Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ; Cardiology Department, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania.
Cardiology Department, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania. ; Cardiology Department, Emergency University Hospital Elias, Bucharest, Romania.
Korean Circ J. 2015 Mar;45(2):96-105. doi: 10.4070/kcj.2015.45.2.96. Epub 2015 Mar 24.
Mitral regurgitation (MR) represents the second most frequent valvular heart disease. The appropriate management of organic MR remains unclear in many aspects, especially in several specific clinical scenarios. This review aims to discuss the current guideline recommendations regarding the management of organic MR, while highlighting the controversial aspects encountered in daily clinical practice. The role of imaging is essential in establishing the most appropriate type of surgical treatment (repair or replace), which is based on morphological mitral valve (MV) characteristics (reparability of the valve) and local surgical expertise in valve repair. The potential advantages of 3-dimensional echocardiography in assessing the MV are discussed. Other modern imaging techniques (tissue Doppler and speckle tracking) may provide additional useful information in borderline cases. Exercise echocardiography (evaluating MR severity, pulmonary pressure, or right ventricular function) may have an important role in the management of difficult cases. Finally, the moment when surgery is no longer an option and alternative solutions should be sought is also discussed. Although in everyday clinical practice the timing of surgery is not always straightforward, some newer clinical and echocardiographic indicators can guide this decision and help improve the outcome of these patients.
二尖瓣反流（MR）是第二大常见的心脏瓣膜病。在许多方面，特别是在几个特定的临床情况下，有机 MR 的适当治疗仍然不明确。本综述旨在讨论目前关于有机 MR 管理的指南建议，同时强调在日常临床实践中遇到的有争议的方面。影像学在确定最合适的手术治疗类型（修复或替换）方面至关重要，这基于二尖瓣（MV）形态特征（瓣膜可修复性）和局部瓣膜修复手术专业知识。讨论了 3 维超声心动图在评估 MV 中的潜在优势。其他现代成像技术（组织多普勒和斑点追踪）在临界情况下可能提供额外的有用信息。运动超声心动图（评估 MR 严重程度、肺动脉压或右心室功能）在处理困难病例中可能具有重要作用。最后，还讨论了何时手术不再是一种选择，应寻求替代解决方案的问题。尽管在日常临床实践中，手术时机并不总是那么简单，但一些较新的临床和超声心动图指标可以指导这一决策，并有助于改善这些患者的预后。
