Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Catheter Cardiovasc Interv. 2018 Sep 1;92(3):607-610. doi: 10.1002/ccd.27438. Epub 2017 Dec 8.
The MitraClip (Abbott Vascular, Santa Clara, CA) procedure has emerged as a safe and effective treatment option for treatment of selected patients with severe mitral regurgitation (MR) who are at high risk for surgery. Effective reduction of MR is important to ensure an optimal clinical outcome. We present here the first case report of a significant commissural leak after a MitraClip procedure treated with a GORE CARDIOFORM Septal Occluder device (WL Gore & Associates, Flagstaff, AZ).
An 81-year-old male presented with symptomatic recurrent MR following a MitraClip procedure using two clips. After adding another clip, there was still a residual jet medially. We plugged the gap using 12-mm AMPLATZER Muscular VSD Occluder device (St. Jude Medical, Minneapolis, MN). MR was reduced but hemolysis occurred. We retrieved the VSD Occluder device to improve hemolysis, but the MR jet worsened to severe, so we placed a 30-mm GORE CARDIOFORM Septal Occluder device. The device was stable, the MR jet was reduced dramatically, and hemolysis was not observed. Materials of these devices are mesh fabric made from nitinol and polyester in a VSD Occluder device and expanded polytetrafluoroethylene in GORE CARDIOFORM Septal Occluder device. The difference between device materials affects flow pattern of residual jet and hemolysis. In conclusion, the patient's risk for hemolysis is potentially affected by the occluder or plug material. GORE CARDIOFORM is a feasible choice to reduce the risk of hemolysis in a selected patient.
MitraClip（雅培血管，圣克拉拉，加利福尼亚）程序已成为一种安全有效的治疗选择，用于治疗因手术风险高而选择的患有严重二尖瓣反流（MR）的选定患者。有效降低 MR 对于确保最佳临床结果很重要。我们在此报告首例使用戈尔 CARDIOFORM 隔瓣塞装置（WL 戈尔公司，弗拉格斯塔夫，亚利桑那州）治疗 MitraClip 手术后出现明显交界性渗漏的病例报告。
一名 81 岁男性因二尖瓣夹合术（使用两个夹子）后出现症状性复发性 MR 而就诊。在添加另一个夹子后，仍然存在内侧残余射流。我们使用 12 毫米 AMPLATZER 肌肉 VSD 封堵器（圣犹达医疗公司，明尼苏达州明尼阿波利斯）封堵缺口。MR 减少，但发生溶血。我们取出 VSD 封堵器以改善溶血，但 MR 射流恶化至重度，因此我们放置了 30 毫米戈尔 CARDIOFORM 隔瓣塞装置。该装置稳定，MR 射流明显减少，且未观察到溶血。这些装置的材料是 VSD 封堵器中的由镍钛合金和聚酯制成的网织物和戈尔 CARDIOFORM 隔瓣塞装置中的膨体聚四氟乙烯。装置材料的差异会影响残余射流和溶血的流动模式。总之，患者发生溶血的风险可能受到封堵器或塞子材料的影响。戈尔 CARDIOFORM 是降低选定患者发生溶血风险的可行选择。
