Yap Jonathan, Chen Sarah, Smith Thomas W R, Rogers Jason H, Singh Gagan D
Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California, USA.
Department of Cardiology, National Heart Centre Singapore, Singapore.
Catheter Cardiovasc Interv. 2020 Sep 1;96(3):699-705. doi: 10.1002/ccd.28902. Epub 2020 Apr 7.
The MitraClip procedure is carried out almost exclusively via the transfemoral approach. However, in some patients transfemoral delivery of MitraClip is not technically feasible (e.g., occluded inferior vena cava or tortuous/obstructive iliofemoral venous anatomy). The technical considerations and challenges of the MitraClip procedure are amplified when an alternate route is considered. We describe a successful case of MitraClip performed via the right internal jugular (IJ) approach in a patient with a flail A3 scallop and previous mitral valve repair. We reviewed prior cases in the literature and discuss step-by-step the pertinent clinical and technical considerations for performing this procedure via the transjugular route. In summary, the right IJ access site provides a reasonable alternative to perform the MitraClip procedure in cases where femoral access is contraindicated or prohibitive. A thorough understanding of the technical considerations is crucial in improving procedural success rates.
MitraClip手术几乎完全通过经股动脉途径进行。然而，在一些患者中，经股动脉植入MitraClip在技术上不可行（例如，下腔静脉闭塞或髂股静脉解剖结构迂曲/阻塞）。当考虑采用替代途径时，MitraClip手术的技术考量和挑战会放大。我们描述了一例通过右颈内静脉（IJ）途径对一名连枷样A3扇贝形病变且曾行二尖瓣修复术的患者成功实施MitraClip手术的病例。我们回顾了文献中先前的病例，并逐步讨论了经颈静脉途径实施该手术的相关临床和技术考量。总之，在股动脉入路禁忌或不可行的情况下，右颈内静脉入路部位为实施MitraClip手术提供了一个合理的替代方案。透彻理解技术考量对于提高手术成功率至关重要。
