Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, California.
Catheter Cardiovasc Interv. 2021 Feb 15;97(3):542-548. doi: 10.1002/ccd.29238. Epub 2020 Sep 8.
Systemic atrioventricular valve regurgitation (AVVR) is frequently encountered in adults with congenital heart disease (CHD). Surgical intervention is the mainstay of therapy, but in a specific high-risk subset, percutaneous valve repair might offer a lower-risk alternative.
Three patients with complex CHD and severe symptomatic AVVR underwent percutaneous mitral valve repair at a single center. All were deemed to be high-risk for surgery by a multidisciplinary CHD team and provided informed consent for the compassionate use of the MitraClip (Abbott, Santa Clara, CA). Three-dimensional heart models were generated for the procedure, which was performed by an adult CHD cardiologist (who provided imaging support) and an interventional cardiologist with expertise in CHD and percutaneous mitral valve repair.
The first case was a 39 year-old-woman with [S,L,D] dextrocardia, double outlet right ventricle, mild tricuspid hypoplasia, and a secundum atrial septal defect, who was palliated at age 35 with a right bidirectional Glenn and later developed severe, symptomatic mitral regurgitation, and underwent placement of one MitraClip XT device. Two patients with L-loop transposition of the great arteries each successfully underwent placement of two MitraClip XT devices; one patient had a single-leaflet detachment of one of the clips with no change in regurgitation or clip position on follow-up. All patients had significant reduction of AVVR and improvement in NYHA functional class.
Percutaneous atrioventricular valve repair in adults with CHD is feasible with the MitraClip but requires significant preprocedural planning and a multidisciplinary team that combines CHD and interventional therapeutic expertise.
在先天性心脏病（CHD）患者中，常可发现系统性房室瓣反流（AVVR）。手术干预是治疗的主要手段，但在特定的高危亚组中，经皮瓣膜修复可能提供一种风险较低的替代方法。
在一家中心，有 3 名患有复杂 CHD 和严重症状性 AVVR 的患者接受了经皮二尖瓣修复。所有患者均被多学科 CHD 团队认为手术风险高，并对同情使用 MitraClip（雅培，圣克拉拉，加利福尼亚州）获得知情同意。为该手术生成了三维心脏模型，由一位成人 CHD 心脏病专家（提供影像学支持）和一位具有 CHD 和经皮二尖瓣修复专业知识的介入心脏病专家进行。
首例患者为 39 岁女性，患有右旋心、右心室双出口、三尖瓣轻度发育不良和房间隔缺损，35 岁时进行了右双向 Glenn 姑息手术，后来出现严重、有症状的二尖瓣反流，并放置了一个 MitraClip XT 装置。2 例大动脉转位 L 环患者均成功放置了两个 MitraClip XT 装置；其中 1 例患者其中一个夹子的单叶瓣脱落，但反流或夹子位置在随访中没有变化。所有患者的 AVVR 均明显减少，NYHA 心功能分级改善。
MitraClip 可用于成人 CHD 患者的经皮房室瓣修复，但需要进行大量的术前规划，并且需要一支结合 CHD 和介入治疗专业知识的多学科团队。
