunction, and restenosis.

Embolism of cerebral and coronary arteries are the main cause of death and disability in patients with an artificial heart valve. Their frequency is from 7% with anticoagulant therapy to 26% without it. With an increase in the period after surgery and wear of the prosthesis, the number of complications increases. Atriomegaly, atrial fibrillation, inadequate anticoagulant therapy or its sudden cancellation, exacerbation of rheumatism, septic endocarditis, etc. contribute to the occurrence of complications.

Late septic endocarditis(this includes all cases of endocarditis that occurred 3-6 months after surgery and is not associated with hospital infection) is one of the most severe complications. Intractable, despite adequate antibiotic therapy, infection, development of heart failure, systemic thromboembolism not only lead to complete disability of the operated patients, but also end in death, on average, in 65% of patients. The frequency of this complication is 3.9-6.0%, most of the cases occur in the first 2 years after surgery. Patients with suspected infective endocarditis of artificial heart valves require hospitalization to confirm the diagnosis and surgical intervention if conservative therapy is ineffective. Removal of the affected valve and its prosthetics are the main method of surgical treatment. According to G.I. Zuckerman et al. (1993), good results of reoperation after 5 years are 50%. The main causes of poor outcomes are the progression of myocardial insufficiency and intractable infection.

The formation of a paravalvular fistula is associated with the eruption of part of the sutures that fix artificial heart valve (AIV). Predisposing factors are friability of the tissues of the fibrous ring, calcification, infective endocarditis. Fistula, as a rule, occurs in the first months or after 1-2 years, less often - in the long-term period, up to 10 years. The average incidence of this complication is 17%. Recognition in most cases is not difficult. The diagnosis is made on the basis of the appearance of systolic murmur in paramitral and diastolic murmurs in para-aortic fistulas, hemolytic anemia, peripheral symptoms of mitral or aortic insufficiency and is confirmed by echocardiography. Treatment - reoperation.

ICS dysfunction. Its causes are mechanical wear of the prosthesis, periodic jamming of the prosthesis element, the formation of extensive parietal blood clots that “crawl” onto the prosthesis, and calcification. Signs of dysfunction are:
- Complaints about attacks of arrhythmias, fainting;
- periodic loss of pulse during the rhythmic activity of the heart;
- change in the amplitude of valve tones;
- the appearance of intermittent and varying noise, vibration;
- any change in the usual auscultatory picture, etc.

Presence of ICS dysfunction of any origin upon confirmation
diagnosis is an indication for reoperation.

The stability of good results of reoperation for paravalvular fistula and dysfunction of ICS with non-infectious genesis reaches 78% at a 5-year follow-up period.

Restenosis, according to B.A. Konstantinov (1981), occurs in 11-20% of operated patients. After a closed mitral commissurotomy, the peak of restenosis formation falls on the 6th year, after an open one - on the 10th year. The causes of restenosis are well known: inadequate elimination of stenosis during the first operation, repeated attacks of rheumatism, infectious complications, etc.

Stenosis is diagnosed by the return of subjective and objective signs of defect. In some cases, deterioration in the patient's condition may be due to the addition of a new defect. With restenosis, repeated surgical intervention is indicated - technically more complex, but having undoubted advantages over conservative treatment in improving the patient's quality of life and its duration.

A specific complication is the occurrence of mental disorders in cardiac surgery patients - cardiophobia, feelings of pointless anxiety, hypochondriacal syndrome, and depression. The frequency of these disorders in those operated on for a defect reaches 26% or more. After the operation they
need to consult a psychotherapist for treatment and psychological rehabilitation.

Criteria and indicative terms of VUT.
Temporary disability is established for a patient with heart disease for the entire period of instrumental examination, preoperative preparation, surgical treatment and subsequent medical, physical and psychological forms of rehabilitation in conditions rehabilitation center and a sanatorium. Its duration depends on the severity of the defect, the condition before surgery, the volume of surgical treatment and its adequacy, complications, and the rate of regression of symptoms. Therefore, it is more correct to focus not on the average period of temporary disability, but on an objective assessment of prognostic factors and criteria for the restoration of working capacity.

With a favorable prognosis - an isolated defect, a small amount of surgery performed before the development of severe organic changes in the heart and lungs, positive dynamics of hemodynamic disorders and the absence of severe complications - it is advisable to treat for temporary disability within 10 months. until full or partial restoration of working capacity with referral to the MSE with incomplete treatment, or for rational employment (if there are contraindicated factors in the nature and working conditions in the patient's main profession).

In patients with a dubious and aggravated prognosis after an effective operation and with unsatisfactory results of treatment, the duration of temporary disability should not exceed 4 months, followed by referral to the ITU.

Indicators of the patient's ability to work after surgery can be:
- normalization of hematological and biochemical parameters;
- clinical signs of improvement, positive dynamics and stabilization of hemodynamic parameters (pulmonary hypertension not more than grade I, NC not higher than stage IIA), confirmed by ECG, cardiography, FCG, radiography, tetrapolar rheography;
- completed treatment of complications without severe consequences;
I and II FC according to NYHA;
- psychological readaptation with a positive attitude to work.

Contraindicated types and working conditions:
- work with constant significant physical stress, long walking and fast pace; subsequently, with an increase in tolerance to stress, the regimen can be expanded;
- work in adverse working conditions (high and low temperatures, temperature and pressure drop, high humidity, dust and gas contamination of premises, drafts);
- work at height, near moving mechanisms, driving Vehicle, especially those operated on for aortic defects due to the possible development of acute cerebral or coronary insufficiency.

Indications for referral to ITU.
After surgical treatment of acquired defects, patients are sent to the MSE:
- with a favorable prognosis with incomplete treatment to extend the period of temporary disability for more than 10 months and with effective completed treatment, if they need a significant reduction in the amount of work, a change in profession or the acquisition of a new one;
- those operated on in stages III and IV of the defect, for multivalvular defects, who underwent valve prosthetics, who need a long period to compensate or improve blood circulation;
- with a aggravated prognosis, with incomplete correction of the defect, persistent pronounced changes in hemodynamics, with severe complications in the postoperative period and with unsatisfactory results of surgical treatment, for whom any professional work is contraindicated.

Examination standards for referral to the ITU after surgery:
- clinical blood test;
- coagulogram;
- biochemical blood tests (C-reactive protein, proteinogram, sialic acids, diphenylamic acid, fibrinogen, aminotransferases, etc.);
- the main indicators of hemodynamics and the function of external respiration at rest and with exercise;
- ECG in dynamics, FCG, echocardiogram; roentgenogram of organs chest in dynamics;
- bicycle ergometry data;
- blood culture (if necessary).

All operated patients should have a detailed extract from the medical history indicating the nature of operations, complications, data from invasive research methods, and a prognostic assessment of the results by a cardiac surgeon. Depending on the nature of the complication, the conclusion of a psychologist, a neuropathologist is necessary; in violation of hemodynamics in the brain - REG, EEG, Doppler sonography.

Criteria for determining disability groups.
III disability group after heart surgery, it is established with persistent moderate limitation of life in any and its manifestations in patients:
- with FC I and II after plastic surgery, commissurotomy in the 2nd year after surgery without severe complications, regularly receiving anti-relapse and symptomatic therapy, but employed in professions of heavy and moderate physical labor, and with FC III - in all professions of physical labor and with significant neuro-emotional overload or without a profession with limited opportunities (I and II degrees) of training in educational institutions general type;
- after valve replacement 1 year after surgery, without thromboembolic and infectious-septic complications, with pulmonary hypertension (PH) not more than I degree, NK not more than IIA stage;
- with persistent residual manifestations of the defect after surgery or its complications (stage IIA NC, chronic coronary and cardiocerebral insufficiency of degree I, rhythm disturbances), which significantly limit the scope of production activities.

foundation to determine group II disability after surgery are severe limitations of life that persist or arise as a result of ineffective intervention or complications, when labor activity can be carried out in specially created conditions.

Group II is established by patients:
- operated on in stage IV of the defect with a dilated heart with PH II degree and NC II and III stages at the time of examination or coronary insufficiency II degree;
- with atrial fibrillation, hemodynamically significant (with NC at least stage IIB) or complicated by a history of repeated thromboembolism;
- after valve prosthetics and reconstruction with multi-valve defects in the first year after surgery;
- with a current rheumatic process or septic endocarditis established after surgery;
- with severe complications of the postoperative period (endocarditis, thromboembolism), not eliminated by treatment during the period of temporary disability;
- Requiring reoperation for restenosis, paravalvular fistula, valve dysfunction, "prosthesis endocarditis", not cured by conservative treatment.

I disability group is determined by a patient with a pronounced decrease in vital activity, an unfavorable prognosis, who have lost the ability to self-service. The reason for this may be:
- Ineffective surgical treatment with the preservation and (or) progression of severe hemodynamic disorders and dystrophic changes in organs;
- severe consequences of thromboembolism of cerebral and coronary vessels;
- progression of the pathological process in case of impossibility of repeated surgical treatment with the development of stage III NK.

Disability with a pacemaker for pensioners, if we are talking only about the implantation of the pacemaker, is also assigned in rare cases. ITU experts can legally refuse to assign a disability if they find that there is no absolute dependence of a person’s life on the work of the ECS (the act indicates that there are minor restrictions). In any case, ITU experts never, on their own initiative, offer to conduct an appropriate survey, and they do not have the necessary equipment.

Do they give a disability group after heart surgery

ITU Appeal decision ITU decision I am disabled, a year after heart valve replacement surgery, my health is not very good, but they say they will remove it, and the attending physician cannot do anything.read answers (1) Tags: Heart surgery Replacement Is disability for a child 7 months after heart surgery secondary ASD?read answers (1) Tags: Is disability allowed Heart surgery My daughter underwent 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 the federal law Cash My child had heart surgery, in the first month of life, defect, now we are 4 months old, can I receive any cash payments?read answers (1) Tags: cash payment Payout I have a prosthetic aortic valve.

Medical and social expertise

Why is a pacemaker given disability? Disability with a pacemaker is given only if the functions of the body are severely impaired and there is an unfavorable labor prognosis (the possibility of continuing professional activity– i.e. after the operation, the patient has restrictions on working with a pacemaker, which were not there 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 expertise (ITU, formerly called the medical and labor expert commission, VTEK). When deciding whether a disability is due, the commission should be guided by data on the degree of dependence of the patient on the operation of the apparatus.
If it is written in the postoperative epicrisis: “discharged with improvement ...” (and this usually happens), then the assignment of the group will be refused.
An assessment will be made of the severity of cardiac arrhythmias before and after implantation of the stimulator, the frequency and severity of attacks of concomitant diseases. If there is a pacemaker, the following disability groups can be given: 3 temporary, 3 permanent, 2 temporary, 2 permanent.

The exact answer, which group of disability is due, if an ECS is installed, can only be given by a medical commission. Group 3 of the 0th and 1st degree are workers, 2nd and 3rd degrees are not workers, but without a ban on work (the employee has the right to continue working). The 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 the restriction in labor 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 goes for group 2.

Heart disease, in which they give disability

Tags: Congenital heart disease Lawyer Disability Less than a month ago, she underwent surgery to replace the mitral valve plus concomitant diseases, today the doctors said that the commission on reading the answers (1) Tags: Federal Law of the Russian Federation Social guarantees Establishment of disability heart surgery, diagnosis of congenital heart disease Tetralogy of Fallot.read answers (1) Tags: Is disability allowed? Government of the Russian Federation Establishment of a disability group Formation of a disability group My child underwent open heart surgery (AMPP), they always gave disability for a year after the operation. But the ITU refused me.

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

Info

With persistent circulatory failure of the II degree, patients can work at home. Knowledge workers can sometimes perform work in much easier conditions.

When circulatory disorders reach III degree, patients cannot perform professional work and sometimes need 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 lowering their qualifications, or by retraining.

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

Rehabilitation after mitral valve replacement

Attention

How to get disability after pacemaker implantation?

1. To determine the degree of dependence of one's life and health on the operation of the pacemaker - this can be done when checking the operation of the IVR.
2. You need to take a referral to the ITU from the cardiologist you are seeing (district specialist) (by reporting symptoms: shortness of breath, dizziness, darkening in the eyes, etc.).
3. The certificate of absolute dependence must be copied - keep the original for yourself, and give a copy to the ITU.

It is not necessary to scandal and argue anywhere and with anyone. If they do not make contact voluntarily, then applications are written in two copies - one to the head doctor, the second (with a note of acceptance) again to yourself.

Responsible persons lose the desire to argue and swear if they see a more or less prepared citizen in front of them, aware of their rights.

Mitral insufficiency

Telephone consultation 8 800 505-91-11 The call is free up to 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 for a control examination.

Disability after heart surgery

For this purpose, the following were 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 assist in determining 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 labor. The labor prognosis of patients with isolated insufficiency is generally favorable. This is explained by the fact that circulatory disorders rarely occur with this defect, and if it occurs, it progresses slowly and has the character of right ventricular failure, which is easily amenable to therapeutic effects.

The 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 the restriction in labor 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 goes for group 2. Discussions on the topic Is disability due to the installation of a pacemaker - there are many for other diseases, but the situation with pacemakers is well described. Legal advice on assigning a disability group after an operation to install a stimulator is not very informative material, because. the specialist was obviously too lazy to answer.

Medical and social expertise

The treatment prescribed for acquired defects can be conservative and surgical. Conservative treatment includes the prevention of complications, the occurrence of relapses of the underlying disease that caused the acquired defect, and the correction of the heart. If the ongoing therapeutic treatment does not bring the desired result, the patient is shown a consultation with 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 heart disease, the medical and social expert commission, abbreviated as ITU, decides. The commission consists of several experts.

Heart disease, in which they give disability

24-hour legal advice by phone GET A FREE LAWYER'S ADVICE BY PHONE: MOSCOW AND MOSCOW REGION: SAINT PETERSBURG AND LENIGRAD REGION: REGIONS, FEDERAL NUMBER: Do they give disability after heart surgery? The heart is the most important organ of the human body. It delivers blood to all tissues and organs, so it has enormous loads. Improper 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 with its diseases.

Is there a disability after heart surgery?

VPS), a month later they are invited for a control examination. Do they want to remove the disability now?read answers (1) Subject: Get a disability groupMy child has a congenital heart defect after surgery we will be put on disability I want to know which group will be and how much they will pay.read answers (1) Less than a month ago I underwent mitral replacement surgery valves plus concomitant diseases today the doctors said that the commission to read the answers (1) Topic: Is a disability group allowed Is a child (10 months) disabled after radical heart surgery, diagnosed with CHD Tetralogy of Fallot. read answers (1) Topic: Disability of the child Will be given Is there a disability for a child after abdominal heart surgery, if everything is fine after the operation?read answers (1) My child had an open heart surgery (ASD), they always gave disability for a year after the operation.

Do they give disability with heart disease and how to apply for it

Coronary heart disease, smoking and obesity also contribute to the progression of myocardial infarction. 2. Hypertension 3 stages. The disease is characterized high blood pressure, the presence of crises, leading to impaired blood supply to the brain, which often leads 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 disability registration. If you want to receive a disability due to heart disease, then you need to contact your doctor to declare this desire. Registration of disability after bypass surgery After the operation of bypass heart vessels, temporary disability is observed.

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

Disability after heart surgery

Info

Worldwide, heart and vascular diseases are the most common cause of death. Both adults and children suffer from these diseases. Heart disease disability - severe, often incurable disease. Symptoms that signal the presence of a disease such as heart disease cannot be ignored.
It is important to diagnose the disease in time and start treatment as early as possible. What is called heart disease Heart disease is called pathological disorders in the structure and work of the heart, which lead to heart failure.
Topic: Free medicines Disabled child, 2 years old, two heart surgeries, after the first surgery, Sildenafil was prescribed for health reasons until the 3rd elective surgery read answers (1) Topic: Heart surgery Recently had the most complicated operation on the heart (aortic valve replacement)., and now I found out that I have some benefits, how can I find out more about this? read answers (1) Subject: Heart surgery I had heart surgery and epilepsy appeared after the operation, what disability group should be given? Thank you.read answers (1) Topic: Copyright and related rightsAfter heart surgery, aksh was not given disability at work, they say that you can’t work in your specialty, you have to quit of your own free will.read answers (2) Topic: After surgeryMy daughter is 4 years old, she has CHD, secondary ASD. We were put on a waiting list for an operation.

According to what law is disability given when replacing a heart valve

Achieving complete recovery is possible only by surgery. The consequence of the development of such a serious disease as heart disease is a gradual violation of the functions of other human organs to one degree or another. To maintain health and exclude the development of more severe complications, correct knowledge about the dangers of heart disease is necessary.
Modern medicine is so high level development, which even in the most difficult cases of an organ disease is capable, if not completely cured, then provide a person decent life. birth defects hearts Congenital pathologies of the cardiovascular system are caused by various reasons.

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

Important

Group III disability can be assigned to patients with uncomplicated postoperative course, as well as with 1-2 classes (FC) of angina pectoris, heart failure or without it. Work in the field of professions that do not pose a threat to the patient's cardiac activity may be allowed. At the same time, prohibited professions include work in field conditions, with toxic substances, at height, the driver's profession.

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

1. Congenital. Violations in the structure of the heart organ occurs even before a person is born.
2. Acquired. Heart pathology develops during a person's life, for example, in case of complications after an illness.

Heart defects are chronic diseases, gradually progressing. 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, not a purely medical one. From a practical point of view, the issue of assigning a disability to a person after a pacemaker implantation operation is decided on the basis of an expert assessment of the patient's preservation of labor functions. Those. education, specialty, place of work and working conditions, self-service opportunities and the degree of reduction in working capacity should be taken into account.

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

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 sends it to other specialists, who also make appropriate entries in the patient's card. Often a complete examination of the patient with all the necessary laboratory tests is carried out in a hospital. After passing a complete diagnosis, the patient must collect a package of all necessary documents to submit them to the ITU for a final conclusion.