心臟血管專科：瓣膜閉鎖不全治療方案及風險評估-心臟血管專科

瓣膜閉鎖不全？

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醫師您好家母目前快60歲，前陣子心臟不適目前診斷為中度二尖瓣脫垂(閉鎖不全+血液逆流)輕度三尖瓣脫垂心臟微微脹大第一位醫師開~得安穩80mg半顆但連續胸痛背痛就診第二位醫師開~可悅您膜衣錠50mg每天半顆愛信達錠25mg每天半顆但手臂痛、頭暈、人無力感以下為檢查資料杜卜勒氏彩色心臟血流圖超音波心臟圖(包括單面、雙面)Result: TAPE NO. ＜ GE E9 ＞ BEGINS ＜ ＞ ENDS ＜ ＞ WT: ＜ ＞ KG TAPE NO. ＜ ＞ BEGINS ＜ ＞ ENDS ＜ ＞ BP:＜ ＞/＜ ＞ mmHG COMMENTS： LA (4.2 CM) CHAMBER DILATATION LV (5.2, 3.1 CM) CHAMBER SIZE MILD AR ＆ PR PROLAPSE OF ANTERIOR MITRAL LEAFLET WITH MODERATE MR MODERATE TR WITH PEAK/MEAN SYSTOLIC PG -- 39/25 MMHG SUGGEST PULMONARY HYPERTENSION NORMAL LV SYSTOLIC WALL MOTION. THE LV EJECTION FRACTION IS 58 % MV E/A RATIO ＞ 1 MV E/E’ SEPTAL— 10.8 MV E/E’ LATERAL — 6.5 END壓力與重分佈心肌斷層灌注掃描Result: Finding: A myocardial perfusion gated SPECT study using Tc-99m MIBI obtained in both persantin-stress and rest status (one-day protocol): ＞＞ Moderately decreased myocardial perfusion at the following areas: -- the apex and the apical lateral wall, the apical to mid anterior wall under persantin-stress status with marked recovery on rest status. -- the mid to basal inferolateral wall under persantin-stress status with no apparent change on rest status. -- the mid anteroseptal wall under persantin-stress status, which showed more pronounced on rest status (reverse redistribution). . ＞＞ Normal wall motion of the left ventricle. . ＞＞ Ejection Fraction (EF) of left ventricle: -- Under Stress = 60 % -- After Resting = 61 % . Impression: -- The moderately decreased myocardial perfusion at the apex and the apical lateral wall, the apical to mid anterior wall, and the reverse redistribution at the mid anteroseptal wall may be due to CAD (ischemia with or without infartion). Further evaluation or close follow-up is recommended. -- The moderately decreased myocardial perfusion at the mid to basal inferolateral wall may be due to mild CAD or have no clinical significance (attenuation effect or motion artifact by diaphragm). Suggest medical treatment first with close follow-up. -- Reference for the interpretation of reverse redistribution: In patients without infarction and high pretest likelihood of CAD, the reverse redistribution is evaluated as ischemia, whereas in subjects with low pretest likelihood, this finding has no diagnostic value. In a patient with a previous myocardial infarction, reverse redistribution at the infarct site is evaluated as a sign of viability想問以下問題1.近期仍感心痛、手臂痛、胸痛、背痛是藥的副作用還是本身疾病可能帶來的問題?2.會建議吃哪種藥，或是再改藥?3.醫生有提到，可用手術進行瓣膜修復，但提到可能須自費，費用可能高達百萬請問目前檢查結果會建議開刀還是吃藥觀察?4.如果開刀，會建議用哪種方式進行?以上感謝醫生回復~

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玉玉，60~69歲女性，詢問日期：2023/03/23