University of Liege, University Hospital Sart Tilman, Liege, Belgium.
J Cardiovasc Med (Hagerstown). 2012 Apr;13(4):260-5. doi: 10.2459/JCM.0b013e3283515c70.
Primary mitral regurgitation is generally an insidious disease with late onset of symptoms. Current European and American guidelines recommend surgery in severe primary mitral regurgitation when symptoms, overt left ventricular dysfunction, pulmonary hypertension or atrial fibrillation, occur. However, recent large studies reported an improved outcome in asymptomatic patients with severe mitral regurgitation referred for early mitral valve repair despite the risk of operative mortality or mitral valve replacement. Moreover, primary mitral regurgitation appears to have an important dynamic character in up to one-third of patients. This article provides an overview of the incremental evidence of the ability of exercise echocardiography to assess the functional repercussions of mitral regurgitation and the identification of high-risk patients who might benefit from early referral for surgery.
原发性二尖瓣反流通常是一种隐匿性疾病，症状出现较晚。目前的欧美指南建议在出现症状、明显左心室功能障碍、肺动脉高压或心房颤动时，对严重原发性二尖瓣反流进行手术。然而，最近的大型研究报告称，对于无症状的严重二尖瓣反流患者，尽管手术死亡率或二尖瓣置换术的风险较高，但早期进行二尖瓣修复可改善预后。此外，原发性二尖瓣反流在多达三分之一的患者中似乎具有重要的动态特征。本文概述了运动超声心动图评估二尖瓣反流功能后果的能力的增量证据，并确定了可能受益于早期手术转诊的高危患者。
