Cardiac Surgery Innovation Lab, Queen's University, Kingston.
Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada.
Curr Opin Cardiol. 2021 Mar 1;36(2):154-162. doi: 10.1097/HCO.0000000000000827.
The review summarizes the key parameters that can aid in determining the optimal treatment of ischemic mitral regurgitation (IMR).
Left ventricular (LV) and mitral valve (MV) parameters are important for surgical planning and risk stratification in IMR. Although LV dimensions is one of the main parameters used in the guidelines, volumes more accurately depict LV remodelling. Furthermore, wall motion abnormalities and wall motion score index can also be useful for surgical planning in treatment of IMR. Viability is best measured with cardiac magnetic resonance, but it is not feasible in certain centres. In contrast, measurement of strain with echocardiography is an emerging and feasible tool for estimating viability. MV leaflet tethering and pattern measured with echocardiography are also useful for MV surgery. Anterior leaflet excursion angle can identify patients in whom undersized ring annuloplasty is potentially unsuitable.
Treatment of IMR relies on accurate parameters that can determine the optimal surgical approach. In some patients, lack of viable myocardium suggests inadequacy of revascularization and thus, an adjunctive left ventricular reconstruction may be necessary. Degree and pattern of MV leaflet tethering can indicate whether ring annuloplasty, which is the most common repair technique, is sufficient or an adjunctive sub-valvular intervention is beneficial.
本文总结了有助于确定缺血性二尖瓣反流（IMR）最佳治疗方法的关键参数。
左心室（LV）和二尖瓣（MV）参数对于 IMR 的手术计划和风险分层很重要。尽管 LV 尺寸是指南中使用的主要参数之一，但容积更能准确描述 LV 重塑。此外，运动异常和运动评分指数也可用于 IMR 治疗的手术计划。心脏磁共振是测量存活心肌的最佳方法，但在某些中心不可行。相比之下，超声心动图测量应变是一种新兴且可行的工具，可用于估计存活心肌。MV 瓣叶牵拉力和超声心动图测量的模式也对 MV 手术有用。前瓣叶活动角度可识别出环缩术可能不适合的小瓣环患者。
IMR 的治疗依赖于能确定最佳手术方法的准确参数。在某些患者中，缺乏存活心肌提示血运重建不足，因此可能需要辅助左心室重建。MV 瓣叶牵拉力的程度和模式可以表明最常见的修复技术——瓣环成形术是否足够，或者是否需要辅助瓣下干预。
