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| ===Recruitment of the Interstitial Fluid=== | | ===Recruitment of the Interstitial Fluid=== |
| The second phase results in the recruitment of the initially extravasated fluid. Intravascular overload with [[polyuria]] and [[pulmonary edema]] often occur. Edema may be more severe due to massive fluid supply in the initial phase. It's necessary to monitor the patient in order to switch to depletion treatment with [[diuretics]] or [[hemofiltration]]. | | The second phase results in the recruitment of the initially extravasated fluid. Intravascular overload with [[polyuria]] and [[pulmonary edema]] often occur. Edema may be more severe due to massive fluid supply in the initial phase. It's necessary to monitor the patient in order to switch to depletion treatment with [[diuretics]] or [[hemofiltration]]. |
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| {{Family tree/start}}
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| {{Family tree | | | | | | | | | | | | | A01 | | | | | | | A01= Prodrome: Weakness, malaise, myalgias, abdominal pain'}}
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| {{Family tree | | | | | | | | | | | | | |!| | | | | | | | }}
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| {{Family tree | | | | | | | | | | | | | B01 | | | | | | | B01= [[Mitral regurgitation stages#Primary Mitral Regurgitation Stages|What is the severity of MR]]? }}
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| {{Family tree | | | | | | | |,|-|-|-|-|-|^|-|-|-|-|-|.| |}}
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| {{Family tree | | | | | | | C01 | | | | | | | | | | C02 | C01= '''Severe MR''' <br><div style="float: left; text-align: left; width:15em ">
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| ❑ Severe MVP with loss of coaptation <br>
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| ❑ RHD with loss of central coaptation<br>
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| ❑ Left ventricular dilation <br>
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| ❑ Regurgitation fraction ≥ 50% <br>
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| ❑ Regurgitation volume ≥ 60ml <br>
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| ❑ Effective regurgitation orifice ≥ 0.4cm² <br>
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| ❑ Vena contracta ≥ 0.7cm </div>| C02= '''Progressive MR'''<br> ''(Stage B)'' <br><div style="float: left; text-align: left; width:15em ">
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| ❑ Severe MVP with normal coaptation <br>
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| ❑ RHD with normal coaptation <br>
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| ❑ No Left ventricular dilation <br>
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| ❑ Regurgitation fraction < 50% <br>
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| ❑ Regurgitation volume < 60ml <br>
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| ❑ Effective regurgitation orifice < 0.4cm² <br>
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| ❑ Vena contracta < 0.7cm </div>}}
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| {{Family tree | | | | | | | |!| | | | | | | | | | | |!|}}
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| {{Family tree | | | | | | | D00 | | | | | | | | | | |!| D00= Is the patient symptomatic?}}
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| {{Family tree | | | |,|-|-|-|^|-|-|-|.| | | | | | | |!| }}
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| {{Family tree | | | D01 | | | | | | D02 | | | | | | |!| D01= Yes <br> ''([[Mitral regurgitation stages#Primary Mitral Regurgitation Stages|Stage D]])''| D02= No <br> ''([[Mitral regurgitation stages#Primary Mitral Regurgitation Stages|Stage C]])''}}
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| {{Family tree | | | |!| | | |,|-|-|-|+|-|-|-|.| | | |!| }}
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| {{Family tree | | | E01 | | E02 | | E03 | | E04 | | |!| E01= Is the [[LVEF]]>30%?| E02= [[LVEF]] 30-60% <br> OR <br> LVESD≥40 mm <br> ''([[Mitral regurgitation stages#Primary Mitral Regurgitation Stages|Stage C2]])''| E03= [[LVEF]]>60% <br> AND <br> LVESD<40 mm <br> ''([[Mitral regurgitation stages#Primary Mitral Regurgitation Stages|Stage C1]])''| E04= New onset [[atrial fibrillation]]<br> OR <br> PASP>50 mmHg <br> ''([[Mitral regurgitation stages#Primary Mitral Regurgitation Stages|Stage C1]])''}}
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| {{Family tree | |,|-|^|-|.| |!| | | | |!| |!| | | | |!| }}
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| {{Family tree | |!| | | |!| |!| | | | | F00 | | | | |!| F00= <div style="float: left; text-align: left; width:15em ">Is the likelihood of success for the valve repair >95% and the expected mortality <1%? </div>}}
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| {{Family tree | |!| | | |!| |!| | |,|-|-|^|-|.| | | |!| }}
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| {{Family tree | F01 | | F02 |!| | F03 | | | F04 | | |!| F01= No| F02= Yes| F03= Yes| F04= No}}
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| {{Family tree | |!| | | | |!|!| | |!| | | | |!| | | |!| }}
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| {{Family tree | G01 | | | G02 | | G03 | | | G04 | | G05 | G01= [[Mitral valve surgery]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]])| G02= [[Mitral valve surgery]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]])| G03= [[Mitral valve repair]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]])|G04= Periodic monitoring| G05= Periodic monitoring}}
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| {{Family tree/end}}
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| ===dications for Surgery in Chronic Secondary Mitral Regurgitation===
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| Shown below is an algorithm depicting the indications for mitral valve surgery or period monitoring among patients with chronic secondary MR according to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease.<ref name="pmid24603192">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= 2438-88 | pmid=24603192 | doi=10.1016/j.jacc.2014.02.537 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603192 }} </ref> Note that when [[mitral valve surgery]] is indicated, [[mitral valve repair]] is preferred over [[mitral valve replacement]] whenever feasible.<ref name="pmid24603192">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= 2438-88 | pmid=24603192 | doi=10.1016/j.jacc.2014.02.537 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603192 }} </ref>
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| <span style="font-size:85%">'''Abbreviations:''' '''MR:''' mitral regurgitation</span>
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| {{Family tree/start}}
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| {{Family tree | | | | | A01 | | | | | A01= Secondary MR and patient is receiving medical therapy}}
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| {{Family tree | | | | | |!| | | | | | }}
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| {{Family tree | | | | | A02 | | | | A02= [[Mitral regurgitation stages#Secondary Mitral Regurgitation Stages|What is the severity of MR]]?}}
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| {{Family tree | |,|-|-|-|+|-|-|-|.| | }}
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| {{Family tree | B01 | | B02 | | B03 | | B01= Symptomatic ([[New york heart association functional classification|NYHA class III-IV]]) severe MR <br> ''([[Mitral regurgitation stages#Secondary Mitral Regurgitation Stages|Stage D]])'' | B02= Asymptomatic severe MR <br> ''([[Mitral regurgitation stages#Secondary Mitral Regurgitation Stages|Stage C]])'' | B03= Progressive MR <br> ''([[Mitral regurgitation stages#Secondary Mitral Regurgitation Stages|Stage B]])''}}
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| {{Family tree | |!| | | |!| | | |!| | | }}
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| {{Family tree | C01 | | C02 | | C03 | | C01= [[Mitral valve surgery]] ([[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]])| C02= Periodic monitoring| C03= Periodic monitoring}}
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| {{Family tree/end}}
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| ==Complications== | | ==Complications== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: M. Hassan, M.B.B.S
Overview
Natural History
The episode usually consists of two phases
The Capillary Leak Phase (1-4 days)
The initial phase is the capillary leak phase, lasting from 1 to 4 days. Clinical features are abdominal pain, nausea, generalized edema and hypotension that may result in cardiopulmonary collapse. Acute renal failure is due to acute tubular necrosis consequent to hypovolemia and rhabdomyolysis.
Recruitment of the Interstitial Fluid
The second phase results in the recruitment of the initially extravasated fluid. Intravascular overload with polyuria and pulmonary edema often occur. Edema may be more severe due to massive fluid supply in the initial phase. It's necessary to monitor the patient in order to switch to depletion treatment with diuretics or hemofiltration.
Complications
Most common complications of capillary leak syndrome include the following:[1][2]
Complications of Capillary Leak Syndrome
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Prognosis
Mortality is reported in 21% of the 57 cases described. However, better management of this condition has recently led to lower mortality.
In the Mayo Clinic’s experience, the median survival of 25 patients that were followed over 30 years (counting only SCLS-related deaths) was approximately 15 years, and their 5-year survival rate was 76%. In European experience, the 5-year post-diagnosis survival rate was 85% in 23 patients who had received prophylactic treatment and 20% in 5 patients who had not. However, better identification and management of this condition appears to be resulting in lower mortality and improving survival and quality-of-life results as of late.
References
Template:WikiDoc Sources