二尖瓣反流

最后审阅: 3 九月 2022
最后更新: 12 四月 2022

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 劳力性呼吸困难
  • 运动耐量下降
  • 下肢水肿
  • 全收缩期杂音
更多 关键诊断因素

其他诊断因素

  • 疲劳
  • 最大搏动的移位点
  • 端坐呼吸
  • 阵发性夜间呼吸困难
  • 心悸
  • 发汗
  • 肺动脉瓣关闭音大于主动脉瓣关闭音
  • S3 心音
  • S1 心音减弱
其他诊断因素

危险因素

  • 二尖瓣脱垂
  • 风湿性心脏病病史
  • 感染性心内膜炎
  • 心脏创伤史
  • 心肌梗死病史
  • 先天性心脏病病史
  • 缺血性心脏病病史
  • 左室收缩功能障碍
  • 肥厚型心肌病
  • 食欲抑制剂/多巴胺能药物
  • 收缩压升高
更多 危险因素

诊断性检查

首要检查

  • 经胸超声心动图
  • 心电图 (ECG)
更多 首要检查

需考虑的检查

  • 血流会聚法或近端等速表面积
  • 彩色多普勒血流
  • 经食管超声心动图
  • 心导管检查
  • 心脏磁共振成像(CMR)
更多 需考虑的检查

治疗流程

急症处理

急性重度 MR

持续性治疗

慢性重度原发性 MR:无症状

慢性原发性 MR:有症状

慢性重度继发性 MR

撰稿人

作者

Prakash P. Punjabi, FRCS, FESC, MS, MCh, FCCP, FFSTEd, Diplomate NBE

Professor

National Heart and Lung Institute

Imperial College London

Consultant Cardiothoracic Surgeon

Department of Cardiothoracic Surgery

Hammersmith Hospital

Imperial College Healthcare NHS Trust

London

UK

利益声明

PPP is an author of references cited in this topic. PPP declares that he has no competing interests.

鸣谢

Dr Prakash P. Punjabi would like to gratefully acknowledge Dr Samir Kapadia and Dr Mehdi H. Shishehbor, previous contributors to this topic.

利益声明

SK and MHS declare that they have no competing interests.

同行评议者

Matthew Czarny, MD

Assistant Professor of Medicine

Department of Cardiovascular Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

利益声明

MC is a co-investigator for several clinical trials for Medtronic and Edwards Lifesciences involving transcatheter valve replacement or repair for the aortic, mitral, and tricuspid valves for which the Johns Hopkins University receives research funding. MC does not receive any direct or indirect support or remuneration for these roles. MC has received travel and accommodation from Abbott, the manufacturer of the MitraClip(TM) transcatheter edge-to-edge repair system, for attending training meetings.

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