缺血性二尖瓣反流的外科治疗

摘要

The ischemic mitral regurgitation( IMR) is present in 20% to 30% of patients with old myocardial infarction. In patients with heart failure after myocardial infarction , the incidence of IMR is even as high as 50%.IMR has adverse effects on the prognosis of patients and is positively correlated with the degree of reflux , including increased risk of heart failure and mortality of cardiovascular disease.Patients with severe hemodynamic abnormalities, and in the case of have accepted the best drug treatment is still difficult to alleviate symptoms of heart failure , surgical treatment should be implemented.However, the surgical treatment strategy of IMR is still controversial, that is, for the moderate IMR, only the blood transport reconstruction is sufficient to restore the natural form of the valve, whether the valve operation needs to be performed simultaneously ; In the case of severe IMR, simultaneous valvular surgery has been agreed upon.The controversy is that the mitral valve repair(MVP) and mitral valve replacement(MVR) are both superior and inferior.The purpose of this paper is to review the literature on IMR sur-gery in order to help us understand this important question.%陈旧性心肌梗死患者中20%～30%会出现缺血性二尖瓣反流( ischemic mitral regurgita-tion,IMR).而在心肌梗死后心力衰竭患者中,IMR的发病率甚至高达50%. IMR对患者预后产生不利影响,并且与反流程度呈正相关,包括增加心力衰竭发生风险和心血管疾病病死率.因此,如果明确患者出现严重的血流动力学异常,并且在已接受最佳药物治疗的情况下仍然难以缓解心力衰竭症状,应实施外科手术治疗.但是,IMR的外科治疗策略目前依然具有争议,即对于中度IMR,仅血运重建是否足以恢复瓣膜的自然形态,是否需要同时实施瓣膜手术;对于重度IMR,需同时行瓣膜手术已达成一致,争议在于二尖瓣修复(MVP)与二尖瓣置换(MVR)两者,孰优孰劣,如何抉择.本文旨在回顾IMR外科治疗的相关文献,以期能有助于我们对这一重要问题的理解.