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