Primarna mitralna insuficijencija

master's thesis

• Title (english): Primary mitral insufficiency
• Author: Hrvoje Klement
• Mentor: Nikola Bulj (mentor)
• Committee member: Matias Trbušić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Nikola Bulj (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-09-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Mitralna insuficijencija označava neadekvatno zatvaranje mitralnog zaliska, što omogućuje povrat krvi iz lijevog ventrikula u lijevi atrij u sistoli. MI je česta u općoj populaciji s prevalencijom 1.6 do 1.7 %, uz povećanje incidencije u starijoj životnoj dobi. Druga je najčešće operirana bolest zalistaka, nakon aortne stenoze. Prema uzroku se MI dijeli na primarnu i sekundarnu. Primarna je uzrokovana patološki promjenjenim zaliskom, dok je sekundarna uzrokovana patologijom ventrikula. Mitralni zalistak je građen od dva listića (kuspisa), fibroznog anulusa i subvalvularnog aparata koji čine chordae tendinae i papilarni mišići. Najčešća etiologija primarne mitralne insuficijencije u razvijenim zemljama je prolaps zaliska, dok je u zemljama u razvoju reumatska bolest zaliska. Mitralna insuficijencija je klasificirana po Carpentieru, prema pokretljivosti kuspisa, na tri tipa. Pacijenti s kroničnom MI ostaju asimptomatski dugi niz godina u kompenzacijskoj fazi bolesti. Kada se razvije dekompenzacija, pacijenti se najčešće prezentiraju sa simptomima ljevostranog srčanog zatajenja, dispnejom i nepodnošenjem napora. Karakteritičan auskultacijski nalaz MI je holosistolički šum, najbolje čujan nad srčanim apeksom, sa širenjem u područje lijeve aksile. Zlatni standard u dijagnostici MI je ehokardiografija. Najčešće se koristi dvodimenzionalna transtorakalna i Doppler ehokardiografija. Definitivno liječenje kronične MI je kirurško. Postoje dvije opcije kirurškog liječenja: popravak mitralnog zaliska i zamjena mitralnog zaliska. Zlatni standard kirurškog liječenja je popravak mitralnog zaliska zbog nižeg operativnog mortaliteta, veće stope preživljenja te manje komplikacija.

Abstract (english)

Mitral insufficiency is defined as inadequate closure of the mitral valve, allowing blood to return from the left ventricle to the left atrium in systole. MI is common in the general population with a prevalence of 1.6 to 1.7%, with an increase in incidence in the elderly. It is the second most frequent indication for heart valve surgery after aortic valve stenosis. According to the cause, MI is classified as primary or secondary. The primary is caused by a pathologically altered valve, while the secondary is caused by ventricular pathology. The mitral valve is made up of two leaflets, a fibrous annulus and a subvalvular apparatus, which is made of chordae tendinae and papillary muscles. The most common etiology of primary mitral regurgitation in developed countries is valve prolapse, while in developing countries it is rheumatic valve disease. Mitral regurgitation is classified by Carpentier into three types, based on leaflet motility. Patients with chronic MI remain asymptomatic for many years in the compensatory phase of the disease. When decompensation develops, patients are most often presented with symptoms of left-sided heart failure, dyspnea, and exercise intolerance. A characteristic auscultatory finding of MI is holosystolic murmur, best heard at the apex of the heart with radiation to the left axilla. The gold standard in the diagnosis of MI is echocardiography. Two-dimensional transthoracic and Doppler echocardiography are most commonly used. Definitive treatment of chronic MI is surgical. There are two surgical treatment options: mitral valve repair and mitral valve replacement. The gold standard of surgical treatment is mitral valve repair due to lower operative mortality, higher survival rates and fewer complications.

• Keywords: bolesti srčanih zalistaka; mitralna insuficijencija; dijagnoza; terapija
• Keywords (english): heart valve diseases; mitral valve insufficiency; diagnosis; treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:191633
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-02-24 10:59:19