이 책은 이러한 혼란스러운 우리나라 임상 환경에서 임상 수의사들이 이첨판 폐쇄부전증에 의한 심부전의 진행 단계를 보다 객관적인 검사 지표를 통해 진단 내리고 이를 통해 보다 적절하게 심부전에 대한 약물 관리를 할 수 있게 가이드라인을 제공하고자 저술하였다. 이 책은 크게 5장으로 구성되어 있다. 1장은 심혈관계의 해부학적 구조와 기능에 대해 소개하고 있고, 2장은 심부전의 치료제와 치료전략에 대해 다루고 있으며, 3장은 이첨판 폐쇄부전증에 대한 내용을 열거하고 있다. 4장은 다양한 형태의 이첨판 폐쇄부전증 환자의 임상 증례를 소개하고 있다. 마지막 5장은 신약물과 최신 연구결과, 외과적 치료법 내용을 설명하고 있으며, 저자가 사용하고 있는 이 질환의 영상 진단 기준은 부록을 통해 소개하고 있다. 이 책이 소동물 임상 수의사들에게 개의 이첨판 질환을 진단하고 관리하는 데 도움이 되었으면 하는 소망을 가지고 저술하였다 CANINE MYXOMATOUS MITRAL VALVE DISEASE (CHRONIC MITRAL VALVE INSUFFICIENCY) Canine myxomatous mitral valve disease is the definitive, all-in-one resource for under?standing and managing the most prevalent acquired heart disease in dogs. Authored by Dr. Changbaig Hyun & Yong-Wei Hung, a world-renowned authority on vet?erinary cardiology and interventional cardiac therapy, this comprehensive textbook bridges the gap between foundational cardiovascular science and cutting-edge clinical practice. The book provides an in-depth, evidence-based review of the pathology and progression of myxomatous mitral valve disease (MMVD), detailing current diagnostic methodologies, including advanced echocardiography and cardiac biomarkers. Crucially, it offers clear, sys?tematic treatment guidelines for all stages of the disease, from asymptomatic to refractory heart failure. With dedicated chapters on practical case studies and the latest interventional, surgical, and pharmaceutical therapeutics, this volume is an essential guide for veterinary practi?tioners, specialists, residents, and advanced students seeking to master the complexities of MMVD and significantly improve long-term outcomes for their canine patients. Over the past several decades, my career has been dedicated to advancing the field of veter?inary cardiology, with a particular focus on the profound challenges posed by myxomatous mitral valve disease (MMVD). This degenerative disease, often a silent threat, remains the leading cause of heart failure in our small canine companions. It has been my enduring professional mission to contribute to better diagnostic clarity and more effective treatment options, including the development of new interventional and surgical therapies. This textbook, Canine Myxomatous Mitral Valve Disease, is the culmination of my clinical experience, research findings, and years spent educating countless students and veterinari?ans both domestically and internationally. My primary goal in writing this book is to provide practitioners with a single, comprehen?sive resource-a guide that systematically covers the fundamental anatomy, pharmacologic strategies, and the latest advancements in interventional and surgical management. I hope this volume not only deepens your understanding of MMVD’s complexities but also serves as an immediately practical reference to enhance the quality of care and improve the lon?gevity of your patients. I extend my sincere gratitude to co-author Dr. Yong-Wei Hung, my colleagues, students, and, most importantly, the dedicated owners who entrust their beloved companions to our care. May this book serve as a valuable tool in our shared commitment to veterinary excellence. Dr. Changbaig Hyun, DVM, PhD

Book Introduction iii Preface v About the Author vii CHAPTER 01 | Basic Structure and Function of the Cardiovascular System 1 1.1 Basic Anatomy of the Cardiovascular System 1 Pericardium 1 Lungs 1 Heart 2 Cardiac Blood Vessels 8 Cardiac Conduction System 9 1.2 Function of the Cardiovascular System 11 Cardiovascular Circulation 11 Cardiac Cycle 14 Cardiac Contraction and Relaxation 16 Cardiovascular Regulation 18 Cardiac Conduction Pathway 22 CHAPTER 02 | Therapeutic Strategies and Medications for Heart Failure in Small Animals 27 2.1 Medications Used in Heart Failure 28 Diuretics 28 RAAS Blockers (Renin-Angiotensin-Aldosterone System Blockers) 32 Vasodilators 34 Inotropes 39 Beta-Blockers 43 Antiarrhythmics 44 Anticoagulants/Thrombolytics 46 2.2 Nutritional Therapy for Heart Disease 46 Sodium Restriction 47 Protein 48 Potassium 49 Vitamins 49 Antioxidants 50 2.3 Treatment Strategies for Heart Failure (American College of Veteri?nary Internal Medicine Guidelines) 50 Strength of Recommendation 53 Strength of Evidence 54 Diagnosis and Treatment Guidelines 54 Problems with the ACVIM Guidelines 63 CHAPTER 03 || Myxomatous mitral valve disease 67 3.1 Introduction 67 3.2 Pathogenesis 69 3.3 Clinical Findings 70 3.4 Diagnosis 73 3.5 Treatment and Prognosis 79 3.6 Complications that Worsen the Progression of Heart Valve Disease 80 3.7 Systemic Complications Due to Heart Valve Disease 83 Cardiorenal Syndrome (CRS) 83 Pancreatitis 86 3.8 Echocardiographic Diagnostic Guidelines for Mitral Valve Insufficiency Patients 87 3.9 Diagnostic guideline for determining the severity of mitral valve disease 105 CHAPTER 04 || Case Studies 111 ▶CASE 1 111 Patient Information 111 History and Physical Examination 111 Diagnostic Tests 111 Treatment and Patient Monitoring 116 Case Discussion 117 ▶CASE 2 121 Patient Information 121 Physical Examination and Phonocardiogram 121 Diagnostic Tests 121 Treatment and Patient Monitoring 126 Case Discussion 126 ▶CASE 3 130 Patient Information 130 Physical Examination 130 Diagnostic Tests 130 Treatment and Patient Monitoring 131 Case Discussion 135 ▶CASE 4 139 Patient Information 139 Physical Examination 139 Diagnostic Tests 139 Treatment and Patient Observation 142 Case Discussion 146 ▶CASE 5 149 Patient Information 149 Physical Examination and Phonocardiography 149 Diagnostic Tests 149 Treatment and Patient Observation 151 Case Discussion 153 ▶CASE 6 Mitral Regurgitation - Transcatheter Edge-to-Edge Mitral Valve Repair (TEER) with V-clamp 155 Patient Information 155 Treatment and Patient Monitoring 157 Discussion 159 CHAPTER 05 || New Medical and Surgical Therapeutics 163 5.1 New Medical Therapeutics and Approaches 163 New Medications and New Findings 163 5.2 Drug Trials 171 5.3 New Surgical Therapeutics and Approaches 174 New Cardiac Interventions 174 New Hybrid Therapies 180 New Surgical Therapies 183 Appendix Imaging Diagnosis Guidelines for Myxomatous Mitral Valve Disease 187 Chest Radiographic Indicators 187 Key Echocardiographic Indicators Used by the Author 190 Index 199