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<P><FONT style="BACKGROUND-COLOR: #ff0099">집에 한글이 안깔려있어서..요기다 걍 쓸테니 알아서 봐주세요...죄송죄송...아...후져...ㅡㅜ^</FONT></P>
<P> </P>
<P>♡MR(mitral regurgitation, 승모판 역류)♡</P>
<P> </P>
<P>1. et.</P>
<P> chronic rheumatic ht. dz., congenital anomaly, after ischemia/infarction</P>
<P> hypertrophic cardiomyopathy, degenerative change, infective endocarditis, MVP</P>
<P> progressive property(severe MR에서 LV나 LA가 확장되면 AV가 제대로 닫히지 못해...)</P>
<P> </P>
<P>2. Pathophysiology☆</P>
<P> 1) LV contraction -> LA로 regurgitation!!</P>
<P> *. LV regurgitation에 대한 보상작용으로써, 초기에 LV emptying 보다 많이 하려함.</P>
<P> -> 결국 LV 확장이 일어남</P>
<P> *. forward(effective) CO 감소</P>
<P> a. regurgitation</P>
<P> b. ejection fraction은 보통 증가 ( <60% 정도로 약간만 줄어도 significant LV dysfx.시사</P>
<P> 2) LV contractility 감소</P>
<P> </P>
<P>3. Symptoms</P>
<P> *. chronic, severe MR : fatigue, exertional dyspnea, orthopnea</P>
<P> *. pulmonary HTN : Rt.-sided ht. failure( painful hepatic congestion, ankle edema, ascites..)</P>
<P> *. acute, severe MR : LV failure with acute pulmonary edema</P>
<P> *. systemic embolization </P>
<P> </P>
<P>4. Auscultation ☆</P>
<P> 1) S1 : generally absent, soft </P>
<P> 2) S2 : wide splitting (<-premature closure of aortic valve)</P>
<P> 3) severe MR : </P>
<P> low-pitched S3(after A2),</P>
<P> holosystolic murmur(Grade III,IV) - apex에서 가장 잘 들림</P>
<P> isometric strain시 mm증가, valsalva maneuver시 mm감소</P>
<P> 4) S4</P>
<P> </P>
<P>5. Laboratory exam.</P>
<P> 1) EKG : LA enlargement</P>
<P> 2) chest PA : cardiomegaly, double contour(LAE)</P>
<P> 3) echocardiography : 수축기에 LV->LA로 regurgitant jet보임</P>
<P> 4) cardiac catheterization : late systole 때 PCWP(LA의 pr.) 증가</P>
<P> </P>
<P>6. Tx.</P>
<P> 1) medical approach</P>
<P> *. physical activity 제한, sodium intake 감소, diuretics로 sodium excretion증가시킴.</P>
<P> *. vasodilators, digitalis </P>
<P> *. acute/severe MR : IV nitroprusside or nitroglycerin -> afterload감소 -> 역류 감소</P>
<P> *. chronic MR : ACE inhibitor</P>
<P> *. 심부전 말기 : anticoagulation, leg binder</P>
<P> *. endocarditis prophylaxis(moderate risk)</P>
<P> 2) surgical approach</P>
<P> *. Ix. for operative Tx. </P>
<P> - 적절한 약물 치료에도 일상생활에 장애가 있는 경우</P>
<P> - 무증상이라도 MR이 진행하는 경우 : echo상 LV EF < 60%</P>
<P> *. conservative tx. 로 기대하기 어려운 hemodynamic의 개선이 가능</P>
<P> *. chordae가 끊어진 경우 EF < 30%에서는 수술 금기</P>
<P> 3) 수술 방법</P>
<P> *. Mitral valve replacement with prosthesis</P>
<P> *. Mitral valve reconstruction/mitral annuloplasty</P>
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