门诊病人二尖瓣返流手术时机的判断

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1、FollowingtheOutpatientwithSevereMitralRegurgitationMarilynWeignerMDRIACC9/02MitralRegurgitationPotentiallysurgical:moderatetosevereorseveremitralregurgitationProbablynotsurgical:mildormildtomoderatemitralregurgitationHowcloselyshouldIfollowapatientwi

2、thseveremitralregurgitation?Shouldthespecificmitralvalveanatomyinfluencetimingofintervention?Aremedications(ACEinhibitors/betablockers)usefulinthesepatients?WhenshouldIrefertoacardiologist?Isit“toolate”?Thepatientisa44yearoldmanwithmitralvalveprolaps

3、eandseveremitralregurgitation.Hehasbeenfollowedwithofficevisitsandserialechocardiograms.Henowcomplainsofnewonsetdyspneaandfatiguewithaactivitieswhichhadpreviouslybeeneasyforhim.Onexam:bp120/85hr70bpmjvpflatCardiac:RRRloudholosystolicmurmuratapexLungs

4、:clearExtremities:normalNormalLVSizeandfunction(EF60%)MitralleafletprolapseandseveremitralregurgitationPApressureestimatedat50mmHg(elevated)EnlargedleftatriaManagement?a)Startcaptoprilandlasixandfollowthepatientcloselyb)Repeatechoandexamin6monthsc)Su

5、ggestasurgicalconsultformitralvalvereplacement(heisyoungandtheStJudevalveslastalongtime)d)Referforcardiaccath(cathisabettertestthanecho)e)SuggestsurgicalconsultformitralvalverepairACCGuidelines:www.acc.orgSymptoms:DyspneaandorfatigueAnatomy:Prolapse/

6、FlailcanoftenberepairedTheleftventricle:Dysfunction/EnlargementPulmonaryarterypressure:elevationissignofdecompensationRhythm:atrialfibrillationSurvivalisbetteramongstpatientswhounderwentrepairReoperationratesslightlylowerinpatientswhohadrepairHowshou

7、ldIfollowapatientwithasymptomaticseveremitralregurgitation?Patientwithpotentiallysurgicalmitralregurgitation:-examevery6monthsandserialechocardiographylookingforanysignsofdeteriorationDoesthespecificsofmitralvalveanatomymatter?Yes.Patientswhohaveseve

8、remitralregurgitationandmitralvalveprolapse/flailleaftletsrequireclosestfollow-upbecausethe“threshold”forsurgicalinterventionshouldbelowerAreanymedicationshelpful?Ingeneral,patientswithseveremitralregurgitationshouldprobablynotbetreatedwithmedication