transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2021-13-1-40-48transplantologiya-555Research ArticleОБЗОРНЫЕ СТАТЬИ И ЛЕКЦИИREVIEW ARTICLES AND LECTURESХирургическое лечение вторичной митральной регургитации при сердечной недостаточности: современный взглядSurgical treatment of secondary mitral regurgitation in heart failure: a present-day viewhttps://orcid.org/0000-0002-6074-1201АгафоновЕ. Г.AgafonovE. G.

 Евгений Геннадьевич Агафонов, научный сотрудник отделения кардиохирургии, врач сердечно-сосудистый хирург

129110, Москва, ул. Щепкина, д. 61/2

 Evgeniy G. Agafonov, Research Associate at the Department of Cardiac Surgery 

61/2 Shchepkin St., Moscow 129110

https://orcid.org/0000-0002-0316-8410ПоповМ. А.PopovM. A.

 Михаил Александрович Попов, научный сотрудник отделения кардиохирургии, врач сердечно-сосудистый хирург

129110, Москва, ул. Щепкина, д. 61/2

 Mikhail A. Popov, Research Associate at the Department of Cardiac Surgery, Cardiovascular Surgeon 

61/2 Shchepkin St., Moscow 129110

popovcardio88@mail.ruhttps://orcid.org/0000-0001-7087-5441ЗыбинД. И.ZybinD. I.

 Дмитрий Игоревич Зыбин, канд. мед. наук, заведующий отделением кардиохирургии

129110, Москва, ул. Щепкина, д. 61/2

 Dmitriy I. Zybin, Cand. Sci. (Med.), Head of the Department of Cardiac Surgery 

61/2 Shchepkin St., Moscow 129110

https://orcid.org/0000-0003-4204-8865ШумаковД. В.ShumakovD. V.

 Дмитрий Валерьевич Шумаков, чл.-корр. РАН, проф., руководитель отдела хирургии сердца и сосудов

129110, Москва, ул. Щепкина, д. 61/2

 Dmitriy V. Shumakov, Corresponding Member of the Russian Academy of Sciences, Prof., Head of the Department of Surgery of Heart and Vessels 

61/2 Shchepkin St., Moscow 129110

ГБУЗ МО МОНИКИ им. М.Ф. ВладимирскогоРоссияMoscow Regional Research and Clinical Institute n.a. M.F. VladimirskiyRussian Federation2021240320211314048Copyright © Агафонов Е.Г., Попов М.А., Зыбин Д.И., Шумаков Д.В., 20212021Агафонов Е.Г., Попов М.А., Зыбин Д.И., Шумаков Д.В.Agafonov E.G., Popov M.A., Zybin D.I., Shumakov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/555

Актуальность. Вторичная, или функциональная, митральная регургитация является наиболее распространенным осложнением сердечной недостаточности. У 39–74% больных встречается дисфункция одной или нескольких структур митрального клапана, что осложняет течение болезни и существенно ухудшает прогноз у пациентов с дилатацией левого желудочка. Неблагоприятный прогноз у больных при развитии митральной регургитации обусловлен прогрессирующими изменениями, образующими порочный круг: продолжающаяся объемная перегрузка и дилатация левого желудочка вызывают его ремоделирование, приводящее к дальнейшей дилатации кольца митрального клапана. Дисфункции папиллярных мышц приводят к усилению напряжения стенки левого желудочка и усилению митральной регургитации. Клинически этот процесс проявляется прогрессированием застойной сердечной недостаточности и ухудшением прогноза дальнейшего течения, что в последующем может привести к постановке вопроса о включении данной группы пациентов в лист ожидания для трансплантации сердца.Цель. Целью данной статьи является рассмотрение роли хирургического лечения пациентов с сердечной недостаточностью, осложненной митральной регургитацией.Выводы. Основными принципами лечения функциональной митральной регургитации являются обратное ремоделирование левого желудочка и реконструкция или протезирование митрального клапана, которые приводят к улучшению качества жизни, переходу пациентов в меньший функциональный класс, уменьшению частоты госпитализаций, а также к регрессии или замедлению прогрессирования сердечной недостаточности и улучшению выживаемости.

Rationale. Secondary, or functional, mitral regurgitation is the most common complication of heart failure. Dysfunction of one or more mitral valve structures occurs in 39–74% of patients thus complicating the course of the disease and significantly worsening the prognosis in patients with left ventricle dilatation. An unfavorable prognosis in patients with the development of mitral regurgitation is conditioned by the progressive changes that form a vicious circle: the continuing volume overload and dilatation of the left ventricle cause its remodeling, leading to further dilatation of the mitral valve annulus. Dysfunctions of the papillary muscles lead to the increased tension of the left ventricle wall and increased mitral regurgitation. Clinically, this process is manifested by the congestive heart failure progression and worsened prognosis of the further course, which in the future may lead to considering the inclusion of this patient group on the waiting list for heart transplantation.Purpose. The purpose of this article is to review the role of surgical management in patients with heart failure complicated by mitral regurgitation.Conclusions. The main principles of the treatment for functional mitral regurgitation include the reverse left ventricular remodeling and mitral valve repair or replacement surgery which lead to an improved quality of life, the transition of patients to a lower functional class, reduced hospital admission rates, and also to a regression or slower progression of the heart failure and to an improved survival.

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The authors declare that there are no conflicts of interest present.