Naeim Hesham Abdo, Alamodi Osama, Ajaz Ghani Mohamed, Albagi Ahmed Nore, Abuelatta Reda
Madina Cardiac Centre, Madina, Saudi Arabia.
J Cardiol Cases. 2020 May 30;22(2):64-67. doi: 10.1016/j.jccase.2020.05.006. eCollection 2020 Aug.
Severe mitral regurgitation and stenosis due to failed mitral annuloplasty ring can be managed with percutaneous mitral valve in ring in high surgical risk patients. A 66-year-old male underwent coronary artery bypass surgery and mitral valve ring annuloplasty 7 years previously. He started to have shortness of breath with minimal effort in the past 2 years. Transthoracic echocardiogram revealed a new severe mitral regurgitation and severe mitral stenosis. The patient was turned down from surgery due to high surgical risk. The transcatheter mitral valve in ring implantation was decided. In this case, there was a low probability of left ventricular outflow tract obstruction. A stiff wire crossed the mitral valve ring and positioned in the left ventricular apex. The Sapien 3 valve size 26 mm (Edwards Lifesciences, Irvine, CA, USA) was positioned to have 80% ventricular and 20% atrial side. Transesophageal echocardiogram evaluation revealed a mean gradient of 5 mmHg. The left ventricular outflow tract (LVOT) had laminar color flow and the mean pressure gradient across LVOT was 1 mmHg. The patient was discharged after 2 days in good condition. At one year follow up, he had no shortness of breath and no rehospitalization. In conclusion, the percutaneous mitral valve in ring is feasible in selected patients. The risk of LVOT obstruction should be assessed carefully before the procedure with a transthoracic and transesophageal echocardiogram. 〈 Understand how to guide the mitral valve in ring procedure with a transesophageal echocardiogram and how to avoid left ventricular outflow tract obstruction. Understand how to position the Sapien valve in mitral valve ring.〉.
因二尖瓣环成形环失败导致的严重二尖瓣反流和狭窄，可在手术风险高的患者中采用经皮二尖瓣瓣中瓣治疗。一名66岁男性7年前接受了冠状动脉搭桥手术和二尖瓣环成形术。在过去2年里，他稍作活动就开始出现气短症状。经胸超声心动图显示新发严重二尖瓣反流和严重二尖瓣狭窄。由于手术风险高，该患者被拒绝手术。于是决定行经导管二尖瓣瓣中瓣植入术。在这种情况下，左心室流出道梗阻的可能性较低。一根硬导丝穿过二尖瓣环并置于左心室心尖。将尺寸为26 mm的Sapien 3瓣膜（美国加利福尼亚州尔湾市爱德华兹生命科学公司）定位，使其80%位于心室侧、20%位于心房侧。经食管超声心动图评估显示平均压差为5 mmHg。左心室流出道（LVOT）有层流血流，LVOT的平均压力梯度为1 mmHg。患者术后2天情况良好出院。在1年随访时，他没有气短症状，也没有再次住院。总之，经皮二尖瓣瓣中瓣在选定患者中是可行的。在手术前应通过经胸和经食管超声心动图仔细评估左心室流出道梗阻的风险。〈了解如何通过经食管超声心动图引导二尖瓣瓣中瓣手术以及如何避免左心室流出道梗阻。了解如何在二尖瓣环中定位Sapien瓣膜。〉
