physical examination

- physical examination of MR

physical examination of MR

classification

- classification of MR

- Carpentier's classification

classification of MR

- acute MR

** native valve

** prosthetic valve

native valve classification - ischemic MR - nonischemic MR

prosthetic valve classification

- chronic MR

Carpentier's classification

- type 1 normal leaflet motion

- type 2 excessive leaflet motion

- type 3 restricted leaflet motion

pathogenesis

- pathogenesis of mitral regurgitation

- etiology of mitral regurgitation

pathogensis of mitral regurgitation

etiology of mitral regurgitation

- degenerative disease

- rheumatic disease

- mitral annular calcification

- infective endocarditis

- ischemic cardiomyopathy

- dilated cardiomyopathy and submitral left ventricular aneurysm

investigation

- EKG

- CXR

- preop CAG

- echocardiography

EKG

- EKG finding

EKG finding

CXR

- CXR finding

CXR finding

preop CAG

- indication preop CAG >> cardiac catheterization

echocardiography

- echocardiography ใช้ประเมิณอะไรบ้าง

- echocardiography finding

- severity classification of chronic MR

- parameter of echo for MR

- severity classification of primary MR

- severity classification of secondary MR

echocardiography ใช้ประเมิณอะไรบ้าง

echocardiography finding of MR

- mild regurgitation : no flow convergence and a small regurgitant jet area

- severe central MR: a prominent flow convergence and large regurgitant jet area

- severe eccentric MR: small jet area impinging on the wall of the left atrium but a large flow convergence and a wide vena contracta.

severity classification of chronic MR

parameter of echo for MR

- LVEF

- vena contracta

- regurgitant volume

- regurgitant fraction

- ERO

- LVESD

- SPAP

severity classification of primary MR

severity classification of secondary MR

Treatment

- medication

- surgery

surgery

- indication srugery (overview)

- indication surgery

- ปัจจัยที่ใช้พิจารณาว่าจะผ่าตัดหรือไม

indication surgery (overview)

- symptoms

- left ventricular dysfunction and enlargement

** ทำไมต้องอ้างอิง LVEF < 60% or LVESD > 40 mm

- atrial fibrillation and pulmonary hypertension

indication surgery

- severe symptomatic severe chronic MR

** with ...

** with refractory to medical therapy with low comorbidity ....

- severe asymptomatic severe chronic MR

** LVEF < 60% or LVESD > 45 mm ....

** LVEF > 60% or LVESD < 45 mm

++ with new onset of AF or SPAP > 50 mmHg

++ with low risk ...

ปัจจัยที่ใช้พิจารณาว่าจะผ่าตัดหรือไม่

- symptoms

- left ventricular dysfunction and enlargement

- atrial fibrillation and pulmonary hypertension

follow up

- จะติดตามคนไข้หลังผ่าตัดอย่างไร

จะติดตามคนไข้หลังผ่าตัดอย่างไร

- asymptomatic patient with moderate MR and preserved LV function

- asymptomatic patient with severe MR with LVEF > 60%