Magne Julien, Sénéchal Mario, Dumesnil Jean G, Pibarot Philippe
Laval Hospital Research Center/Québec Heart Institute, Faculty of Medicine, Laval University, Québec, QC, Canada.
Cardiology. 2009;112(4):244-59. doi: 10.1159/000151693. Epub 2008 Aug 30.
Ischemic mitral regurgitation (MR) is a complex multifactorial disease that involves global and regional left ventricular remodeling as well as dysfunction and distortion of the components of the mitral valve including the chordae, annulus and leaflets. This is a frequent (13-59%) complication of myocardial infarction, which is associated with a poor prognosis. The suboptimal results obtained with the most commonly used surgical strategy, that is, restrictive annuloplasty combined with coronary artery bypass graft, emphasize the need to develop alternative or concomitant surgical techniques that directly target the causal mechanisms of the disease. A comprehensive assessment of mitral valve configuration and left ventricular geometry and function prior to surgery as well as an accurate quantification of MR severity at rest and during exercise may help improve patient risk stratification and better individualize the surgical strategy based on the patient's specific characteristics. The purpose of this review is to summarize the current state of knowledge with regard to the definition, prevalence, mechanisms, outcome and treatment of ischemic MR.
缺血性二尖瓣反流（MR）是一种复杂的多因素疾病，涉及左心室整体和局部重构，以及二尖瓣各组成部分（包括腱索、瓣环和瓣叶）的功能障碍和结构变形。这是心肌梗死常见（发生率为13% - 59%）的并发症，与预后不良相关。最常用的手术策略（即限制性瓣环成形术联合冠状动脉搭桥术）效果欠佳，这凸显了开发直接针对该疾病病因机制的替代或辅助手术技术的必要性。术前对二尖瓣结构以及左心室几何形态和功能进行全面评估，以及准确量化静息和运动时的MR严重程度，可能有助于改善患者风险分层，并根据患者的具体特征更好地制定个体化手术策略。本综述的目的是总结缺血性MR在定义、患病率、机制、结局和治疗方面的当前知识状况。
