Hansen James W, Gadey Gautam, Piemonte Thomas C
Lahey Hospital and Medical Center, Burlington, MA, United States.
Lahey Hospital and Medical Center, Burlington, MA, United States.
Cardiovasc Revasc Med. 2018 Jan-Feb;19(1 Pt B):126-132. doi: 10.1016/j.carrev.2017.07.014. Epub 2017 Jul 24.
Prosthetic valve paravalvular leak (PVL) is a known and relatively common complication of surgical valve replacement, which may lead to significant morbidity. Patients with significant mitral valve replacement (MVR) PVL typically present with symptoms of heart failure and elevated filling pressures or with hemolytic anemia. Percutaneous closure of these leaks has become the preferred therapy. Percutaneous closure of MVR PVL can be technically challenging, given the anatomy of the approach (trans-septal, trans-apical), the level of associated comorbidities and the geographic location of the paravalvular defect. Steerable catheters offer a unique ability to position themselves coaxial to the PVL. The Dexterity catheter (Spirus Medical LLC, Bridgewater, MA, USA) is a semi-rigid steerable catheter used in our lab with the ability to articulate at two separate points on the distal tip and flex greater than 360 degrees. We present cases of surgical valves that developed PVL which underwent successful repair with a Dexterity catheter.
人工瓣膜瓣周漏（PVL）是外科瓣膜置换术一种已知且相对常见的并发症，可能导致严重的发病情况。二尖瓣置换术（MVR）出现严重PVL的患者通常表现为心力衰竭症状、充盈压升高或溶血性贫血。经皮封堵这些漏口已成为首选治疗方法。鉴于入路解剖结构（经房间隔、经心尖）、相关合并症的程度以及瓣周缺损的位置，经皮封堵MVR的PVL在技术上可能具有挑战性。可操纵导管具有独特的能力，能够使其自身与PVL同轴定位。灵巧导管（美国马萨诸塞州布里奇沃特市Spirus Medical LLC公司）是我们实验室使用的一种半刚性可操纵导管，能够在远端尖端的两个不同点进行关节运动，并且弯曲角度大于360度。我们展示了一些出现PVL的外科瓣膜通过灵巧导管成功修复的病例。
