Hamid Umar Imran, Aksoy Rezan, Sardari Nia Peyman
Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Ann Cardiothorac Surg. 2022 May;11(3):281-289. doi: 10.21037/acs-2021-ami-23.
Papillary muscle rupture (PMR) is a significant mechanical complication following myocardial infarction (MI), a condition associated with a high mortality. It results in severe mitral valve regurgitation (MR), often accompanied by cardiogenic shock and pulmonary edema, requiring both emergent medical treatment and surgical intervention. Surgical treatment includes either chordal sparing mitral valve replacement or mitral valve repair, which is associated with a high mortality. Mitral valve repair is believed to be superior to mitral valve replacement with respect to improving left ventricular function, albeit with risk of repair failure and resulting in increased cross clamp times. Concomitant coronary revascularization may improve both short- and long-term outcomes after surgery. With advances in medical innovations in the field of transcatheter devices, these devices may serve as a bridge to recovery or treatment in the setting of acute MR due to PMR. However, long-term data will be required to establish the non-inferiority of one treatment modality over the other. Management of these patients should be guided by a dedicated mitral heart team.
乳头肌破裂（PMR）是心肌梗死（MI）后一种严重的机械性并发症，该病症死亡率很高。它会导致严重的二尖瓣反流（MR），常伴有心源性休克和肺水肿，需要紧急药物治疗和手术干预。手术治疗包括保留腱索的二尖瓣置换术或二尖瓣修复术，这两种手术死亡率都很高。二尖瓣修复术在改善左心室功能方面被认为优于二尖瓣置换术，尽管存在修复失败的风险并会导致交叉钳夹时间延长。同期进行冠状动脉血运重建可能会改善术后的短期和长期疗效。随着经导管装置领域医学创新的进展，这些装置在因PMR导致急性MR的情况下可作为恢复或治疗的桥梁。然而，需要长期数据来确定一种治疗方式相对于另一种治疗方式的非劣效性。这些患者的管理应由专业的二尖瓣心脏团队指导。
