Bonow R O, Nikas D, Elefteriades J A
Northwestern University Medical School, Chicago, Illinois, USA.
Cardiol Clin. 1995 Feb;13(1):73-83, 85.
Patients with aortic regurgitation and severe left ventricular dysfunction remain candidates for aortic valve replacement, as long as the risks of late left ventricular dysfunction and congestive heart failure have been fully discussed with the patient, the patient's family, and the referring physician. In contrast, patients with mitral regurgitation and severe systolic dysfunction are at considerable risk of more severe left ventricular dysfunction after operation, especially if mitral valve repair or chordal-sparing procedure cannot be performed. In patients who are candidates for such procedures that preserve the integrity of the subvalvular mitral apparatus, operation may be successful in selected patients despite moderate-to-severe depression of systolic function. Prognosis is guarded to poor in patients with regurgitant valvular lesions and advanced left ventricular dysfunction, and the emerging alternative treatments discussed in other articles in this Cardiology Clinics deserve consideration in these patients.
只要已与患者、患者家属及转诊医生充分讨论了晚期左心室功能障碍和充血性心力衰竭的风险，主动脉瓣反流和严重左心室功能障碍的患者仍是主动脉瓣置换术的候选者。相比之下，二尖瓣反流和严重收缩功能障碍的患者术后发生更严重左心室功能障碍的风险相当高，尤其是在无法进行二尖瓣修复或保留腱索手术的情况下。对于那些适合保留二尖瓣瓣下结构完整性的手术的患者，尽管收缩功能有中度至重度降低，但在部分选定患者中手术可能成功。有反流性瓣膜病变和晚期左心室功能障碍的患者预后不佳，《心血管病临床》其他文章中讨论的新出现的替代治疗方法值得这些患者考虑。
