Intermountain Heart Institute, Salt Lake City, Utah.
Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.
Catheter Cardiovasc Interv. 2021 Feb 1;97(2):353-358. doi: 10.1002/ccd.29232. Epub 2020 Aug 31.
The purpose of this study was to define anterior mitral leaflet (AML) length and mitral ring characteristics associated with LVOT obstruction and PVL following MViR.
Transcatheter Mitral Valve in Ring (MViR) procedural complications including parvalvular leak (PVL) and left ventricular outflow tract (LVOT) obstruction are frequent.
Clinical records, computer tomographic scans (CTs) and echocardiograms of consecutive MViR patients were retrospectively reviewed for anterior mitral leaflet length, CT-simulated neoLVOT, and aortomitral angle among patients with and without MViR-induced LVOT obstruction. Acute and 1-year outcomes are described.
Twenty-two patients underwent MViR. Technical success was achieved in 13/22 (57.1%) patients, limited by paravalvular regurgitation requiring second transcatheter heart valves (THVs) in seven patients. Second valves were needed in 6/11 (54.5%) patients with 3-dimensional rings but 1/11 (9.1%, p = .06) of patients with planar rings. Procedure success at 30 days was achieved in 20/22 (90.9%) patients. There were no procedural, in-hospital, or 30-day deaths. Two patients developed significant LVOT obstruction, one managed with urgent surgery and one with elective alcohol septal ablation. Anterior mitral leaflets were longer among the two patients with LVOT obstruction than the 20 patients who did not develop LVOT obstruction when measured by TEE (30 mm vs. 21 mm, p = .009) or by CT (29 mm vs. 22 mm, p = .026).
AML >25 mm increases the risk of MViR induced LVOT obstruction. PVL is common, particularly in 3-dimensional rings which can be managed with a second THV.
本研究旨在定义二尖瓣环成形术（MViR）后左心室流出道（LVOT）梗阻和二尖瓣前叶裂（PVL）相关的前二尖瓣叶（AML）长度和二尖瓣环特征。
经导管二尖瓣环成形术（MViR）的程序并发症包括瓣周漏（PVL）和左心室流出道（LVOT）梗阻，较为常见。
回顾性分析连续接受 MViR 的患者的临床记录、计算机断层扫描（CT）和超声心动图，以评估患者有无 MViR 引起的 LVOT 梗阻，并分析前二尖瓣叶长度、CT 模拟的新 LVOT 和主瓣环夹角。描述急性和 1 年的结果。
22 例患者接受了 MViR。在 22 例患者中，有 13 例（57.1%）技术上获得成功，其中 7 例因瓣周反流需要再次行经导管心脏瓣膜（THV）。在使用 3 维环的 11 例患者中有 6 例（54.5%）需要第二次瓣膜，而在使用平面环的 11 例患者中有 1 例（9.1%，p=0.06）需要第二次瓣膜。22 例患者中有 20 例（90.9%）在 30 天内获得手术成功。无手术、住院或 30 天内死亡。2 例患者出现明显的 LVOT 梗阻，1 例经紧急手术治疗，1 例经择期酒精室间隔消融术治疗。通过 TEE（30mm 对 21mm，p=0.009）或 CT（29mm 对 22mm，p=0.026）测量，LVOT 梗阻的 2 例患者的 AML 均长于未发生 LVOT 梗阻的 20 例患者。
AML＞25mm 增加了 MViR 引起的 LVOT 梗阻的风险。PVL 很常见，特别是在 3 维环中，可通过第二次 THV 治疗。
