Ischemic mitral regurgitation: current understanding and surgical options

被引:3
作者
Brescia, Alexander Angelo [1 ]
Watt, Tessa Maria Fontana [1 ]
Bolling, Steven Frederic [1 ]
机构
[1] Univ Michigan, Dept Cardiac Surg, Frankel Cardiovasc Ctr, 1500 East Med Ctr Dr, Ann Arbor, MI 48109 USA
基金
美国国家卫生研究院;
关键词
Functional mitral regurgitation; Ischemic mitral regurgitation; Mitral valve repair; CARDIAC RESYNCHRONIZATION THERAPY; ARTERY-BYPASS SURGERY; VALVE REPAIR; HEART-FAILURE; DILATED CARDIOMYOPATHY; PERCUTANEOUS REPAIR; ANNULOPLASTY; REPLACEMENT; REVASCULARIZATION; INSIGHTS;
D O I
10.1007/s12055-019-00811-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Secondary, or functional, mitral regurgitation (MR) occurs with impaired coaptation of structurally normal valve leaflets due to abnormal structure and/or function of the left ventricle (LV). A leading cause of functional mitral regurgitation is ischemic cardiomyopathy, resulting in left ventricular dysfunction and subsequent congestive heart failure (CHF) and ischemic mitral regurgitation (IMR). The value of surgical or transcatheter correction of IMR remains controversial, since the underlying pathology of IMR is attributed to a dysfunctional left ventricle. However, even mild IMR has been shown to be harmful to CHF patients, as IMR is both a surrogate of advanced CHF and an independent contributor to CHF morbidity and mortality. While observational and randomized studies have examined surgical treatment of IMR with conflicting outcomes, additional well-designed randomized controlled trials should be performed to further clarify the optimal treatment for IMR. Additionally, close attention should be paid to the quality of interventions performed, as durable reduction in IMR provides the best hope of a positive clinical outcome. This review focuses on the pathophysiology of IMR, current evidence regarding surgical and transcatheter interventions, and future directions in management of IMR.
引用
收藏
页码:27 / 33
页数:7
相关论文
共 58 条
  • [1] Mitral valve surgery in heart failure: Insights from the Acorn Clinical Trial
    Acker, Michael A.
    Bolling, Steven
    Shemin, Richard
    Kirklin, James
    Oh, Jae K.
    Mann, Douglas L.
    Jessup, Mariell
    Sabbah, Hani N.
    Starling, Randall C.
    Kubo, Spencer H.
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2006, 132 (03) : 568 - U20
  • [2] Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation
    Acker, Michael A.
    Parides, Michael K.
    Perrault, Louis P.
    Moskowitz, Alan J.
    Gelijns, Annetine C.
    Voisine, Pierre
    Smith, Peter K.
    Hung, Judy W.
    Blackstone, Eugene H.
    Puskas, John D.
    Argenziano, Michael
    Gammie, James S.
    Mack, Michael
    Ascheim, Deborah D.
    Bagiella, Emilia
    Moquete, Ellen G.
    Ferguson, T. Bruce
    Horvath, Keith A.
    Geller, Nancy L.
    Miller, Marissa A.
    Woo, Y. Joseph
    D'Alessandro, David A.
    Ailawadi, Gorav
    Dagenais, Francois
    Gardner, Timothy J.
    O'Gara, Patrick T.
    Michler, Robert E.
    Kron, Irving L.
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2014, 370 (01) : 23 - 32
  • [3] [Anonymous], J AM COLL CARDIOL
  • [4] [Anonymous], CONGESTIVE HEART FAI
  • [5] [Anonymous], MITRAL VALVE REPAIR
  • [6] Correction of Mitral Regurgitation in Nonresponders to Cardiac Resynchronization Therapy by MitraClip Improves Symptoms and Promotes Reverse Remodeling
    Auricchio, Angelo
    Schillinger, Wolfgang
    Meyer, Sven
    Maisano, Francesco
    Hoffmann, Rainer
    Ussia, Gian Paolo
    Pedrazzini, Giovanni B.
    van der Heyden, Jan
    Fratini, Simona
    Klersy, Catherine
    Komtebedde, Jan
    Franzen, Olaf
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011, 58 (21) : 2183 - 2189
  • [7] EARLY IMPROVEMENT IN CONGESTIVE-HEART-FAILURE AFTER CORRECTION OF SECONDARY MITRAL REGURGITATION IN END-STAGE CARDIOMYOPATHY
    BACH, DS
    BOLLING, SF
    [J]. AMERICAN HEART JOURNAL, 1995, 129 (06) : 1165 - 1170
  • [8] Mitral Valve Enlargement in Chronic Aortic Regurgitation as a Compensatory Mechanism to Prevent Functional Mitral Regurgitation in the Dilated Left Ventricle
    Beaudoin, Jonathan
    Handschumacher, Mark D.
    Zeng, Xin
    Hung, Judy
    Morris, Eleanor L.
    Levine, Robert A.
    Schwammenthal, Ehud
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2013, 61 (17) : 1809 - 1816
  • [9] Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment
    Benjamin, Mina M.
    Smith, Robert L.
    Grayburn, Paul A.
    [J]. CURRENT CARDIOLOGY REPORTS, 2014, 16 (08)
  • [10] EARLY OUTCOME OF MITRAL-VALVE RECONSTRUCTION IN PATIENTS WITH END-STAGE CARDIOMYOPATHY
    BOLLING, SF
    DEEB, GM
    BRUNSTING, LA
    BACH, DS
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 1995, 109 (04) : 676 - 683