Pate Gordon E, Al Zubaidi Abdul, Chandavimol Mann, Thompson Christopher R, Munt Bradley I, Webb John G
Division of Cardiology, St. Paul's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.
Catheter Cardiovasc Interv. 2006 Oct;68(4):528-33. doi: 10.1002/ccd.20795.
Paravalvular leaks (PVLs) are a well-recognized complication of prosthetic valve replacement. Most are asymptomatic and benign, but some may cause symptoms due to a large regurgitant volume or hemolysis. Medical therapy is palliative, while reoperation carries significant morbidity and mortality. Percutaneous transcatheter closure techniques, now routinely applied in the management of pathological cardiac and vascular communications, may be adaptable to PVL closure, potentially offer symptomatic relief.
We reviewed our experience with attempted percutaneous closure of PVLs, using data from medical and procedural records.
Between 2001 and 2004, 14 procedures were performed in 10 patients, all under general anesthesia, with transesophageal and radiographic guidance. Mitral (9) and aortic (1) valve replacements were involved, both mechanical and bioprosthetic. A variety of devices were used, including atrial septal occluders, patent ductus arteriosus occluders, and coils (all of label use). Six had a single procedure, which was technically successful in four: in two, the PVL could not be crossed. Four underwent a second procedure, which was technically successful in three; in one the previously deployed device was dislodged necessitating urgent, but ultimately uneventful, surgical removal and leak repair. One patient had transient severe hemolysis, which resolved after 1 week. At 1-year follow-up (9/10 pts) three had died, five had sustained symptomatic improvement while 1 patient with a residual leak still required regular blood transfusions.
Percutaneous closure of PVLs is time-consuming but feasible in selected patients, with a reasonable degree of technical and clinical success. A second procedure may be necessary and a variety of complications can occur.
瓣周漏（PVL）是人工瓣膜置换术后一种公认的并发症。多数患者无症状且病情良性，但部分患者可能因反流量大或溶血而出现症状。药物治疗只能缓解症状，再次手术则有较高的发病率和死亡率。经皮导管封堵技术目前常用于治疗病理性心脏和血管分流，可能适用于瓣周漏封堵，有望缓解症状。
我们回顾了尝试经皮封堵瓣周漏的经验，数据来自医疗和手术记录。
2001年至2004年间，对10例患者进行了14次手术，均在全身麻醉下，经食管和影像学引导。涉及二尖瓣（9例）和主动脉瓣（1例）置换，包括机械瓣膜和生物瓣膜。使用了多种装置，包括房间隔封堵器、动脉导管未闭封堵器和弹簧圈（均按标签说明使用）。6例患者接受了单次手术，其中4例技术成功：2例未能穿过瓣周漏。4例患者接受了第二次手术，其中3例技术成功；1例患者先前植入的装置移位，需紧急手术取出并修复漏口，最终手术顺利。1例患者出现短暂的严重溶血，1周后缓解。1年随访时（10例患者中的9例），3例死亡，5例症状持续改善，1例仍有残余漏口的患者仍需定期输血。
经皮封堵瓣周漏耗时较长，但在部分患者中可行，技术和临床成功率合理。可能需要进行第二次手术，且会出现多种并发症。
