Department of Interventional Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain.
Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
J Am Coll Cardiol. 2024 May 7;83(18):1799-1817. doi: 10.1016/j.jacc.2023.09.840.
Severe acute mitral regurgitation after myocardial infarction includes partial and complete papillary muscle rupture or functional mitral regurgitation. Although its incidence is <1%, mitral regurgitation after acute myocardial infarction frequently causes hemodynamic instability, pulmonary edema, and cardiogenic shock. Medical management has the worst prognosis, and mortality has not changed in decades. Surgery represents the gold standard, but it is associated with high rates of morbidity and mortality. Recently, transcatheter interventions have opened a new door for management that may improve survival. Mechanical circulatory support restores vital organ perfusion and offers the opportunity for a steadier surgical repair. This review focuses on the diagnosis and the interventional management, both surgical and transcatheter, with a glance on future perspectives to enhance patient management and eventually decrease mortality.
心肌梗死后出现严重急性二尖瓣反流包括部分和完全乳头肌断裂或功能性二尖瓣反流。尽管其发生率<1%，但急性心肌梗死后的二尖瓣反流常导致血流动力学不稳定、肺水肿和心源性休克。药物治疗的预后最差，数十年来死亡率没有变化。手术是金标准，但与较高的发病率和死亡率相关。最近，经导管介入治疗为管理开辟了新的途径，可能提高生存率。机械循环支持恢复重要器官灌注，并为更稳定的手术修复提供机会。这篇综述重点介绍了诊断和介入治疗，包括手术和经导管治疗，并展望了未来的前景，以加强患者管理，最终降低死亡率。
