Kilic Teoman, Coskun Senol, Karauzum Kurtulus, Yavuz Sadan, Sahin Tayfun
Department of Cardiology, Invasive Cardiology Research and Application Unit, Kocaeli University Medical Faculty, Kocaeli, Turkey. Electronic correspondence:
Department of Cardiology, Bursa State Hospital, Bursa, Turkey.
J Heart Valve Dis. 2017 Jan;26(1):54-62.
Various approaches such as antegrade trans-septal, retrograde transfemoral and transapical techniques have been used to close mitral paravalvular leak (PVL) in patients with an aortic prosthesis. During the implementation of these techniques, an arteriovenous guidewire loop is often created for device delivery. However, passing through a mechanical aortic valve may cause hemodynamic compromise and prolong the procedure. To date, no studies have evaluated antegrade mitral PVL closure without the use of an arteriovenous wire loop in patients with a mechanical aortic prosthesis. Herein is described a different mitral PVL closure technique by means of a trans-septal approach without construction of an arteriovenous guidewire loop in this type of patient.
Four patients (two males, two females; mean age 57 ± 10 years; range: 46-67 years) with severe mitral PVL and a mechanical aortic prosthesis were referred for percutaneous closure of a mitral PVL. All patients underwent antegrade trans-septal mitral PVL closure without the creation of an arteriovenous wire loop. Data prospectively collected included assessments from preoperative and postoperative two- and three-dimensional transesophageal echocardiography (TEE).
Preoperative TEE demonstrated severe mitral PVL in all four patients. All patients experienced a substantial reduction in symptoms associated with the marked reduction in PVL following repair. There were no procedural complications. The median procedural time was 113 min (range: 50-145 min) and median fluoroscopy time was 23 min (range: 17-25 min).
An alternative, safe, effective and efficient mitral PVL closure approach in patients with a mechanical aortic prosthesis has been devised. This technique can prevent aortic valve dysfunction, reduce costs, and also decrease complication rates.
多种方法，如顺行经房间隔、逆行经股动脉和经心尖技术，已被用于关闭主动脉瓣置换术后患者的二尖瓣瓣周漏（PVL）。在实施这些技术过程中，常为输送装置建立动静脉导丝环。然而，穿过机械主动脉瓣可能会导致血流动力学受损并延长手术时间。迄今为止，尚无研究评估在机械主动脉瓣置换术后患者中不使用动静脉导丝环进行顺行二尖瓣PVL关闭的情况。本文描述了一种不同的二尖瓣PVL关闭技术，即通过经房间隔途径，在此类患者中不构建动静脉导丝环。
4例（2例男性，2例女性；平均年龄57±10岁；范围：46 - 67岁）患有严重二尖瓣PVL且植入机械主动脉瓣的患者被转诊接受经皮二尖瓣PVL关闭术。所有患者均接受了顺行经房间隔二尖瓣PVL关闭术，未建立动静脉导丝环。前瞻性收集的数据包括术前及术后二维和三维经食管超声心动图（TEE）评估。
术前TEE显示所有4例患者均有严重二尖瓣PVL。所有患者术后与PVL明显减少相关的症状均大幅减轻。无手术并发症。手术中位时间为113分钟（范围：50 - 145分钟），透视中位时间为23分钟（范围：17 - 25分钟）。
已设计出一种适用于机械主动脉瓣置换术后患者的安全、有效且高效的二尖瓣PVL关闭替代方法。该技术可预防主动脉瓣功能障碍，降低成本，并减少并发症发生率。
