Güler Ahmet, Dündar Cihan, Tigen Kürşat
Cardiology Clinic, Kartal Koşuyolu Training and Research Hospital, İstanbul-Turkey.
Anadolu Kardiyol Derg. 2011 Aug;11(5):450-5. doi: 10.5152/akd.2011.113. Epub 2011 Jul 6.
In a dilated heart with impaired systolic functions, functional mitral regurgitation could be seen even in the presence of structurally normal mitral apparatus. A number of mechanisms play role in the development of functional mitral regurgitation. These are increased mitral tethering forces, reduction in closing forces and mechanical and electrical dyssynchrony. Papillary muscle dyssynchrony has also been shown to be related with functional mitral regurgitation. Cardiac resynchronization therapy is known to reduce the amount of functional mitral regurgitation in patients with left ventricular systolic failure although some may not respond to treatment with cardiac resynchronization therapy. Papillary muscle dyssynchrony may predict the response of cardiac resynchronization therapy on the regression of functional mitral regurgitation and may suggest the suitable therapeutic options, such as cardiac resynchronization therapy, mitral valve repair, coronary revascularization separately or in combination. In this review, the mechanisms of functional mitral regurgitation, papillary muscle dyssynchrony and its relationship with functional mitral regurgitation and the relationship of papillary muscle dyssynchrony with the improvement of functional mitral regurgitation after cardiac resynchronization therapy are focused.
在收缩功能受损的扩张型心脏中，即使二尖瓣结构正常，也可出现功能性二尖瓣反流。多种机制在功能性二尖瓣反流的发生发展中起作用。这些机制包括二尖瓣牵拉力量增加、关闭力量降低以及机械和电不同步。乳头肌不同步也已被证明与功能性二尖瓣反流有关。已知心脏再同步治疗可减少左心室收缩功能衰竭患者的功能性二尖瓣反流程度，尽管有些患者可能对心脏再同步治疗无反应。乳头肌不同步可能预测心脏再同步治疗对功能性二尖瓣反流消退的反应，并可能提示合适的治疗选择，如单独或联合进行心脏再同步治疗、二尖瓣修复、冠状动脉血运重建。在本综述中，重点关注功能性二尖瓣反流的机制、乳头肌不同步及其与功能性二尖瓣反流的关系，以及乳头肌不同步与心脏再同步治疗后功能性二尖瓣反流改善的关系。
