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ผู้ป่วยหญิง 75 ปี มาติดตามการรักษาตามนัด case severe MR - Coggle Diagram

- - - - vasoconstriction
        
        RAAS activation
        
        apoptosis fibrosis
      - CKD
        
        inflamation, oxidative stress, endothelial dysfunction
        
        pro inflammatory cytokinase
        
        decrease NO
        
        vascular calcification
    - - LDL oxidation
        
        lipid abnormalities
        
        Artherosclerotic heart disease
        
        Plaque/ischemia
        
        หายใจเหนื่อย เจ็บแน่นหน้าอก
        
        CAG:mild disease,LAD proximal stenosis 40%,mid stenosis,LCX mild disease,RCA mild disease
- - - - Fibrous thickening calcification of valve leaflets
        
        Severe MR
        
        investigate
        
        ECHO:Rheumatic Severe MR, moderate MR, Mild AS ; Mild impair LV systolic function, Severe TR, Preserved RV
        
        Mediansternotomy to MVR with Hancock2 no.25,TV repair with MC3 ring no.26