Núñez-Gil Iván J, Gonçalves Alexandra, Rodríguez Enrique, Cobiella Javier, Marcos-Alberca Pedro, Maroto Luis, Fernandez-Golfin Covadonga, Carnero Manuel, Macaya Carlos, Zamorano José L
Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
Eur J Echocardiogr. 2011 Apr;12(4):335-7. doi: 10.1093/ejechocard/jer011. Epub 2011 Mar 3.
Prosthesis deterioration rate, years after a previous surgical valve replacement, is rising. Usually, the standard management is reoperation, but for very high risk patients an alternative has arisen: the valve-in-valve approach. We present an 84-year-old Caucasian woman with a mitral bioprosthesis (Mosaic II, number 29) since 1994. Over the last few months the patient displayed worsening heart failure symptoms, until her current admission in NYHA III-IV functional class, because of a severely degenerated mitral prosthesis (severe regurgitation, severe pulmonary hypertension). The transapical access, conventionally used for transcatheter aortic valve implantation (Edwards SAPIEN THV 23) was chosen, guided by transoesophageal echocardiography (TOE) with a new three-dimensional (3D) probe. After the procedure, the mitral regurgitation completely disappeared, an appropriate valve opening was achieved (valve area >2 cm(2)) and the patient was discharged 6 days later, remaining well in the outpatient follow-up. Only a restricted number of patients have been submitted to mitral transcatheter valve-in-valve implantation and to the best of our knowledge this is the first accurate description of the 3D TOE part, focusing on the surgeon requirements.
在先前进行人工瓣膜置换术后数年，人工瓣膜的退化率正在上升。通常，标准的治疗方法是再次手术，但对于极高风险的患者，一种替代方法应运而生：瓣中瓣技术。我们介绍一位自1994年起就植入二尖瓣生物瓣（Mosaic II，型号29）的84岁白种女性。在过去几个月里，该患者心力衰竭症状不断恶化，直至因二尖瓣人工瓣膜严重退化（严重反流、严重肺动脉高压）而以纽约心脏协会（NYHA）心功能III - IV级入院。在经食管超声心动图（TOE）的新型三维（3D）探头引导下，选择了常用于经导管主动脉瓣植入术（Edwards SAPIEN THV 23）的经心尖入路。术后，二尖瓣反流完全消失，实现了合适的瓣膜开放（瓣膜面积>2平方厘米），患者于6天后出院，在门诊随访中情况良好。仅有少数患者接受了二尖瓣经导管瓣中瓣植入术，据我们所知，这是对3D TOE部分的首次精确描述，重点关注外科医生的需求。
