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 ¾ÇȵȴÙ.
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.