Cubeddu Robert J, Sarkar Abdullah, Navas Viviana, Navia Jose L
Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA.
Eur Heart J Case Rep. 2020 Apr 24;4(3):1-5. doi: 10.1093/ehjcr/ytaa058. eCollection 2020 Jun.
Transcatheter aortic valve implantation operators have adapted to a less invasive technique by foregoing the use of general anaesthesia and transoesophageal echocardiography. This is known as a 'minimalist approach'. This approach has yet to be explored in transcatheter mitral valve replacement (TMVR). Two patients with high perioperative risk underwent TMVR using only monitored conscious sedation (CS) and intracardiac echocardiography (ICE).
The patients were symptomatic and required treatment of severe mitral regurgitation and severe mitral stenosis in a mitral valve ring and prosthetic mitral valve, respectively. With the use of an antegrade transseptal approach, the procedure was conducted under CS using ICE only. After placement of the prosthetic mitral valve, the valve was assessed by advancing the ICE catheter through the interatrial septal defect and no significant paravalvular leak occurred. In one case, treatment of right to left shunting was successfully pursued. Valve function was excellent immediately and at 24 h after implantation and resulted in significant haemodynamic improvement.
With more TMVR cases being conducted, the 'minimalist approach' with CS and ICE may be considered in selected cases.
经导管主动脉瓣植入术的操作者已通过放弃使用全身麻醉和经食管超声心动图，转而采用侵入性较小的技术。这被称为“极简主义方法”。这种方法尚未在经导管二尖瓣置换术（TMVR）中得到探索。两名围手术期风险高的患者仅使用监测下清醒镇静（CS）和心内超声心动图（ICE）进行了TMVR。
患者有症状，分别需要治疗二尖瓣环严重二尖瓣反流和人工二尖瓣严重二尖瓣狭窄。采用顺行经房间隔途径，仅在CS下使用ICE进行手术。放置人工二尖瓣后，通过将ICE导管推进穿过房间隔缺损来评估瓣膜，未发生明显的瓣周漏。在1例病例中，成功进行了右向左分流的治疗。瓣膜功能在植入后即刻和24小时均极佳，并导致显著的血流动力学改善。
随着更多TMVR病例的开展，对于选定的病例可考虑采用CS和ICE的“极简主义方法”。
