Mitral yetishmovchilik

Mitral etishmovchilik- yurak qopqogʻi kasalligining bir shakli boʻlib, unda mitral qopqoq yetarli emas va yurak qonni pompalasa, toʻgʻri yopilmaydi^[1]. Bu qonning orqaga gʻayritabiiy oqishi – chap qorincha qisqarganda, chap qorinchadan mitral qopqoq orqali chap atriumga regürjitatsiya^[1]. Mitral etishmovchilik yurak qopqogʻi kasalliklarining eng keng tarqalgan shaklidir^[2].

Taʼrif

Mitral etishmovchilik bu chap qorincha qisqarganda chap qorinchadan mitral qopqoq orqali va chap atriumga qonning orqaga qarab oqishi, natijada chap qoʻltiqqa tarqaladigan sistolik shovqin^[3]^[2]

Oddiy va anormal yurak tovushlaridan fonokardiogrammalar

Mitral qopqoq etishmovchiligini mitral qopqoq stenozi bilan taqqoslaydigan rasm

Patofiziologiya

Mitral regurgitatsiya patofiziologiyasi kasallik jarayonining uch bosqichga boʻlinishi mumkin: oʻtkir bosqich, surunkali, kompensatsiyalangan faza va surunkali dekompensatsiyalangan faza. </link>

Yengil mitral etishmovchilik. Rangli bulut qon oqimining qaytishini anglatadi. 1. chap qorincha, 2. chap atrium

MRning oʻtkir va surunkali fazalarini solishtirish
	Oʻtkir	Surunkali
Elektrokardiogramma	Oddiy	P mitral, atriyal fibrilatsiya, chap qorincha gipertrofiyasi
Yurak hajmi	Oddiy	Kardiyomegaliya, chap atriumning kengayishi
Sistolik shovqin	Pastki qismida eshitiladi, boʻyin, umurtqa pogʻonasi yoki boshning tepasiga tarqaladi	Choʻqqisida eshitiladi, qoʻltiq ostiga nurlanadi
Apikal hayajon	Yoʻq boʻlishi mumkin	Hozirgi
Juguler venoz kengayishi	Hozirgi	Yoʻq

Exokardiyogramma

Mitral qopqoq prolapsasining transözofagial ekokardiyogrami

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Ogʻir MR	Afsona
1 Chap atrium (LA) – 2 MR Jet, LV Chap qorincha – RV Oʻng qorincha – RA Oʻng atrium

Itda mitral qopqoq etishmovchiligining animatsiyasi, chap apikal koʻrinish

Mitral etishmovchilikni miqdoriy aniqlash

Mitral regurgitatsiyaning tezlik darajasini regurgitant fraktsiyasi bilan aniqlash mumkin, bu chap atriumga qaytadigan chap qorincha insult hajmining foizidir. </link>

regurgitant fraktsiya =

{\frac {V_{mitral}-V_{aortic}}{V_{mitral}}}\times 100\%

Bu yerda V _mitral va V _aorta mos ravishda yurak siklida mitral klapan va aortal klapan orqali oldinga oqadigan qon hajmidir. Mitral yetishmovchilikda regurgitant fraktsiyani baholash uchun ishlatiladigan usullarga exokardiyografiya, yurak kateterizatsiyasi, tezkor kompyuter tomografiyasi va yurak mitral regurgitatsiyasi kiradi. </link>

Mitral etishmovchilik miqdorini aniqlash uchun PISA usuli

Mitral yetishmovchilik darajasini aniqlash
Daraja ^[4]	Mitral etishmovchilik darajasi	Regurgitant fraksiya	Regurgitant teshigi maydoni
1	Yengil	< 20 foiz
2	Oʻrtacha	20-40 foiz
3	Oʻrtacha va ogʻir	40-60 foiz
4	Ogʻir	> 60 foiz	> 0,4 sm ²

Surunkali MR uchun jarrohlik uchun koʻrsatmalar ^[5]
Alomatlar	LV EF	LVESD
NYHA II	> 30 foiz	< 55 mm
NYHA III-IV	< 30 foiz	> 55 mm
Asemptomatik	30-60 foiz	≥ 40 mm
Oʻpka gipertenziyasi bilan asemptomatik	LV EF > 60 foiz va oʻpka arteriyasining sistolik bosimi >50-60 mmHg
Asemptomatik va qoldiq MRsiz tuzatish imkoniyati >90%	> 60 foiz	< 40 mm

Yana qarang

Trikuspid etishmovchiligi
Aorta etishmovchiligi
Oʻpka etishmovchiligi

Manbalar

↑ ^1,0 ^1,1 Mitral valve regurgitation at Mount Sinai Hospital
↑ ^2,0 ^2,1 Douedi, Steven; Douedi, Hani (2021). Mitral Regurgitation. StatPearls Publishing. PMID 31985928. https://www.ncbi.nlm.nih.gov/books/NBK553135/#article-25198.s3. Qaraldi: 19 December 2021. Mitral yetishmovchilik]]
↑ „What is mitral regurgitation? | Heart Disease“ (en). patient.info. Qaraldi: 2021-yil 15-fevral.
↑ Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi et al. (April 2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance". Journal of the American Society of Echocardiography 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. ISSN 1097-6795. PMID 28314623. https://pubmed.ncbi.nlm.nih.gov/28314623/.
↑ "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.". Circulation 118 (15): e523-661. 2008. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172.

Havolalar

[mountsinai-1] 1,0 ^1,1 Mitral valve regurgitation at Mount Sinai Hospital

[Douedi-2] 2,0 ^2,1 Douedi, Steven; Douedi, Hani (2021). Mitral Regurgitation. StatPearls Publishing. PMID 31985928. https://www.ncbi.nlm.nih.gov/books/NBK553135/#article-25198.s3. Qaraldi: 19 December 2021. Mitral yetishmovchilik]]

[patient.info2020-3] „What is mitral regurgitation? | Heart Disease“ (en). patient.info. Qaraldi: 2021-yil 15-fevral.

[4] Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi et al. (April 2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance". Journal of the American Society of Echocardiography 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. ISSN 1097-6795. PMID 28314623. https://pubmed.ncbi.nlm.nih.gov/28314623/.

[5] "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.". Circulation 118 (15): e523-661. 2008. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172.

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