Abdelrahman Nagwa, Chowdhury Mohammed Andaleeb, Al Nooryani Arif, Elabbassi Wael
Cardiology Department, Al Qassimi Hospital, Sharjah, UAE.
Cardiovascular Medicine, University of Toledo Medical Center, OH, USA.
Cardiovasc Revasc Med. 2016 Dec;17(8):578-581. doi: 10.1016/j.carrev.2016.07.001. Epub 2016 Jul 20.
Functional mitral regurgitation (FMR) is common in severe heart failure. Medical therapy is the standard of care since the role of surgery is less established. Various trans-catheter percutaneous techniques may avoid the risks of surgery; such as edge-to-edge repair using MitraClip system (Abbott Vascular, Illinois, USA) and CARILLON® Mitral Contour System® (Model XE2; Cardiac Dimensions., Kirkland, WA, USA). We present the case of a 41-year-old man with severe dilated cardiomyopathy, NYHA IIIb, and grade 3 MR. Due to high surgical risk (logistic EuroScore 35.1) he initially underwent single MitraClip insertion with significant echocardiographic and clinical improvement (MR reduced from 3+ to 1+, NYHA classes III to II). Fifteen months later, he developed heart failure symptoms due to recurrence of severe MR and was retreated with percutaneous CARILLON® Mitral Contour System® with resolution of MR and doing well at nine-month follow-up. A combined approach of MitraClip followed by percutaneous mitral annuloplasty demonstrated clinically meaningful reduction of MR and resulted in significant symptomatic improvement for up to 6months. Follow-up for longer period is warranted to ensure sustained favorable outcome.
功能性二尖瓣反流（FMR）在严重心力衰竭中很常见。由于手术的作用尚未明确确立，药物治疗是标准的治疗方法。各种经导管经皮技术可能会避免手术风险；例如使用MitraClip系统（美国伊利诺伊州雅培血管公司）和CARILLON®二尖瓣轮廓系统®（XE2型号；美国华盛顿州柯克兰市心脏尺寸公司）进行缘对缘修复。我们报告一例41岁男性患者，患有严重扩张型心肌病，纽约心脏协会（NYHA）心功能分级为IIIb级，二尖瓣反流为3级。由于手术风险高（逻辑欧洲心脏手术风险评估系统评分为35.1），他最初接受了单次MitraClip植入，超声心动图和临床症状有显著改善（二尖瓣反流从3+降至1+，NYHA心功能分级从III级降至II级）。15个月后，他因严重二尖瓣反流复发出现心力衰竭症状，接受了经皮CARILLON®二尖瓣轮廓系统治疗，二尖瓣反流消失，在9个月的随访中情况良好。先进行MitraClip治疗，然后进行经皮二尖瓣环成形术的联合方法显示二尖瓣反流在临床上有意义地减少，并在长达6个月的时间里使症状有显著改善。需要进行更长时间的随访以确保持续的良好结果。
