Smolka Grzegorz, Pysz Piotr, Jasinski Marek, Gocoł Radosław, Domaradzki Wojciech, Hudziak Damian, Deja Marek, Ochała Andrzej, Gasior Zbigniew
3rd Division of Cardiology, Medical University of Silesia, Ul.Ziolowa 45/47, 40-635 Katowice, Poland.
J Invasive Cardiol. 2013 Oct;25(10):497-501.
Paravalvular leak (PVL) may complicate cardiac valve replacement surgery. Radical treatment is required if a PVL produces heart failure (HF) symptoms or severe hemolysis. Even though transcatheter PVL closure (TPVLC) has become a valid alternative to reoperation, a number of anatomical conditions may prove technically challenging for transvascular access. We intended to verify the utility of transapical access in such settings.
We report a prospective series of 7 patients with mitral PVLs who underwent transapical TPVLC. The Heart Team made the choice of treatment and Amplatzer Vascular Plug III devices were used off-label as occluders.
Transapical TPVLC enabled excellent sealing of mitral PVL in 6 cases. This resulted in HF symptom reduction and decreased NT-proBNP plasma concentration. No procedure-related complications occurred.
Transapical access seems to be an efficient and safe alternative for transvascular approach for mitral TPVLC, but further technical development is still needed.
瓣周漏（PVL）可能使心脏瓣膜置换手术变得复杂。如果PVL产生心力衰竭（HF）症状或严重溶血，则需要进行根治性治疗。尽管经导管PVL封堵术（TPVLC）已成为再次手术的有效替代方法，但许多解剖条件可能对经血管通路构成技术挑战。我们旨在验证经心尖通路在此类情况下的实用性。
我们报告了一组前瞻性的7例二尖瓣PVL患者，他们接受了经心尖TPVLC。心脏团队做出治疗选择，并将Amplatzer血管封堵器III型装置作为封堵器超说明书使用。
经心尖TPVLC在6例患者中实现了二尖瓣PVL的良好封堵。这导致HF症状减轻和血浆NT-proBNP浓度降低。未发生与手术相关的并发症。
经心尖通路似乎是二尖瓣TPVLC经血管途径的一种有效且安全的替代方法，但仍需要进一步的技术发展。
