Department of Cardiac Surgery, Academic Hospital, Maastricht, The Netherlands.
J Interv Cardiol. 2011 Oct;24(5):474-6. doi: 10.1111/j.1540-8183.2011.00637.x. Epub 2011 Mar 17.
The valve-in-valve (VIV) technique is an emerging therapeutic option for patients with failure of previously implanted xenografts. We describe a balloon-expandable transthoracic transapical mitral VIV implantation in an emergency setting in a 69-year-old woman with dysfunction of the mitral bioprosthesis.
Left ventricular apical access was applied. After balloon valvuloplasty, a 26-mm Edwards-Sapien transcatheter valve (Edwards Lifesciences LLC, Irvine, CA, USA) was deployed within the mitral xenograft, using rapid ventricular pacing.
The transcatheter valve functioned properly postoperatively and three-dimensional echocardiography carried out 1 month later showed a well-functioning VIV prosthesis and no mitral stenosis (mitral valve area 3 cm(2) , mean gradient 3 mmHg).
In this patient, VIV implantation was found to be a safe alternative to an emergent valve replacement. It might represent a suitable option to conventional procedures even among lower risk patients.
对于先前植入的异种移植物失败的患者，瓣膜内植入（VIV）技术是一种新兴的治疗选择。我们描述了一种在紧急情况下应用于 69 岁女性的经皮球囊扩张经胸经心尖二尖瓣 VIV 植入术，该患者的二尖瓣生物瓣功能障碍。
采用左心室心尖部入路。球囊瓣膜成形术后，在二尖瓣异种移植物内使用快速心室起搏，植入 26 毫米 Edwards-Sapien 经导管瓣膜（Edwards Lifesciences LLC，加利福尼亚州欧文市，美国）。
术后经导管瓣膜功能正常，术后 1 个月行三维超声心动图检查显示 VIV 假体功能良好，无二尖瓣狭窄（二尖瓣瓣口面积 3cm²，平均跨瓣压差 3mmHg）。
在该患者中，VIV 植入术被发现是一种安全的紧急瓣膜置换替代方法。即使在低危患者中，它也可能成为传统手术的一种合适选择。
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