何明俊,韩克

• 1:西安交通大学第一附属医院心内科

摘要(Abstract)：

急性缺血性二尖瓣反流（AIMR）是一种严重危及生命的心血管疾病，常常由急性心肌梗死引起二尖瓣腱索或乳头肌断裂或室壁运动异常导致二尖瓣瓣叶栓系引起。其症状包括呼吸急促、心悸和肺水肿、心原性休克等，治疗极具挑战性，传统的治疗方法包括药物治疗和外科手术干预，但药物治疗对部分患者效果不佳，而外科手术干预对部分患者风险较高而无法实施。随着介入心脏病学的进步，经导管二尖瓣缘对缘修复（TEER）对慢性二尖瓣反流患者的治疗进行了诸多的探索，在缓解症状和提高生活质量方面有很大获益。TEER为AIMR提供了一种全新的选择。本综述将深入探讨TEER在治疗AIMR中的手术策略、器械选择、临床探索以及其面临的挑战与前景。

关键词(KeyWords)： 急性缺血性二尖瓣反流;二尖瓣缘对缘修复;急性心肌梗死;心原性休克

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 何明俊,韩克

参考文献(References)：

• [1]中国医师协会心血管内科医师分会结构性心脏病学组,亚太结构性心脏病俱乐部.中国经导管二尖瓣缘对缘修复术临床路径(2022版)精简版[J].中国介入心脏病学杂志,2023,31(3):161-173.DOI:10.3969/j.issn.1000-3614.2023.03.001.
• [2]Feldman T,Kar S,Elmariah S,et al.Randomized comparison of percutaneous repair and surgery for mitral regurgitation:5-year results of EVERESTⅡ[J].J Am Coll Cardiol,2015,66(25):2844-2854.DOI:10.1016/j.jacc.2015.10.018.
• [3] Otto CM,Nishimura RA,Bonow RO,et al.2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease:A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J].Circulation,2021,143(5):e72-e227.doi:10.1161/CIR.0000000000000923.
• [4]Vahanian A,Beyersdorf F,Praz F,et al.2021 ESC/EACTS Guidelines for the management of valvular heart disease[J].Eur Heart J,2022,43(7):561-632.DOI:10.1093/eurheartj/ehab395.
• [5]亚太心脏病学会(APSC)专家组.经导管缘对缘技术(MitraClip)治疗二尖瓣反流——亚太心脏病学会(APSC)专家共识[J].中国循环杂志,2022,37(1):4-11.DOI:10.3969/j.issn.1000-3614.2022.01.002.
• [6]Giustino G,Camaj A,Kapadia SR,et al.Hospitalizations and mortality in patients with secondary mitral regurgitation and heart failure:the COAPT trial[J].J Am Coll Cardiol,2022,80(20):1857-1868.DOI:10.1016/j.jacc.2022.08.803.
• [7] Goel K,Lindenfeld J,Makkar R,et al.Transcatheter edge-to-edge repair in 5,000 patients with secondary mitral regurgitation:COAPT post-approval study[J].J Am Coll Cardiol,2023,82(13):1281-1297.DOI:10.1016/j.jacc.2023.07.015.
• [8]Bursi F,Enriquez-Sarano M,Nkomo VT,et al.Heart failure and death after myocardial infarction in the community:the emerging role of mitral regurgitation[J].Circulation,2005,111(3):295-301.DOI:10.1161/01.CIR.0000151097.30779.04.
• [9]Naser N,Dzubur A,Kusljugic Z,et al.Echocardiographic assessment of ischaemic mitral regurgitation,mechanism,severity,impact on treatment strategy and long term outcome[J].Acta Inform Med,2016,24(3):172-177.DOI:10.5455/aim.2016.24.172-177.
• [10]Sannino A,Grayburn PA.Ischemic mitral regurgitation after acute myocardial infarction in the percutaneous coronary intervention era[J].Circ Cardiovasc Imaging,2016,9(8):e005323.DOI:10.1161/CIRCIMAGING.116.005 323.
• [11]Kimura T,Roger VL,Watanabe N,et al.The unique mechanism of functional mitral regurgitation in acute myocardial infarction:a prospective dynamic 4D quantitative echocardiographic study[J].Eur Heart J Cardiovasc Imaging,2019,20(4):396-406.DOI:10.1093/ehjci/jey177.
• [12]So CY,Kang G,Lee JC,et al.Transcatheter edge-to-edge repair for acute mitral regurgitation with cardiogenic shock secondary to mechanical complication[J].Cardiovasc Revasc Med,2022,45:44-50.DOI:10.1016/j.carrev.2022.07.003.
• [13]Haberman D,Estevez-Loureiro R,Benito-Gonzalez T,et al.Conservative,surgical,and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction[J].Eur Heart J,2022,43(7):641-650.DOI:10.1093/eurheartj/ehab496.
• [14]Dekker AL,Reesink KD,van der Veen FH,et al.Intraaortic balloon pumping in acute mitral regurgitation reduces aortic impedance and regurgitant fraction[J].Shock,2003,19(4):334-338.DOI:10.1097/00024382-200304000-00007.
• [15]Kettner J,Sramko M,Holek M,et al.Utility of intra-aortic balloon pump support for ventricular septal rupture and acute mitral regurgitation complicating acute myocardial infarction[J].Am J Cardiol,2013,112(11):1709-1713.DOI:10.1016/j.amjcard.2013.07.035.
• [16]谭明,崔建.经导管二尖瓣缘对缘修复术的精准房间隔穿刺原理及定位[J].中国介入心脏病学杂志,2023,31(8):615-618.DOI:10.3969/j.issn.1004-8812.2023.08.009.
• [17]Bilge M,Alemdar R,Yasar AS.Successful percutaneous mitral valve repair with the MitraClip system of acute mitral regurgitation due to papillary muscle rupture as complication of acute myocardial infarction[J].Catheter Cardiovasc Interv,2014,83(1):E137-E140.DOI:10.1002/ccd.24960.
• [18]Wolff R,Cohen G,Peterson C,et al.MitraClip for papillary muscle rupture in patient with cardiogenic shock[J].Can J Cardiol,2014,30(11):1461.e13-e14.DOI:10.1016/j.cjca.2014.07.015.
• [19]Bahlmann E,Frerker C,Kreidel F,et al.MitraClip implantation after acute ischemic papillary muscle rupture in a patient with prolonged cardiogenic shock[J],Ann Thorac Surg,2015,99(2):e41-e42.DOI:10.1016/j.athoracsur.2014.09.075.
• [20] Valle JA,Miyasaka RL,Carroll JD.Acute mitral regurgitation secondary to papillary muscle tear:is transcatheter edgeto-edge mitral valve repair a new paradigm?[J].Circ Cardiovasc Interv,2017,10(6):e005050.DOI:10.1161/CIRCINTERVENTIONS.117.005050.
• [21]Yasin M,Nanjundappa A,Annie FH,et al.Use of MitraClip for postmyocardial infarction mitral regurgitation secondary to papillary muscle dysfunction[J].Cureus,2018,10(7):e3065.DOI:10.7759/cureus.3065.
• [22]Papadopoulos K,Chrissoheris M,Nikolaou I,et al.Edge-toedge mitral valve repair for acute mitral valve regurgitation due to papillary muscle rupture:a case report[J].Eur Heart J Case Rep,2019,3(1):ytz001.DOI:10.1093/ehjcr/ytz001.
• [23]Komatsu I,Cohen EA,Cohen GN,et al.Transcatheter mitral valve edge-to-edge repair with the new MitraClip XTR system for acute mitral regurgitation caused by papillary muscle rupture[J].Can J Cardiol,2019,35(11):1604.e5-1604.e7.DOI:10.1016/j.cjca.2019.06.024.
• [24]Vinck EE,Rendón JC,Castillo MP,et al.MitraClip as bridge to mitral valve replacement in the setting of ischemic cardiogenic shock and papillary muscle rupture[J].Acta Chir Belg,2023,123(1):102-104.DOI:10.1080/00015458.2022.2146297.
• [25]Estevez-Loureiro R,Arzamendi D,Freixa X,et al.Percutaneous mitral valve repair for acute mitral regurgitation after an acute myocardial infarction[J].J Am Coll Cardiol,2015,66(1):91-92.DOI:10.1016/j.jacc.2015.03.597.
• [26]Haberman D,Taramasso M,Czarnecki A,et al.Salvage MitraClip in severe secondary mitral regurgitation complicating acute myocardial infarction:data from a multicentre international study[J].Eur J Heart Fail,2019,21(9):1161-1164.DOI:10.1002/ejhf.1565.
• [27] Estevez-Loureiro R,Shuvy M,Taramasso M,et al.Use of MitraClip for mitral valve repair in patients with acute mitral regurgitation following acute myocardial infarction:effect of cardiogenic shock on outcomes(IREMMI Registry)[J].Catheter Cardiovasc Interv,2021,97(6):1259-1267.DOI:10.1002/ccd.29552.
• [28]Haberman D,Estévez-Loureiro R,Benito-Gonzalez T,et al.Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction[J].J Clin Med,2021,10(9):1819.DOI:10.3390/jcm10091819.