Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
JACC Cardiovasc Interv. 2016 Jun 27;9(12):1280-1288. doi: 10.1016/j.jcin.2016.03.011. Epub 2016 Jun 20.
This study reports a novel transcatheter procedure for residual mitral regurgitation (MR) after MitraClip implantation using the Amplatzer Duct Occluder II (ADO II).
Although the MitraClip procedure is a transcatheter treatment option for patients at high surgical risk with severe MR, management of significant residual MR after MitraClip implantation is still challenging.
We describe a case series of 9 consecutive patients who underwent transcatheter deployment of the ADO II plug for significant residual MR after MitraClip implantation from April to October 2015.
The mean age was 79.3 ± 11.4 years. The deployment of the ADO II plug was performed at the initial MitraClip procedure in 7 patients and at the second procedure for recurrent symptoms in 2 patients. There were 2 types of residual MR seen after MitraClip implantation: residual commissural MR (n = 3) and residual intraclip MR (n = 6). The ADO II was successfully deployed with significant reduction of MR flow and left atrial pressure in all patients. The ADO II plug was retrieved in 1 patient because of device embolization to the ostial right coronary artery. However, all patients were discharged 1.8 ± 1.2 days after the procedure, with no significant MR on pre-discharge transthoracic echocardiography. In 8 patients who underwent 1-month symptomatic assessment, clinical symptoms were diminished to New York Heart Association functional class I or II.
Transcatheter deployment of the ADO II plug was effective for the reduction of residual commissural MR and intraclip MR after MitraClip implantation. The potential role of this technique should be established for challenging cases.
本研究报告了一种使用 Amplatzer 导管封堵器 II（ADO II）治疗二尖瓣夹合术后残余二尖瓣反流（MR）的新型经导管治疗方法。
虽然二尖瓣夹合术是一种经导管治疗选择，适用于高手术风险且有严重 MR 的患者，但二尖瓣夹合术后残余严重 MR 的管理仍然具有挑战性。
我们描述了 9 例连续患者的病例系列，这些患者在 2015 年 4 月至 10 月期间因二尖瓣夹合术后残余严重 MR 而接受了 ADO II 塞的经导管植入。
平均年龄为 79.3 ± 11.4 岁。7 例患者在初始二尖瓣夹合术时植入 ADO II 塞，2 例患者因症状复发而行第二次手术。二尖瓣夹合术后可见两种类型的残余 MR：残余交界性 MR（n = 3）和残余夹合内 MR（n = 6）。所有患者的 ADO II 均成功植入，MR 流量和左心房压力均显著降低。1 例患者因器械栓塞到右冠状动脉口而将 ADO II 塞取出。然而，所有患者在术后 1.8 ± 1.2 天出院，出院前经胸超声心动图未见明显 MR。在 8 例接受 1 个月症状评估的患者中，临床症状减轻至纽约心脏协会功能 I 或 II 级。
经导管植入 ADO II 塞可有效减少二尖瓣夹合术后残余交界性 MR 和夹合内 MR。对于有挑战性的病例，应确定这种技术的潜在作用。
