Degen Hubertus, Lickfeld Thomas, Stoepel Carsten, Haude Michael
Medizinische Klinik I, Städtische Kliniken, Neuss - Lukaskrankenhaus - GmbH, Neuss, Germany.
Herz. 2009 Sep;34(6):451-7. doi: 10.1007/s00059-009-3286-6.
Morbidity in patients with systolic heart failure is significantly increased by functional mitral valve regurgitation. In addition to pharmaceutical treatment or surgical reconstruction of the impaired valve, minimally invasive procedures have continuously advanced into the focus of interest. The Carillon Mitral Contour System (Cardiac Dimensions) is a new catheter-based method to converge dehiscent mitral valve leaflets with implantation of a nitinol clip into the coronary sinus, leading to a closer approach of the valve leaflets with subsequent decrease in mitral regurgitation. The device is implanted via a central venous catheter, using a special delivery system under fluoroscopy. The immediate success of minimizing mitral valve regurgitation is verified by online transesophageal echocardiography (TEE), device-related impairment of perfusion of contiguous coronary vessels is ruled out by coronary angiography performed simultaneously during deployment of the device. As soon as reduction of the mitral valve regurgitation is demonstrated in TEE, the Carillon System is disconnected from the delivery system, before, however, the Carillon device can be withdrawn into the delivery system as necessary. Following the successful implantation of the Carillon Mitral Contour System, a left ventricular lead for cardiac resynchronization therapy can still be successfully placed alongside through the coronary sinus.
功能性二尖瓣反流会显著增加收缩性心力衰竭患者的发病率。除了药物治疗或对受损瓣膜进行手术重建外,微创手术也不断成为关注焦点。卡里隆二尖瓣轮廓系统(心脏维度公司)是一种基于导管的新方法,通过将镍钛合金夹子植入冠状窦来使二尖瓣叶会合,从而使瓣膜叶更靠近,进而减少二尖瓣反流。该装置通过中心静脉导管,在荧光透视下使用特殊输送系统植入。通过在线经食管超声心动图(TEE)验证二尖瓣反流最小化的即刻成功,在装置部署期间同时进行冠状动脉造影以排除与装置相关的相邻冠状动脉灌注受损。一旦TEE显示二尖瓣反流减少,卡里隆系统就与输送系统分离,不过在此之前,卡里隆装置可根据需要撤回输送系统。成功植入卡里隆二尖瓣轮廓系统后,仍可通过冠状窦成功地在旁边放置用于心脏再同步治疗的左心室导线。