继发性二尖瓣返流:心脏重塑、诊断和处理

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Structural Heart Pub Date : 2023-05-01 DOI:10.1016/j.shj.2022.100129
Alex L. Huang MBChB, PhD, Jacob P. Dal-Bianco MD, Robert A. Levine MD, Judy W. Hung MD
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引用次数: 1

摘要

继发性二尖瓣反流(MR)是指由左心室或左心房重构引起的MR。在缺血性或非缺血性心肌病中,左心室扩张(局部或全局)会导致乳头肌移位、束缚和小叶接合不良。在心房功能性MR中,MR发生在左心房扩张和因心房颤动而改变二尖瓣环几何形状的患者中。除了心脏重塑外,小叶重塑也越来越受到重视。二尖瓣小叶组织通过小叶生长主动适应,以确保充分的接合。然而,小叶也会发生不适应的增厚和纤维化,导致硬度增加。心脏和小叶重塑的平衡是继发性MR发展的关键决定因素。临床管理从检测、严重程度分级和识别潜在机制开始,这在很大程度上依赖于超声心动图。继发性MR的治疗包括指南指导的药物治疗、手术修复或置换以及经导管边缘到边缘修复。基于对病理生理学的更好理解,已经开发出新型经皮二尖瓣修复和置换装置,临床试验正在进行中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Secondary Mitral Regurgitation: Cardiac Remodeling, Diagnosis, and Management

Secondary mitral regurgitation (MR) refers to MR resulting from left ventricular or left atrial remodeling. In ischemic or nonischemic cardiomyopathy, left ventricular dilation (regional or global) leads to papillary muscle displacement, tethering, and leaflet malcoaptation. In atrial functional MR, MR occurs in patients with left atrial dilation and altered mitral annular geometry due to atrial fibrillation. In addition to cardiac remodeling, leaflet remodeling is increasingly recognized. Mitral leaflet tissue actively adapts through leaflet growth to ensure adequate coaptation. Leaflets, however, can also undergo maladaptive thickening and fibrosis, leading to increased stiffness. The balance of cardiac and leaflet remodeling is a key determinant in the development of secondary MR. Clinical management starts with detection, severity grading, and identification of the underlying mechanism, which relies heavily on echocardiography. Treatment of secondary MR consists of guideline-directed medical therapy, surgical repair or replacement, and transcatheter edge-to-edge repair. Based on a better understanding of pathophysiology, novel percutaneous mitral repair and replacement devices have been developed and clinical trials are underway.

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来源期刊
Structural Heart
Structural Heart Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.60
自引率
0.00%
发文量
81
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