Raynaud P, Cosnay P, Fauchier J P, Charbonnier B, Monpère C, Desveaux B, Brochier M
Arch Mal Coeur Vaiss. 1985 Jan;78(1):91-101.
18 of 39 cases of ischaemic papillary muscle dysfunction reported elsewhere underwent cardiac catheterisation and angiography. Fifteen patients had previous myocardial infarction. The average age of the patients was less than in the overall series (69 vs 73 years) but the incidence of infarction and the degree of cardiac disease were greater. The absence of catheter data in the other patients is explained by their older age (76.4 years) and the longer period of recruitment. Their results and outcome of medical or surgical treatment are reported. The pathogenesis of the syndrome is reconsidered in the perspective of paroxysmal forms. A protocol for investigation is suggested to guide the therapeutic options. Right heart catheterisation at rest (n = 16), on exercise (n = 12), under vasodilator therapy (n = 6) and during angiography (n = 2) does not show a specific profile. These investigations only provide haemodynamic data related to therapy but they are essential for the interpretation of ventriculography. Ventriculography (n = 8) demonstrated 4 cases of mitral regurgitation (2 major and 2 minor), a reduced EF (0.47 +/- 0.17), asynergy of 36.1 p. 100 of segments analysed, predominantly in the inferior and lateral zones. Coronary angiography showed triple vessel disease in 6 cases, double vessel disease in 1 case and 1 stenosis of the left main coronary artery. Stenosis was commonest on the left circumflex (87.5 p. 100) and right coronary arteries (87.5 p. 100) but also frequently involved the left anterior descending artery (75 p. 100). Of the 12 patients treated medically, 8 died (66.6 p. 100) and the survivors remain symptomatic (33.3 p. 100), half with and half without attacks. After surgery (n = 8) comprising coronary bypass surgery (n = 6) or mitral valve replacement (n = 2), patients were asymptomatic. 1 patient died of cancer. These paroxysmal forms of mitral regurgitation may be explained by the association of aggravating, reversible ischaemic or haemodynamic factors to organic mitral lesions. Mitral valve replacement is justified when dysfunction becomes permanent and coronary bypass surgery is advocated whenever possible. The indications for surgery can only be taken into account after complete haemodynamic and angiographic investigation. A protocol for the interpretation of these investigations is suggested.
其他地方报道的39例缺血性乳头肌功能障碍患者中，18例接受了心导管检查和血管造影。15例患者曾有过心肌梗死。这些患者的平均年龄低于总体病例系列（69岁对73岁），但梗死发生率和心脏疾病程度更高。其他患者未提供导管数据是因为他们年龄较大（76.4岁）且招募时间较长。报告了他们的治疗结果以及药物或手术治疗的转归。从阵发性形式的角度重新考虑了该综合征的发病机制。建议了一个调查方案以指导治疗选择。静息状态下右心导管检查（n = 16）、运动时（n = 12）、血管扩张剂治疗时（n = 6）及血管造影时（n = 2）均未显示出特定特征。这些检查仅提供与治疗相关的血流动力学数据，但对心室造影的解读至关重要。心室造影（n = 8）显示4例二尖瓣反流（2例重度和2例轻度），射血分数降低（0.47±0.17），分析的节段中36.1%存在运动不协调，主要位于下壁和侧壁区域。冠状动脉造影显示6例三支血管病变，1例双支血管病变，1例左主干冠状动脉狭窄。狭窄最常见于左旋支（87.5%）和右冠状动脉（87.5%），但左前降支也常受累（75%）。12例接受药物治疗的患者中，8例死亡（66.6%），幸存者仍有症状（33.3%），一半有发作，一半无发作。手术后（n = 8），包括冠状动脉搭桥手术（n = 6）或二尖瓣置换术（n = 2），患者无症状。1例患者死于癌症。这些阵发性二尖瓣反流形式可能是由加重的、可逆的缺血或血流动力学因素与器质性二尖瓣病变共同作用所致。当功能障碍变为永久性时，二尖瓣置换是合理的，只要可能就提倡冠状动脉搭桥手术。只有在完成全面的血流动力学和血管造影检查后才能考虑手术指征。建议了一个解读这些检查结果的方案。
