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Mitral Insufficiency: Difference between revisions
→Carpentier classification
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==Quantification mitral regurgitation<cite>1</cite>== | ==Quantification mitral regurgitation<cite>1</cite>== | ||
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width=" | {| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="500px" | ||
|- | |- | ||
! | ! | ||
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|<4cm<sup>2</sup> | |<4cm<sup>2</sup> | ||
|4cm-10cm<sup>2</sup> | |4cm-10cm<sup>2</sup> | ||
|10cm<sup>2</sup | |10cm<sup>2</sup> | ||
|- | |- | ||
!ERO | !ERO | ||
|<20 mm<sup>2</sup> | |<20 mm<sup>2</sup> | ||
|20-40mm<sup>2</sup> | |20-40mm<sup>2</sup> | ||
|40mm<sup>2</sup | |40mm<sup>2</sup> | ||
|- | |- | ||
!Vena contracta | !Vena contracta | ||
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==Assess the severity of mitral insufficiency== | ==Assess the severity of mitral insufficiency== | ||
An independent measure seem to be that the regurgitant area trying to access parameters. With the help of the Proximal Isovelocity Surface Area (PISA) method, the effective | An independent measure seem to be that the regurgitant area trying to access parameters. With the help of the Proximal Isovelocity Surface Area (PISA) method, the effective regurgitant orifice (ERO) can be calculated. The vena contracta (narrowest part of regurgitant jet) has a strong relationship with the regurgitant orificium. | ||
Of course, it should not be forgotten. "Old" values in the estimation of the seriousness of the MI In a severe MI will, after all, often the left atrium will be enlarged and the PW measured with E / A ratio of the | Of course, it should not be forgotten. "Old" values in the estimation of the seriousness of the MI In a severe MI will, after all, often the left atrium will be enlarged and the PW measured with E / A ratio of the mitraal inflow >>1 should be, and the velocity E> 1.5 to 1.8 m/s. | ||
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" | {| class="wikitable" cellpadding="0" cellspacing="0" border="0" | ||
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!colspan="3"|[[Image:PISA. | !colspan="3"|[[Image:PISA.svg|500px]] | ||
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!colspan="3" align="center"|Criteria For MR severity<nowiki>*</nowiki> | !colspan="3" align="center"|Criteria For MR severity<nowiki>*</nowiki> | ||
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In the assessment of mitral regurgitation is important also the mechanism of mitral regurgitation study. Carpentier classified the mechanism of regurgitation into three groups: | In the assessment of mitral regurgitation is important also the mechanism of mitral regurgitation study. Carpentier classified the mechanism of regurgitation into three groups: | ||
{| class="wikitable" cellpadding="0" cellspacing="0" border="0" width=" | {| class="wikitable" cellpadding="0" cellspacing="0" border="0" width="750px" | ||
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|bgcolor="#FFFFFF" align="center" colspan="3"|[[Image:Carpentier1.svg|600px]] | |||
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|'''Type I:''' Normal mobility of the leaflets, cleft mitral valve hole in mitral valve endocarditis by | |width="250px" valign="top"|'''Type I:''' Normal mobility of the leaflets, cleft mitral valve hole in mitral valve endocarditis by functional with annulus dilatation | ||
functional with annulus dilatation | |width="250px" valign="top"|'''Type II:''' Excessive movement of the leaflets, mitral valve prolapse notochord elongation, notochord / papillary muscle rupture | ||
|'''Type II:''' Excessive movement of the leaflets, mitral valve prolapse | |width="250px" valign="top"|'''Type III:''' Restrictive mobility of the leaflets, attached the leaflets do not open fully in diastole. Lime in annulus overgrijpend on blade such as hypertension, HCM, AoS. Fusion of commissures as in acute rheumatism, parachute mitral valve. Merger or retraction of subvalvular apparatus. | ||
notochord elongation, notochord / papillary muscle rupture | |||
|'''Type III:''' Restrictive mobility of the leaflets, attached the leaflets do not open fully in diastole. Lime in annulus overgrijpend on blade such as hypertension, HCM, AoS. Fusion of commissures as in acute rheumatism, parachute mitral valve. Merger or retraction of subvalvular apparatus. | |||
|} | |} | ||
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{| class="wikitable" cellpadding="0" cellspacing="0" border="0" | {| class="wikitable" cellpadding="0" cellspacing="0" border="0" | ||
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|bgcolor="#FFFFFF" align="center"|[[Image:Carpentier2.svg|400px]] | |||
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|'''A:''' Normal coaptation and apposition | | | ||
'''A:''' Normal coaptation and apposition | |||
'''B:''' Billowing allowing coaptation point moves towards the bosom, normal apposition | |||
'''C:''' Reduced zone of coaptation by abnormal apposition | |||
'''D:''' Total loss of coaptation with normal apposition<cite>3</cite> | |||
|} | |} | ||