Bouma Wobbe, Brügemann Johan, Hamer Inez J Wijdh-den, Klinkenberg Theo J, Koene Bart M, Kuijpers Michiel, Erasmus Michiel E, van der Horst Iwan Cc, Mariani Massimo A
Department of Cardiothoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands.
J Cardiothorac Surg. 2012 Sep 29;7:100. doi: 10.1186/1749-8090-7-100.
A 37-year-old man with end-stage idiopathic dilated cardiomyopathy underwent an orthotopic heart transplant followed by a reoperation with mitral annuloplasty for severe mitral regurgitation. Shortly thereafter, he developed severe tricuspid regurgitation and severe recurrent mitral regurgitation due to annuloplasty ring dehiscence. The dehisced annuloplasty ring was refixated, followed by tricuspid annuloplasty through a right anterolateral thoracotomy. After four years of follow-up, there are no signs of recurrent mitral or tricupid regurgitation and the patient remains in NYHA class II. Pushing the envelope on conventional surgical procedures in marginal donor hearts (both before and after transplantation) may not only improve the patient's functional status and reduce the need for retransplantation, but it may ultimately alleviate the chronic shortage of donor hearts.
一名37岁终末期特发性扩张型心肌病男性患者接受了原位心脏移植，随后因严重二尖瓣反流接受二尖瓣环成形术再次手术。此后不久，由于瓣环成形环裂开，他出现了严重三尖瓣反流和严重复发性二尖瓣反流。对裂开的瓣环成形环进行重新固定，随后通过右前外侧开胸进行三尖瓣环成形术。经过四年随访，无二尖瓣或三尖瓣反流复发迹象，患者仍处于纽约心脏协会（NYHA）心功能II级。在边缘供心（移植前后）中突破传统手术程序的极限，不仅可以改善患者的功能状态并减少再次移植的需求，而且最终可能缓解供心长期短缺的问题。
