缺血性二尖瓣反流的外科治疗

Surgical treatment of ischemic mitral valve regurgitation

缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)也称为功能性二尖瓣反流或继发性二尖瓣反流,是冠心病常见的并发症之一。二尖瓣反流的发生会加速左心室重构和功能障碍,最终导致不可逆的心力衰竭。尽管在医学和外科治疗方面取得了一定的进展,但IMR的患者与因其他原因而出现二尖瓣关闭不全的患者相比生存率较差。在外科治疗方面,此类患者,尤其是中度及重度IMR患者治疗方式的选择仍存在很大争议。本文将从二尖瓣反流机制和不同程度IMR患者的外科治疗以及介入治疗的进展等方面进行阐述。

Ischemic mitral regurgitation(IMR)is also called functional or secondary mitral regurgitation.It is one of the most common complications of coronary heart diseases. The occurrence of IMR accelerates left ventricular remodeling and dysfunction, ultimately leading to irreversible heart failure. Despite the advances in medicine and surgical treatment, patients with IMR still have a poor survival rate compared to patients with mitral insufficiency due to other causes. Moreover, the surgical treatment strategy of these patients, especially those with moderate and severe IMR, remains controversial. In this review, it is discussed on the mechanism of mitral regurgitation, the surgical treatment of patients with different degrees of IMR and the progress of interventional therapy.