Jesselson Integrated Heart Centre, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel.
San Raffaele University Hospital, Milan, Italy.
Can J Cardiol. 2023 Oct;39(10):1382-1389. doi: 10.1016/j.cjca.2023.05.009. Epub 2023 May 18.
Acute mitral regurgitation (AMR) is a medical emergency which may lead to rapid clinical deterioration and is associated with high morbidity and mortality. The severity of the clinical presentation varies according to several factors, ranging from cardiogenic shock to a milder presentation. The medical management of AMR includes intravenous diuretics, vasodilators, inotropic support, and potentially mechanical support to stabilise patients. Patients persisting with refractory symptoms despite optimal medical therapy are considered for surgical intervention, but high-risk patients deemed to be inoperable frequently experience poor outcomes. This review highlights the variety of clinical presentations of AMR and the pitfalls in diagnosis and management. The emerging role of transcatheter edge-to-edge repair (TEER), particularly in high-risk patients early after myocardial infarction requiring urgent intervention, has demonstrated feasibility and promising efficacy. TEER is well tolerated and improves hemodynamic parameters in AMR. In a recent analysis, the in-hospital and 1-year mortality rates were significantly higher with surgical mitral interventions compared with TEER. The global TEER experience for treating AMR is encouraging, with reports indicating improved clinical outcomes in high-risk patients and its potential as a bridge to recovery. Early recognition of AMR, validated criteria for patient selection, optimal timing of the intervention as well as long-term outcomes and additional prospective data should be addressed in future studies.
急性二尖瓣反流（AMR）是一种医学急症，可能导致病情迅速恶化，并伴有高发病率和死亡率。临床表现的严重程度取决于几个因素，从轻症到心源性休克不等。AMR 的医学治疗包括静脉利尿剂、血管扩张剂、正性肌力支持和潜在的机械支持，以稳定患者。尽管经过最佳的药物治疗，但仍持续出现顽固性症状的患者被认为需要手术干预，但被认为不能手术的高危患者通常预后不佳。本综述强调了 AMR 的各种临床表现以及在诊断和治疗方面的陷阱。经导管缘对缘修复术（TEER）的新兴作用，特别是在需要紧急干预的急性心肌梗死后的高危患者中，已证明其具有可行性和有前途的疗效。TEER 耐受性良好，可改善 AMR 的血液动力学参数。最近的一项分析表明，与 TEER 相比，手术二尖瓣介入治疗的住院和 1 年死亡率明显更高。全球使用 TEER 治疗 AMR 的经验令人鼓舞，报告表明高危患者的临床结局得到改善，以及它作为恢复的桥梁的潜力。在未来的研究中，应解决 AMR 的早期识别、患者选择的验证标准、干预的最佳时机以及长期结局和额外的前瞻性数据。
