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Mitral Regurgitation

1. ¿øÀÎ

¨ç chronic RHD(1/3)

rheumatic MRÀº ³²ÀÚ¿¡¼­ ÈçÇÏ´Ù(cf. MS´Â ¿©ÀÚ¿¡¼­ ÈçÇÏ´Ù)

¨è MVP

¨é congenital anomaly : mc endocardial cushion defect

¨ê healed MIȯÀÚ¿¡¼­ papillary m. fibrosis·Î ÀÎÇØ,

papillary m. base¸¦ ħ¹üÇÏ´Â infarction

¨ë marked LAE -> mitral annulus dilatatio

papillary m. lat. displacement => coaptationÀå¾Ö

¨ì HCM : systolic anterior motionÀ¸·Î MRÀ¯¹ß

¨í calcification of mitral annulus(elderly woman)

* Acute MR

i) valve or chordae tendineae¸¦ ħ¹üÇÏ´Â infective endocarditis¿¡¼­ 2Â÷ÀûÀ¸·Î ¹ß»ý°¡´É

ii) papillamy m. rupture d/t acute MI, trauma, spontaneous

¿øÀο¡ °ü°è¾øÀÌ severe MRÀº ÁøÇàÇÏ¿© LAE¸¦ ÀÏÀ¸Å°°í regurgitationÀ» ´õ¿í

Áõ°¡½ÃŲ´Ù. °á±¹ LA, LV pressure°¡ Áõ°¡ÇÏ¿© vicious cycle·Î µé¾î°£´Ù.

¡Å ÀÌ·± °Ý¾ðÀÌ ÀÖ´Ù: "MRÀÌ MRÀ» ³º´Â´Ù"

2. º´Å»ý¸®

LV emptying½Ã¿¡ ÀúÇ×ÀÌ °¨¼ÒÇÏ¿© LAÂÊÀ¸·Î decompressionµÈ´Ù.

LV size´Â °¨¼ÒµÇ¾î LV tensionÀÌ ±Þ°ÝÈ÷ °¨¼ÒµÈ´Ù.

regurgitationÀÌ ½ÉÇÒ¼ö·Ï LV volumeÀÌ Áõ°¡Çϰí Â÷Ãû LV fxÀÌ ¾ÇÈ­µÈ´Ù.

LV volumeÀÇ Áõ°¡´Â forward C.OÀÇ °¨¼Ò¸¦ µ¿¹ÝÇÑ´Ù.

LA pr. pulse¿¡¼­ v wave´Â ÈçÈ÷ prominentÇÏ´Ù.

early diastole¶§´Â rapid y descent(+) (Fig 228-3)

Áõ»óÀº C.OÀÌ °¨¼ÒÇϰí pul. congestionµÊÀ¸·Î½á 2Â÷ÀûÀ¸·Î ¹ß»ýÇÑ´Ù.

3. Áõ»ó

most prominent complaint : fatigue, exertional dyspnea, and orthopnea

systemic embolism : less frequent

acute, severe MR : LV failure with acute pul. edema°¡ ÈçÇÏ´Ù.

4. Physical findings

JVP : abnormally priminent a wave : marked pul. hypertension

prominent v wave ; severe TRµ¿¹Ý½Ã

systolic thrill : apex¿¡¼­ palpation

* ûÁø

S1 : absent, soft, or buried in the systolic murmur

S2 : wide splitting(severe MR¿¡¼­´Â aortic valve°¡ ÀÏÂï ´ÝÈ÷¹Ç·Î)

S3 : short, rumbling, diastolic murmurÈÄ¿¡ ¿Â´Ù.

S3°¡ ¾ø´Ù¸é MRÀÌ ½ÉÇÏÁö ¾Ê´Ù´Â °ÍÀ» ¶æÇÑ´Ù.

S4 : acute, severe MR of recent onset¿¡¼­ ÀÚÁÖ µéÀ»¼ö ÀÖ´Ù.

presystolic murmur : isolated MR¿¡¼­´Â µéÀ»¼ö ¾øÀ¸¸ç MS¿Í µ¿¹ÝµÉ ¶§ µéÀ»¼ö ÀÖ´Ù.

holosystolic murmur, grade III/IVÀÌ»ó : most characteristic auscultatory findings

- apex¿¡¼­ most priminent, axilla·Î radiation

5. Lab

1) ECG : LAE, RAE

2) roentgenogram : LA & LV - dominent chamber, mitral annulus calcification

3) echo : color flow doppler imaing - most accurate noninvasive technique

6. Ä¡·á

1) medical

¨ç physical activityÁ¦ÇÑ

¨è sodium intakeÁ¦ÇÑ, sodium excretionÃËÁø(diuretics)

¨é vasodilator & digitalis glycoside : failing heart¿¡¼­ forward outputÁõ°¡

IV nitroprusside & NTG = afterload¡é, acute and/or severe MR¿¡¼­

ACE inhibitor : chronic MR¿¡¼­

¨ê AF -> sinus rhythmÀ¸·ÎÀÇ reversion

¨ë anticoagulant & leg binders ; late stage

2) surgical

asymptomatic or minimal sx =>¼ö¼ú´ë»óÀÌ ¾Æ´Ï´Ù.

severe MR + ÀûÀýÇÑ Ä¡·á¿¡µµ ºÒ±¸Çϰí normal household activity°¡ Èûµé¶§

=> Ưº°ÇÑ ±Ý±â°¡ ¾øÀ¸¸é ¼ö¼úÇÑ´Ù.

*¹«Áõ»óÀ̶ó ÇÏ´õ¶óµµ LV dysfunction ÀÌ ÁøÇàÇÒ¶§´Â ¼ö¼úÇÑ´Ù.

: LVEF < 60% and/or end-systolic cavity dimension > 50mm

LV functionÀÌ ³ª»Ü¼ö·Ï op risk°¡ Áõ°¡Çϰí LV performanceȸº¹Àº ºÒ¿ÏÀüÇϸç,

long-term survivalÀÌ °¨¼ÒÇÑ´Ù.