승모판역류증, Intervention 적응증

2020 ACC/AHA Guideline for the Management of Valvular Heart Disease의 intervention 적응증은 다음과 같습니다. Chronic primary MR 환자에서 mitral valve intervention을 할 것인지 여부는 MR의 중증도, 증상의 유무, LVESD과 LVEF, valve repair 용이성, AF 존재, 폐동맥 고혈압의 존재에 의존합니다.

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㉮ 증상 (호흡곤란, 피곤)이 있는 chronic primary severe MR 환자들에서 (Stage D) LVEF과 무관하게 mitral valve intervention이 권고됩니다 (recommended). 설령 이와 같은 그룹의 환자들이 약물 치료에 증상 개선이 있거나 LV가 compensation되는 것 같아 보일지라도 그렇습니다. 만일 증상이 있는지 확인하기 어렵다면 exercise testing이 객관적인 정보를 제공해 줄 것입니다.

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㉯ 무증상 chronic severe primary MR이면서 LVEF ≤60% 또는 LVESD ≥40 mm인 환자에서 (Stage C2) mitral valve surgery가 권고됩니다 (recommended).

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㉰ 수술이 필요한 severe primary MR 환자에서 MR의 해부학적 원인이 degenerative disease이고 성공적이고 내구성 있는 repair가 가능하다면 mitral valve repair가 mitral valve replacement보다 우선하여 권고됩니다 (recommended).

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Stages of Chronic Primary MR

*Several valve hemodynamic criteria are provided for assessment of MR severity, but not all criteria for each category will be present in each patient.

Categorization of MR severity as mild, moderate, or severe depends on data quality and integration of these parameters in conjunction with other clinical evidence. ERO indicates effective regurgitant orifice; IE, infective endocarditis; LA, left atrium/atrial; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD; left ventricular end-systolic dimension; and MR, mitral regurgitation.

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Primary MR

*Several valve hemodynamic criteria are provided for assessment of MR severity, but not all criteria for each category will be present in each patient.

Categorization of MR severity as mild, moderate, or severe depends on data quality and integration of these parameters in conjunction with other clinical evidence. ERO indicates effective regurgitant orifice; IE, infective endocarditis; LA, left atrium/atrial; LV, left ventricular; LVEF, left ventricular ejection fraction; LVESD; left ventricular end-systolic dimension; and MR, mitral regurgitation.

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REF. 2020 ACC/AHA Guideline for the Management of Valvular Heart Disease