Van Assche Lowie M R, Ricciardi Mark J
From the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Cardiol Rev. 2018 Sep-Oct;26(5):230-238. doi: 10.1097/CRD.0000000000000219.
Functional mitral regurgitation (FMR) is common in patients with heart failure and portends a poor prognosis. The etiology is secondary to nonischemic or ischemic (postmyocardial infarction) adverse remodeling. Treatment includes guideline-directed medical therapy, cardiac resynchronization therapy, and in some cases, surgical repair or replacement. Transcatheter mitral valve (MV) repair with the MitraClip device is approved in patients with degenerative MR and is currently under investigation for use in FMR, as are several transcatheter MV replacement devices. This review discusses the basis of FMR pathophysiology, classification, and prognosis; provides an overview of current therapeutic approaches; examines the available literature on the use of MitraClip in patients with FMR; and provides insight into ongoing clinical trials and new investigational devices for the treatment of FMR.
功能性二尖瓣反流（FMR）在心力衰竭患者中很常见，且预示着预后不良。其病因继发于非缺血性或缺血性（心肌梗死后）不良重塑。治疗方法包括指南指导的药物治疗、心脏再同步治疗，在某些情况下还包括手术修复或置换。使用MitraClip装置进行经导管二尖瓣（MV）修复已被批准用于退行性二尖瓣反流患者，目前正在研究其在FMR中的应用，还有几种经导管MV置换装置也在进行相关研究。本综述讨论了FMR病理生理学、分类和预后的基础；概述了当前的治疗方法；研究了关于在FMR患者中使用MitraClip的现有文献；并深入探讨了正在进行的临床试验以及用于治疗FMR的新型研究装置。
