{"id":2137,"date":"2020-07-14T11:02:51","date_gmt":"2020-07-14T15:02:51","guid":{"rendered":"http:\/\/wordpress.world.dan.org\/?post_type=dan_health_resources&#038;p=2137"},"modified":"2020-09-17T13:40:17","modified_gmt":"2020-09-17T17:40:17","slug":"structural-anomalies-of-the-heart","status":"publish","type":"dan_health_resources","link":"https:\/\/world.dan.org\/fr\/health-medicine\/health-resource\/dive-medical-reference-books\/the-heart-diving\/structural-anomalies-of-the-heart\/","title":{"rendered":"Chapitre 3 : Anomalies structurelles du c\u0153ur"},"content":{"rendered":"<p class=\"has-medium-font-size\"><em><strong>\u201cDivers who suffer decompression sickness have a patent foramen ovale (PFO) prevalence twice that of the population in general.\u201d<\/strong><\/em><\/p>\n\n\n\n<p>Having healthy heart valves is essential if your heart is to properly pump and circulate blood throughout your body. Some people are born with structural anomalies in their heart valves or in the walls. Many such disorders are diagnosed early in life and corrected, restoring the affected individuals\u2019 exercise capacity and enabling them to dive safely. However, some inborn structural disorders, like a condition known as patent foramen ovale, may not become obvious until after an affected individual has taken up diving \u2014 and may result in an increased risk of certain diving injuries. In addition, some people are impacted later in life by acquired valvular damage that may affect their fitness to dive.<\/p>\n\n\n\n<p>Dans ce chapitre, vous d\u00e9couvrirez<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><a href=\"#valvular-disorders\">Troubles valvulaires<\/a><\/li><li><a href=\"#mitral-valve-prolapse\">Prolapsus de la valvule mitrale<\/a><\/li><li><a href=\"#patent-foramen-ovale\">Foramen ovale patent<\/a><\/li><\/ul>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"valvular-disorders\">Aper\u00e7u des troubles valvulaires<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"512\" height=\"568\" src=\"http:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/heart-valves-blood-flow-illustration.jpg\" alt=\"Illustration des valves du c\u0153ur montrant le flux sanguin\" class=\"wp-image-2142\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/heart-valves-blood-flow-illustration.jpg 512w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/heart-valves-blood-flow-illustration-325x360.jpg 325w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/heart-valves-blood-flow-illustration-11x12.jpg 11w\" sizes=\"auto, (max-width: 512px) 100vw, 512px\" \/><\/figure><\/div>\n\n\n\n<p>Le c\u0153ur poss\u00e8de quatre valves principales qui facilitent l'activit\u00e9 de pompage du c\u0153ur :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>La valve tricuspide, entre l'oreillette droite et le ventricule droit.<\/li><li>La valve pulmonaire, entre le ventricule droit et l'art\u00e8re pulmonaire.<\/li><li>La valve mitrale, entre l'oreillette gauche et le ventricule gauche.<\/li><li>La valve aortique, entre le ventricule gauche et l'aorte.<\/li><\/ul>\n\n\n\n<p>Each valve consists of a set of flaps (also called \u201cleaflets\u201d or \u201ccusps\u201d) that open and close to enable blood to flow in the correct direction. The function of the valves may be compromised by either congenital or acquired abnormalities. Damage to the valves can occur due to infection, rheumatic fever or aging. For example, the opening in a valve may narrow (a condition known as \u201cstenosis\u201d), meaning the heart has to work harder to get blood through the opening; this generates higher pressure within the heart and eventually causes the cardiac muscle to overdevelop. Another common valvular problem is incomplete closure, which allows the blood to flow backward through the valve (a condition known as \u201cregurgitation\u201d); this overloads the heart with blood, eventually resulting in enlargement (or \u201cdilatation\u201d) of the heart\u2019s cavities.<\/p>\n\n\n\n<p>The two most common valvular disorders in older adults are aortic stenosis and mitral regurgitation. The symptoms of valvular disorders vary depending on which valve is affected as well as on the type and severity of the change. Mild changes may cause no symptoms; a heart murmur \u2014 detected when the heart is examined with a stethoscope \u2014 is often the first sign of valve damage. In aortic stenosis, however, exertion can cause chest pain (known as \u201cangina\u201d) or a feeling of tightness in the chest, shortness of breath, fainting or heart palpitations. Sudden death in otherwise healthy athletes is sometimes caused by aortic stenosis. Regurgitation can also cause detectable symptoms, such as shortness of breath or wheezing when lying down; these complaints may be intensified by exercise, increased resistance to breathing and immersion.<\/p>\n\n\n\n<p>Le traitement des troubles valvulaires implique g\u00e9n\u00e9ralement une intervention chirurgicale. Les valves d\u00e9fectueuses peuvent \u00eatre r\u00e9par\u00e9es ou remplac\u00e9es par des proth\u00e8ses.<\/p>\n\n\n\n<p>La pr\u00e9vention des l\u00e9sions valvulaires est, bien entendu, la meilleure approche. Les examens physiques de routine peuvent r\u00e9v\u00e9ler des signes de maladie valvulaire pr\u00e9coce. Dans ce cas, une surveillance m\u00e9dicale \u00e9troite et r\u00e9guli\u00e8re est conseill\u00e9e afin d'identifier et, esp\u00e9rons-le, de ralentir la progression de la maladie.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>Significant valvular anomalies may preclude diving until they can be corrected. Even after corrective surgery, there must be an assessment of such factors as exercise capacity, the presence of any residual regurgitation and the need for anticoagulation. Such an assessment should include a detailed examination of the heart and of the individual\u2019s ability to exercise at a level consistent with diving, without evidence of ischemia, wheezing, cardiac dysfunction or a problem known as \u201cright-to-left shunting.\u201d<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"mitral-valve-prolapse\">Prolapsus de la valvule mitrale<\/h2>\n\n\n\n<p>Mitral valve prolapse (MVP) may also be referred to as \u201cclick-murmur syndrome\u201d or \u201cfloppy-valve syndrome.\u201d It is a common condition, especially in women. The problem arises as a result of excess tissue and loose connective tissue in the heart\u2019s mitral valve, so that part of the valve protrudes down into the left ventricle during each contraction of the heart.<\/p>\n\n\n\n<p>An individual with MVP may have absolutely no symptoms or may exhibit symptoms ranging from occasional palpitations or an unusual feeling in the chest when the heart beats, to chest pain or a myocardial infarction (or heart attack). MVP is also associated with a slightly increased risk of small strokes (known as \u201ctransient ischemic attacks\u201d) or a transient loss of consciousness.<\/p>\n\n\n\n<p>Beta blockers \u2014 drugs commonly used to treat high blood pressure \u2014 are occasionally prescribed for mitral valve prolapse. They often cause a drop in maximum exercise capacity and may also affect the airways. These side effects normally pose no problem for the average diver, but they may be significant in emergency situations.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"471\" src=\"http:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/mitral-valve-prolapse-MVP-illustration.jpg\" alt=\"Illustration du prolapsus de la valve mitrale par rapport \u00e0 l&#039;\u00e9tat normal et \u00e0 l&#039;\u00e9tat de r\u00e9gurgitation\" class=\"wp-image-2140\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/mitral-valve-prolapse-MVP-illustration.jpg 1024w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/mitral-valve-prolapse-MVP-illustration-360x166.jpg 360w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/mitral-valve-prolapse-MVP-illustration-768x353.jpg 768w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/mitral-valve-prolapse-MVP-illustration-18x8.jpg 18w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>Souvent, le MVP n'entra\u00eene aucune modification de la circulation sanguine susceptible d'emp\u00eacher un individu de plonger en toute s\u00e9curit\u00e9. Un plongeur atteint de MVP qui ne pr\u00e9sente aucun sympt\u00f4me (c'est-\u00e0-dire aucune douleur thoracique, aucun trouble de la conscience, aucune palpitation ni aucun rythme cardiaque anormal) et qui ne prend aucun m\u00e9dicament pour ce probl\u00e8me peut plonger en toute s\u00e9curit\u00e9. En revanche, une personne atteinte de MVP qui pr\u00e9sente un rythme cardiaque anormal, susceptible de provoquer des palpitations, ne doit pas plonger, sauf si les palpitations peuvent \u00eatre contr\u00f4l\u00e9es par une faible dose de m\u00e9dicaments antiarythmiques.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"patent-foramen-ovale\">Foramen ovale patent<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/patent-forament-ovale-DAN-512x576-1.jpg\" alt=\"\" class=\"wp-image-9467\" width=\"322\" height=\"362\" srcset=\"https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/patent-forament-ovale-DAN-512x576-1.jpg 512w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/patent-forament-ovale-DAN-512x576-1-320x360.jpg 320w, https:\/\/world.dan.org\/wp-content\/uploads\/2020\/07\/patent-forament-ovale-DAN-512x576-1-11x12.jpg 11w\" sizes=\"auto, (max-width: 322px) 100vw, 322px\" \/><\/figure><\/div>\n\n\n\n<p>Patent foramen ovale (PFO) is a fairly common, congenital, generally benign hole between the heart\u2019s left and right atria (see illustration).<\/p>\n\n\n\n<p>While a fetus is developing in utero, the wall separating the left and right atria of the heart develops from the septum primum, which grows up, and septum secundum, which grows down. The septa overlap, creating a sort of trap door (known as the \u201cforamen ovale\u201d), which allows oxygenated blood from the mother\u2019s placenta that has entered the fetus\u2019 right atrium to pass through to its left atrium. At birth, the baby\u2019s lungs expand, and the resulting pressure in the left atrium closes the foramen ovale. Typically, shortly after birth, this former opening fuses shut \u2014 but in about 27 percent of babies, it fails to fuse completely and results in a PFO.<\/p>\n\n\n\n<p>A PFO often causes no symptoms, and most people who have one are never aware of the fact. PFO is diagnosed by injecting a small amount of air into a vein and observing its passage through the heart using echocardiography. There are two methods of echocardiography. Transthoracic echocardiography (TTE) is easy and noninvasive \u2014 it involves simply placing an ultrasound probe on the outer wall of chest \u2014 but it detects a PFO in only 10 percent to 18 percent of the population \u2014 about half of those who probably have one. Transesophageal echocardiography (TEE) \u2014 which involves local anesthesia and intravenous sedation, so the probe can be passed into the esophagus \u2014 detects a PFO in 18 percent to 33 percent of the population. However, even though TEE is more sensitive than TTE, there are still many false-negative results with both techniques; a properly conducted TTE may in fact be more reliable than a TEE.<\/p>\n\n\n\n<p>L'un des traitements les plus courants du FOP est une proc\u00e9dure appel\u00e9e fermeture transcath\u00e9ter ; elle consiste \u00e0 faire passer un cath\u00e9ter par l'aine et la veine f\u00e9morale jusqu'au c\u0153ur, o\u00f9 un dispositif appel\u00e9 occluder est implant\u00e9 \u00e0 travers le FOP. Les occludeurs se pr\u00e9sentent sous diff\u00e9rentes formes, mais la plupart agissent comme un double parapluie qui s'ouvre de chaque c\u00f4t\u00e9 de la paroi auriculaire et scelle le trou. Avec le temps, le tissu se d\u00e9veloppe sur l'occluder et recouvre compl\u00e8tement sa surface. L'implantation est r\u00e9alis\u00e9e sous anesth\u00e9sie locale et s\u00e9dation intraveineuse, le patient restant conscient. Elle dure moins d'une heure et peut \u00eatre r\u00e9alis\u00e9e en ambulatoire ou avec un s\u00e9jour d'une nuit. La plupart des patients peuvent reprendre leurs activit\u00e9s normales au bout de deux jours, mais ils doivent prendre des m\u00e9dicaments anticoagulants et\/ou antiplaquettaires pendant trois \u00e0 six mois. Parmi les autres restrictions postop\u00e9ratoires, citons l'absence de soins dentaires non urgents (tels que les nettoyages) pendant trois mois, l'absence de sports de contact pendant trois mois et l'absence de port de charges lourdes pendant une semaine. Un plongeur qui subit une fermeture transcath\u00e9ter du FOP doit s'abstenir de plonger pendant trois \u00e0 six mois.<\/p>\n\n\n\n<p>Aucune donn\u00e9e n'est disponible sur les r\u00e9sultats de la fermeture du FOP chez les plongeurs. Mais les r\u00e9sultats suivants ont \u00e9t\u00e9 enregistr\u00e9s chez des patients ayant subi une fermeture du FOP pour la pr\u00e9vention d'un accident vasculaire c\u00e9r\u00e9bral (il convient toutefois de noter que ces patients pr\u00e9sentent des conditions m\u00e9dicales sous-jacentes qui peuvent contribuer \u00e0 un risque plus \u00e9lev\u00e9 que la moyenne de r\u00e9sultats d\u00e9favorables) :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Efficacit\u00e9 :<\/strong>&nbsp;La fermeture compl\u00e8te de l'ouverture a \u00e9t\u00e9 obtenue dans 95 % des cas et la fermeture incompl\u00e8te dans 4 \u00e0 5 % des cas ; aucune am\u00e9lioration n'a \u00e9t\u00e9 constat\u00e9e dans seulement 1 % des cas.<\/li><li><strong>Complications :<\/strong>&nbsp;La mortalit\u00e9 globale \u00e9tait inf\u00e9rieure \u00e0 1\/10e de 1 % (0,093 %). La n\u00e9cessit\u00e9 d'une op\u00e9ration de suivi en raison d'un \u00e9v\u00e9nement ind\u00e9sirable associ\u00e9 au dispositif \u00e9tait inf\u00e9rieure \u00e0 1 % (0,83 %).<\/li><li><strong>Complications graves :<\/strong>&nbsp;L'incidence des d\u00e9c\u00e8s, des accidents vasculaires c\u00e9r\u00e9braux, des infections, des h\u00e9morragies ou des l\u00e9sions des vaisseaux sanguins \u00e9tait de 0,2 % ; celle des mouvements ou des d\u00e9placements du dispositif, de 0,25 % ; celle de la formation de caillots sur le dispositif, de 0,3 % ; celle des complications majeures dans la p\u00e9riode p\u00e9riop\u00e9ratoire, de 1,2 % ; et celle des complications mineures \u00e0 moyen terme, de 2,4 %.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Effet sur la plong\u00e9e<\/h3>\n\n\n\n<p>Les plongeurs qui souffrent d'un accident de d\u00e9compression (DCS) ont une pr\u00e9valence de FOP deux fois sup\u00e9rieure \u00e0 celle de la population en g\u00e9n\u00e9ral. Chez les plongeurs qui pr\u00e9sentent des sympt\u00f4mes neurologiques de DCS, la pr\u00e9valence du FOP est quatre fois plus \u00e9lev\u00e9e. Le risque de DCS semble augmenter avec la taille du PFO. Sur la base de ces faits, on suppose que les plongeurs avec un PFO sont plus expos\u00e9s au risque de DCS que ceux qui n'ont pas de PFO ; cependant, la seule \u00e9tude prospective con\u00e7ue pour mesurer directement le risque relatif de DCS chez les plongeurs avec un PFO est toujours en cours.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"has-text-align-right\"><strong>Suivant : <a href=\"https:\/\/world.dan.org\/fr\/health-medicine\/health-resource\/dive-medical-reference-books\/the-heart-diving\/ischemic-heart-disease\/\">Chapter 4 \u2013 Ischemic Heart Disease &gt;<\/a><\/strong><\/p>","protected":false},"excerpt":{"rendered":"<p>&#8220;Divers who suffer decompression sickness have a patent foramen ovale (PFO) prevalence twice that of the population in general.&#8221; Having healthy heart valves is essential if your heart is to [&hellip;]<\/p>\n","protected":false},"featured_media":0,"parent":2110,"menu_order":49,"template":"","dan_health_resource_types":[405],"class_list":["post-2137","dan_health_resources","type-dan_health_resources","status-publish","hentry","dan_health_resource_types-dive-medical-reference-books"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.0 (Yoast SEO v27.3) - 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