St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Interv. 2010 Jul;3(7):759-65. doi: 10.1016/j.jcin.2010.04.013.
This study sought to describe a method of paravalvular leak closure using a purpose-specific occlusion device.
Transcatheter closure of paravalvular leaks has been hampered by technical challenges, the limitations of available imaging modalities, and the lack of closure devices specifically designed for this purpose.
Patients with severe symptomatic paravalvular regurgitation at high risk for repeat surgery underwent transcatheter leak closure. Both left ventricular puncture and retrograde transfemoral approaches were used with fluoroscopic and 3-dimensional transesophageal guidance. A purpose-specific occluder (Vascular Plug III, AGA Medical Corp., Plymouth, Minnesota) was used.
Five patients with severe prosthetic mitral and aortic paravalvular leaks underwent attempted closure. Implantation of the device was successfully accomplished in all. In 1 patient, the plug interfered with closure of a mechanical valve leaflet and was removed and replaced with an alternate device. Complications included pericardial bleeding in 2 patients with a transapical approach. There was no procedural mortality. At a median follow-up of 191 days (interquartile range [IQR] 169 to 203 days) all patients were alive. New York Heart Association functional class fell from 4 (IQR 3 to 4) to 2 (IQR 2 to 3), hemoglobin rose from 89 g/l (IQR 87 to 108 g/l) to 115 g/l (IQR 104 to 118 g/l), creatinine fell from 109 micromol/l (IQR 106 to 132 micromol/l) to 89 micromol/l (IQR 89 to 126 micromol/l). Median echocardiographic follow-up at 58 days (IQR 56 to 70 days) reported residual regurgitation to be reduced from grade 4 to grade 2 (IQR 1.5 to 2.25).
Closure of mitral and aortic prosthetic paravalvular leaks with the Vascular Plug III using either a transapical (mitral) or a retrograde (aortic) approach appears promising.
本研究旨在描述一种使用特定用途封堵器来闭合瓣周漏的方法。
经导管闭合瓣周漏一直受到技术挑战、现有成像方式的局限性以及缺乏专门为此设计的封堵器的限制。
对高危再次手术的严重症状性瓣周反流患者进行经导管漏口闭合。使用透视和 3 维经食管引导，经心尖和逆行股动脉入路。使用特定用途的封堵器（AGA Medical Corp.，明尼苏达州普利茅斯的血管塞 III）。
5 例严重的人工二尖瓣和主动脉瓣周漏患者尝试进行了封堵。所有患者均成功植入封堵器。在 1 例患者中，封堵器干扰了机械瓣叶的闭合，被取出并用另一个封堵器替换。并发症包括经心尖入路的 2 例患者的心包积血。无手术死亡。中位随访 191 天（四分位距[IQR]169-203 天），所有患者均存活。纽约心脏协会功能分级从 4 级（IQR3-4）降至 2 级（IQR2-3），血红蛋白从 89g/L（IQR87-108g/L）升至 115g/L（IQR104-118g/L），肌酐从 109μmol/L（IQR106-132μmol/L）降至 89μmol/L（IQR89-126μmol/L）。58 天（IQR56-70 天）中位超声心动图随访报告残余反流从 4 级减少到 2 级（IQR1.5-2.25）。
使用血管塞 III 经心尖（二尖瓣）或逆行（主动脉）入路闭合二尖瓣和主动脉人工瓣周漏似乎很有前景。
