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紧急经心尖二尖瓣瓣中瓣植入术治疗生物瓣膜功能障碍：在一名重症患者功能失调的二尖瓣生物瓣膜中经心尖植入爱德华 Sapien-XT 瓣膜

Emergency transapical mitral valve-in-valve implantation for bioprosthesis failure: transapical implantation of an Edwards Sapien-XT in a dysfunctional mitral bioprosthesis in a critical patient.

作者信息

Zanobini Marco, Manganiello Sabrina, Bonalumi Giorgia, Biondi Raoul, Russo Marco, Mapelli Massimo, Alamanni Francesco, Saccocci Matteo

机构信息

Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138, Milano, Italy.

Department of CardioVascular Surgery, Heart Center - University Hospital of Zurich, Zurich, Switzerland.

出版信息

J Cardiothorac Surg. 2017 Dec 13;12(1):114. doi: 10.1186/s13019-017-0680-7.

DOI:10.1186/s13019-017-0680-7
PMID:29237501
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5729393/
Abstract

BACKGROUND

Valve-in-Valve (VIV) Transcatheter Aortic Valve Replacement (TAVR) is now the treatment of choice in high-surgical-risk patients with failing aortic bioprosthesis. Although less performed, VIV-Transcatheter Mitral Valve Replacement (TMVR) is a valid treatment option for selected high-risk patients with degenerated mitral bioprostheses. Several cases of elective ViV- TAVR and -TMVR have been reported but only few were performed in critical hemodynamic conditions.

CASE PRESENTATION

We report the case of a patient underwent balloon-expandable transapical mitral valve-in-valve implantation in an emergency setting due to a severe stenosis of a bioprosthesis in mitral position. The procedure was successfully performed, with no residual mitral regurgitation or paravalvular leaks, and uneventful.

CONCLUSION

Transcatheter transapical mitral valve-in-valve implantation could represent a feasible and effective strategy even in critical setting.

摘要

背景

瓣中瓣经导管主动脉瓣置换术（VIV-TAVR）目前是主动脉生物瓣功能衰竭的高手术风险患者的首选治疗方法。虽然瓣中瓣经导管二尖瓣置换术（VIV-TMVR）开展较少，但对于选定的二尖瓣生物瓣退化的高风险患者而言，它是一种有效的治疗选择。已有多例择期VIV-TAVR和VIV-TMVR的病例报告，但只有少数是在严重血流动力学情况下进行的。

病例报告

我们报告了一例患者，因其二尖瓣位生物瓣严重狭窄，在紧急情况下接受了球囊扩张经心尖二尖瓣瓣中瓣植入术。手术成功完成，无残余二尖瓣反流或瓣周漏，且过程顺利。

结论

即使在危急情况下，经导管经心尖二尖瓣瓣中瓣植入术也可能是一种可行且有效的策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/801ba8cbf901/13019_2017_680_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/16f205560895/13019_2017_680_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/796935583942/13019_2017_680_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/b3e5baa3ab8a/13019_2017_680_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/801ba8cbf901/13019_2017_680_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/16f205560895/13019_2017_680_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/796935583942/13019_2017_680_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/b3e5baa3ab8a/13019_2017_680_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a7c/5729393/801ba8cbf901/13019_2017_680_Fig4_HTML.jpg

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本文引用的文献

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Catheter Cardiovasc Interv. 2018 Sep 1;92(3):592-596. doi: 10.1002/ccd.26990. Epub 2017 Mar 15.
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Transcatheter Mitral Valve-in-Valve Therapy.经导管二尖瓣瓣中瓣治疗
Interv Cardiol Clin. 2016 Jan;5(1):117-123. doi: 10.1016/j.iccl.2015.08.011. Epub 2015 Oct 17.
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Emergency transthoracic transapical mitral valve-in-valve implantation.
经胸经心尖二尖瓣瓣中瓣植入术治疗二尖瓣反流。
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