Cameli Matteo, Sciaccaluga Carlotta, Mandoli Giulia E, D'Ascenzi Flavio, Tsioulpas Charilaos, Mondillo Sergio
Department of Cardiovascular Disease, University of Siena, Siena, Italy.
Department of Cardiac Surgery, University of Siena, Siena, Italy.
Echocardiography. 2019 Aug;36(8):1559-1565. doi: 10.1111/echo.14426. Epub 2019 Jul 1.
The right management of both mitral and aortic disease can be challenging, especially in asymptomatic patients. The current guidelines recommend valve repair or replacement when symptoms arise or when there is an evident left ventricular dysfunction. However, deciding the optimal surgical timing can be very difficult, since the line between the absence of symptoms and being minimally symptomatic, especially in the elderly, is blurred. Another relevant issue regards the second surgical criterion: operating on a patient with a reduced left ventricular ejection fraction or with a dilated left ventricle might jeopardize the possibility of a fully reverse remodeling of the heart after surgery. In this scenario, the left atrium might play an important role. In particular, left atrial deformation might be a very useful tool to detect early ultrastructural alterations, and help or support guiding a patient-tailored treatment at an early stage, optimizing the outcome in the long term.
二尖瓣和主动脉疾病的正确管理可能具有挑战性，尤其是在无症状患者中。当前指南建议在出现症状或存在明显左心室功能障碍时进行瓣膜修复或置换。然而，确定最佳手术时机可能非常困难，因为无症状与轻微症状之间的界限，尤其是在老年人中，很模糊。另一个相关问题涉及第二个手术标准：对左心室射血分数降低或左心室扩张的患者进行手术可能会危及术后心脏完全逆向重塑的可能性。在这种情况下，左心房可能起重要作用。特别是，左心房变形可能是检测早期超微结构改变的非常有用的工具，并有助于或支持在早期指导个体化治疗，从长期来看优化治疗结果。
