Mitral Regurgitation in Patients Undergoing Noncardiac Surgery
Mitral Regurgitation in Patients Undergoing Noncardiac Surgery
复制标题
接受非心脏手术的患者的二尖瓣反流
DOI：
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发表时间：
2021
影响因子：
1.4
通讯作者：
S. Bhandary
中科院分区：
文献类型：
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作者：
Ellen W. Richter;I. Shehata;Hamdy M. Elsayed;Matthew A. Klopman;S. Bhandary
二尖瓣返流（MR）是美国最常见的心脏瓣膜病类型之一。接受非心脏手术的严重二尖瓣返流（中度至重度或重度）患者围手术期心血管并发症的风险增加。二尖瓣返流可由多种原因引起，分为两大类：原发性（瓣膜固有疾病）和继发性（通过影响左心室或二尖瓣环破坏正常瓣膜功能的疾病）。本文重点介绍了美国心脏病学家学会（ACC）和美国心脏协会（AHA）的关键指南更新，这些指南为麻醉师护理接受非心脏手术的MR患者提供了决策信息。急性和慢性二尖瓣返流的病理生理学和自然史，慢性原发性和继发性二尖瓣返流的分期，以及瓣膜矫正手术时机的考虑进行了综述。这些主题，然后应用于麻醉管理的讨论，包括术前风险评估，麻醉剂的选择，血流动力学目标，术中监测的非心脏手术患者的MR。
Mitral regurgitation (MR) is one of the most frequently encountered types of valvular heart disease in the United States. Patients with significant MR (moderate-to-severe or severe) undergoing noncardiac surgery have an increased risk of perioperative cardiovascular complications. MR can arise from a diverse array of causes that fall into 2 broad categories: primary (diseases intrinsic to the valvular apparatus) and secondary (diseases that disrupt normal valve function via effects on the left ventricle or mitral annulus). This article highlights key guideline updates from the American College of Cardiologists (ACC) and the American Heart Association (AHA) that inform decision-making for the anesthesiologist caring for a patient with MR undergoing noncardiac surgery. The pathophysiology and natural history of acute and chronic MR, staging of chronic primary and secondary MR, and considerations for timing of valvular corrective surgery are reviewed. These topics are then applied to a discussion of anesthetic management, including preoperative risk evaluation, anesthetic selection, hemodynamic goals, and intraoperative monitoring of the noncardiac surgical patient with MR.
影响因子：
2.8
作者：
Singh, JP;Evans, JC;Benjamin, EJ
通讯作者：
Benjamin, EJ