Stolz Lukas, Doldi Philipp M, Weckbach Ludwig T, Stocker Thomas J, Braun Daniel, Orban Martin, Wild Mirjam G, Hagl Christian, Massberg Steffen, Näbauer Michael, Hausleiter Jörg, Orban Mathias
Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
Front Cardiovasc Med. 2022 Oct 12;9:993618. doi: 10.3389/fcvm.2022.993618. eCollection 2022.
Since transcatheter edge-to-edge repair (TEER) has become a valuable therapy in the treatment of both, mitral (MR) and tricuspid regurgitation (TR), the question of optimized patient selection has gained growing importance. After years of attributing rather little attention to the right ventricle (RV) and its function in the setting of valvular heart failure, this neglect has recently changed. The present review sought to summarize anatomy and function of the RV in a clinical context and aimed at presenting the current knowledge on how the RV influences outcomes after TEER for atrioventricular regurgitation. The anatomy of the RV is determined by its unique shape, which necessitates to use three-dimensional imaging methods for detailed and comprehensive characterization. Complex parameters such as RV to pulmonary artery coupling (RVPAc) have been developed to combine information of RV function and afterload which is primary determined by the pulmonary vasculature and LV filling pressure. Beyond that, TR, which is closely related to RV function also plays an important role in the setting of TEER. While mitral valve transcatheter edge-to-edge repair (M-TEER) leads to reduction of concomitant TR in some patients, the prognostic value of TR in the setting of M-TEER remains unclear. Overall, this review summarizes the current state of knowledge of the outstanding role of RV function and associated TR in the setting of TEER and outlines the unsolved questions associated with right-sided heart failure.
由于经导管缘对缘修复术（TEER）已成为治疗二尖瓣反流（MR）和三尖瓣反流（TR）的一种重要疗法，优化患者选择的问题变得越来越重要。多年来，在瓣膜性心力衰竭的背景下，人们对右心室（RV）及其功能关注甚少，而这种忽视最近有所改变。本综述旨在总结临床背景下右心室的解剖结构和功能，旨在介绍目前关于右心室如何影响房室反流经导管缘对缘修复术后结果的知识。右心室的解剖结构由其独特的形状决定，这就需要使用三维成像方法进行详细和全面的表征。已经开发出诸如右心室与肺动脉耦合（RVPAc）等复杂参数，以整合右心室功能和后负荷的信息，而后负荷主要由肺血管系统和左心室充盈压决定。除此之外，与右心室功能密切相关的三尖瓣反流在经导管缘对缘修复术中也起着重要作用。虽然二尖瓣经导管缘对缘修复术（M-TEER）在一些患者中可导致合并的三尖瓣反流减少，但三尖瓣反流在M-TEER背景下的预后价值仍不清楚。总体而言，本综述总结了右心室功能和相关三尖瓣反流在经导管缘对缘修复术中的突出作用的当前知识状态，并概述了与右侧心力衰竭相关的未解决问题。
