Mitral Regurgitation in Patients Undergoing Noncardiac Surgery.

IF 1.1 Q3 ANESTHESIOLOGY Seminars in Cardiothoracic and Vascular Anesthesia Pub Date : 2022-03-01 Epub Date: 2021-09-01 DOI:10.1177/10892532211042827
Ellen W Richter, Islam M Shehata, Hamdy M Elsayed-Awad, Matthew A Klopman, Sujatha P Bhandary
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引用次数: 2

Abstract

Mitral regurgitation (MR) is one of the most frequently encountered types of valvular heart disease in the United States. Patients with significant MR (moderate-to-severe or severe) undergoing noncardiac surgery have an increased risk of perioperative cardiovascular complications. MR can arise from a diverse array of causes that fall into 2 broad categories: primary (diseases intrinsic to the valvular apparatus) and secondary (diseases that disrupt normal valve function via effects on the left ventricle or mitral annulus). This article highlights key guideline updates from the American College of Cardiologists (ACC) and the American Heart Association (AHA) that inform decision-making for the anesthesiologist caring for a patient with MR undergoing noncardiac surgery. The pathophysiology and natural history of acute and chronic MR, staging of chronic primary and secondary MR, and considerations for timing of valvular corrective surgery are reviewed. These topics are then applied to a discussion of anesthetic management, including preoperative risk evaluation, anesthetic selection, hemodynamic goals, and intraoperative monitoring of the noncardiac surgical patient with MR.

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非心脏手术患者的二尖瓣返流。
二尖瓣反流(MR)是美国最常见的瓣膜性心脏病类型之一。严重MR(中度至重度或重度)患者接受非心脏手术围手术期心血管并发症的风险增加。MR可由多种原因引起,可分为两大类:原发性(瓣膜固有疾病)和继发性(通过影响左心室或二尖瓣环破坏正常瓣膜功能的疾病)。本文重点介绍了来自美国心脏病学会(ACC)和美国心脏协会(AHA)的最新指南,这些指南为麻醉医师治疗接受非心脏手术的MR患者提供了决策依据。本文回顾了急性和慢性MR的病理生理学和自然史,慢性原发性和继发性MR的分期,以及瓣膜矫正手术时机的考虑。然后将这些主题应用于麻醉管理的讨论,包括术前风险评估、麻醉剂选择、血流动力学目标和非心脏手术患者MR术中监测。
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CiteScore
3.60
自引率
14.30%
发文量
31
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