Turina J
Departement für Innere Medizin, Universitätsspital Zürich.
Schweiz Med Wochenschr. 1991 May 11;121(19):671-6.
Mitral valve prolapse is found in 2-5% of the whole population and is thus the most common valvular anomaly. The vast majority of patients are asymptomatic and remain free of complications during the follow-up. The most important complications are severe mitral regurgitation, bacterial endocarditis, cerebral ischemic stroke and arrhythmias. The risk of these complications is increased in patients with a holosystolic murmur, enlarged left atrium and/or ventricle, and redundant, thickened mitral leaflets. The complication rate increases with age and is generally higher in males. The risk of complications is very low in patients with an isolated systolic click or silent prolapse. Prophylactic treatment for endocarditis is recommended for patients with a systolic murmur. For patients surviving ischemic stroke, aspirin is recommended. Where the left atrium is enlarged and rhythm disturbances are present, anticoagulation treatment is preferable. Rhythm disturbances should be treated only when symptomatic. In cases of severe mitral regurgitation surgery should be considered early, since reconstruction of the valve can be achieved in the majority of patients.
二尖瓣脱垂在整个人口中的发生率为2%至5%,是最常见的瓣膜异常。绝大多数患者无症状,在随访期间无并发症。最重要的并发症是严重二尖瓣反流、细菌性心内膜炎、脑缺血性中风和心律失常。全收缩期杂音、左心房和/或心室增大以及二尖瓣叶冗长、增厚的患者发生这些并发症的风险增加。并发症发生率随年龄增长而增加,男性通常更高。孤立性收缩期喀喇音或无症状性脱垂患者发生并发症的风险非常低。有收缩期杂音的患者建议进行心内膜炎预防性治疗。对于缺血性中风幸存者,建议使用阿司匹林。左心房增大且存在节律紊乱时,抗凝治疗更佳。仅在出现症状时才应治疗节律紊乱。对于严重二尖瓣反流患者,应尽早考虑手术,因为大多数患者可实现瓣膜重建。