首例人体经导管带袢涤纶毡补片辅助三尖瓣环成形术治疗重度三尖瓣关闭不全。
First-in-human transcatheter pledget-assisted suture tricuspid annuloplasty for severe tricuspid insufficiency.
机构信息
Divisions of Cardiology and Cardiac Surgery, Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia, USA.
Henry Ford Health System, Detroit, Michigan, USA.
出版信息
Catheter Cardiovasc Interv. 2021 Jan 1;97(1):E130-E134. doi: 10.1002/ccd.28955. Epub 2020 May 8.
OBJECTIVES
We report the first pledget-assisted suture tricuspid annuloplasty (PASTA) in a patient with torrential tricuspid regurgitation (TR).
BACKGROUND
Tricuspid valve regurgitation is a common malignant disease with no commercially available transcatheter therapy. PASTA is a "percutaneous surgical" procedure using pledgeted sutures to create a double-orifice tricuspid valve.
METHODS
An 83-year-old man had end-stage TR caused by a defibrillator lead. He consented to undergo PASTA on a compassionate basis. A double-orifice valve was created with pledgeted sutures from percutaneous right ventricular apical access.
RESULTS
TR was reduced from torrential to trace. The vena contracta reduced to from 23 to 1 mm and annular area reduced from 1817 to 782 mm . However, the annulus dehisced and required closure with a percutaneous nitinol plug. The patient was discharged home and was alive 6 months later but with persistent symptoms.
CONCLUSIONS
The anatomy of a double-orifice valve can eliminate TR but a better solution is required to avoid excessive suture tension on annular tissue.
目的
我们报告首例丘比特夹辅助三尖瓣环成形术（PASTA）治疗大量三尖瓣反流（TR）患者。
背景
三尖瓣反流是一种常见的恶性疾病，尚无商业可用的经导管治疗方法。PASTA 是一种“经皮手术”程序，使用丘比特夹缝线创建双孔三尖瓣。
方法
一名 83 岁男性因除颤器导线导致终末期 TR。他同意基于同情接受 PASTA。通过经皮右心室心尖入路的丘比特夹缝线创建双孔瓣膜。
结果
TR 从大量反流减少到微量。收缩期瓣口宽度从 23 毫米减少到 1 毫米，瓣环面积从 1817 毫米减少到 782 毫米。然而，瓣环裂开，需要用经皮镍钛诺塞子闭合。患者出院回家，6 个月后仍存活，但仍有持续症状。
结论
双孔瓣膜的解剖结构可以消除 TR，但需要更好的解决方案来避免环形组织的缝线张力过大。
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