¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

Mitral Valve Prolapse

= systolic click-murmur syndrome

= Barlow's syndrome

= Floppy-valve syndrome

= Billowing mitral leaflet syndrome

MVÀÇ myxomatous degeneration and acid mucopolysaccharide concentration¡è

: connective tissue disorderÀÇ ÈçÇÑ ¼Ò°ßÀÌ´Ù.

´ëºÎºÐ ȯÀÚ¿¡¼­ MV¿¡ ±¹ÇѵǸç post. leafletÀÌ ´õ Àß Ä§¹üµÈ´Ù(ant. leafletº¸´Ù).

MV annulus´Â Å©°Ô dilatationµÇ°í, ´ëºÎºÐÀÇ È¯ÀÚ°¡ chordae tendineae°¡ ±æ¾îÁ®

regurgitationÀ» ÀÏÀ¸Å²´Ù.

1. ¿øÀÎ - unknown

i) genetically determined collagen tissue disorder

: type III collagen»ý¼º¡é, collagen fibril fragmentation

ii) acute rheumatic fever, ischemic heart disease, cardiomyopathy¿¡¼­ ³ªÅ¸³ª±âµµ ÇÑ´Ù.

2. ÀÓ»óƯ¡

- ¿©¼º¿¡¼­ ´õ ÈçÇÏ´Ù.

- Àü ¿¬·É¿¡¼­ ´Ù »ý±æ¼ö ÀÖÀ¸³ª 14-30¼¼ »çÀÌ¿¡ °¡Àå ÈçÇÏ´Ù.

- ÀÓ»ó°æ°ú´Â ¾ç¼ºÀÌÁö¸¸ 50¼¼ ÀÌ»ó(ÁÖ·Î ³²¼º), MRµ¿¹Ý½Ã¿¡´Â Áõ»óÀÌ º¸´Ù ½ÉÇÏ°í ¼ö¼úÀÌ

ÇÊ¿äÇÏ´Ù.

- familial incidence°¡ ³ôÀºµ¥ autosomal dominant·Î »ý°¢µÈ´Ù.

- ÀÓ»ó°æ°ú´Â systolic click, murmurºÎÅÍ chordal rupture·Î ÀÎÇÑ severe MR±îÁö ´Ù¾çÇÏ´Ù.

- ´ëºÎºÐÀÇ È¯ÀÚ°¡ Àü ¼ö¸íÀ» ´Ù »ìÁö¸¸ ºÏ¹Ì¿¡¼­ ¼ö¼úÀ» ÇÊ¿ä·Î ÇÏ´Â isolated severe

MRÀÇ mc cause°¡ ¹Ù·Î MVPÀÌ´Ù.

i) arrhythmia : most commonly

VPC, PSVT & VT => palpitation, light-headedness, and syncopeÀ¯¹ß

sudden death´Â very rare

ii) chest pain

iii) TIA : mitral valve·ÎºÎÅÍÀÇ emboli¿¡ ÀÇÇÑ TIA°¡ º¸°íµÊ.

(endothelial disruption¿¡ ÀÇÇØ)

iv) infective endocarditis : MR associated with MVP¿¡¼­ ¹ß»ý

* ûÁø

most important finding : mid- or late(nonejection) systolic click

S1ÈÄ 0.14sÀÌ»ó Áö³ª¼­.

- standing, valsalva maneuver¿Í °°ÀÌ LV volumeÀ» °¨¼Ò½ÃŰ´Â »óÅ¿¡¼­´Â

´õ ÀÏÂï µé¸°´Ù.

- squatting, isometric exercise, LV volumeÀ» Áõ°¡½ÃŰ´Â »óȲ¿¡¼­´Â prolapse°¡

°¨¼ÒµÇ°Å³ª ¼Ò½ÇµÈ´Ù.

3. Lab

ECG : normal

biphasic or inverted T wave(lead II, III, aVF)°¡ º¸À̱⵵ ÇÑ´Ù.

°£È¤ supraventricular or ventricular premature contractions

2D echo

: parasternal view¿¡¼­ systolic displacement(mitral annulus planeÀ§·Î Àû¾îµµ

2mmÀÌ»ó)

mitral valve leaflet thickening

= infective endocarditis risk¡è, severe MR·ÎÀÇ ÁøÇàÀ§Çè¡è

4. Ä¡·á

i) asymptomatic pt without severe MR or arrhythmia : reassurance

ii) systolic m. and/or thickening of MV leaflet

: infective endocarditis¿¹¹æÀ§ÇØ antibiotic prophylaxis

iii) ¥â-blocker : chest pain relieve

iv) sysmptomatic tachyarrhythmia ; antiarrhythmic agent

v) MRÁõ»ó ¹ß»ý½Ã -> MVR

vi) TIA : antiplatelet agent(aspirin) -> È¿°ú°¡ ¾øÀ¸¸é anticoagulant