Noack T, Mohr F-W
Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig, 04289, Strümpellstraße 39, Leipzig, Deutschland.
Herz. 2016 Feb;41(1):10-8. doi: 10.1007/s00059-015-4385-1.
Mitral valve (MV) disease is one of the most common heart valve diseases. The surgical and interventional treatment for MV disease requires a multidisciplinary approach. For primary mitral valve regurgitation (MVR) surgical MV repair is the treatment of choice, which can be performed with an excellent outcome and long-term survival in reference centers. The surgical technique used for MV repair depends on the pathological mechanism, the morphological dimensions of the MV, the operative risk and the expertise of the cardiac surgeon. The surgical and interventional treatment of secondary MVVR is the subject of on-going discussions. In patients with moderate secondary MVR undergoing coronary artery bypass grafting, concomitant MV repair should be performed. In the presence of severe secondary MR with risk factors for failure of MV repair, patients should consider having MV replacement. In the rare cases of patients presenting with mitral valve stenosis (MVS) MV repair can be considered in young patients and who are most often treated with MV replacement. The choice between biological or mechanical MV replacement depends on the pathophysiology, the comorbidities, the amount of anticoagulation necessary and the age of the patient. New percutaneous techniques for MV replacement offer new treatment options for reoperation in high-risk patients.
二尖瓣疾病是最常见的心脏瓣膜疾病之一。二尖瓣疾病的外科手术和介入治疗需要多学科方法。对于原发性二尖瓣反流（MVR），外科二尖瓣修复是首选治疗方法，在参考中心进行该手术可取得优异的效果和长期生存率。用于二尖瓣修复的手术技术取决于病理机制、二尖瓣的形态尺寸、手术风险以及心脏外科医生的专业技能。继发性二尖瓣反流（MVVR）的外科手术和介入治疗是正在讨论的主题。对于中度继发性MVR且正在接受冠状动脉旁路移植术的患者，应同时进行二尖瓣修复。对于存在严重继发性二尖瓣反流且有二尖瓣修复失败风险因素的患者，应考虑进行二尖瓣置换。在极少数二尖瓣狭窄（MVS）患者中，年轻患者可考虑二尖瓣修复，而二尖瓣狭窄患者大多接受二尖瓣置换治疗。生物瓣或机械瓣置换的选择取决于病理生理学、合并症、所需抗凝量以及患者年龄。新的经皮二尖瓣置换技术为高危患者再次手术提供了新的治疗选择。
