Hernández-Enríquez Marco, Freixa Xavier, Sanchis Laura, Regueiro Ander, Burgos Felip, Navarro Ricard, Masotti Mónica, Sitges Marta, Sabaté Manel
Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain. Electronic correspondence:
J Heart Valve Dis. 2018 Jan;27(1):114-116.
A patient with ischemic myocardiopathy who had undergone resynchronization therapy was admitted to the authors' institution with progressive dyspnea. Echocardiography demonstrated a left ventricular ejection fraction (LVEF) of 25%, with a massive mitral regurgitation (MR) secondary to anterior leaflet prolapse and posterior leaflet restriction. Despite intensive medical treatment, the patient developed cardiogenic shock and required mechanical ventilation, inotropic support and intra-aortic balloon pumping. The patient was rejected for surgery due to the high operative risk, but subsequently underwent a successful percutaneous repair with two MitraClip® devices. Immediately after the intervention there was a progressive improvement that allowed the patient to be discharged, such that the clinical outcome was favorable at the six-month follow up (NYHA class II/IV). This case report describes the benefits of minimally invasive therapy in selected patients who are at very high surgical risk and who, despite being in a critical condition and with low LVEF, experience an outstanding clinical improvement following the resolution of a massive MR.
一名接受过心脏再同步治疗的缺血性心肌病患者因进行性呼吸困难入住作者所在机构。超声心动图显示左心室射血分数（LVEF）为25%，继发于前叶脱垂和后叶受限的大量二尖瓣反流（MR）。尽管进行了强化药物治疗，患者仍发生心源性休克，需要机械通气、正性肌力支持和主动脉内球囊泵血。由于手术风险高，患者被拒绝手术，但随后使用两个MitraClip®装置成功进行了经皮修复。干预后立即出现逐步改善，患者得以出院，在六个月随访时临床结果良好（纽约心脏协会II/IV级）。本病例报告描述了微创治疗对手术风险极高的特定患者的益处，这些患者尽管病情危急且LVEF较低，但在大量MR得到解决后临床有显著改善。
