Naeim Hesham Abdo, Alamodi Osama, Saeed Waleed, Mahmood Abeer, Khedr Lamiaa, ELRowiny Ramy, Abuelatta Reda
Madina Cardiac Centre, Madina, Shoribat, Saudi Arabia.
J Saudi Heart Assoc. 2020 Apr 17;32(1):93-97. doi: 10.37616/2212-5043.1015. eCollection 2020.
Progressive remodelling of the left ventricle with lateral and apical displacement of one or both papillary muscles can lead to recurrence of severe mitral regurgitation (MR) in the presence of the mitral valve (MV) ring. The MitraClip (Abbott, USA) is the only option in cases with annuloplasty rings too large for implantation of a Sapien prosthesis in high surgical-risk patients. We present a case where the MR jet was directed toward a para-ring hole, and the MitraClip system was used successfully to treat this severe MR.
An 80-year-old woman underwent coronary artery bypass surgery plus MV repair with C-shaped ring 6 years ago. In the past year, she experienced severe shortness of breath; her ejection fraction dropped to 15%. A transesophageal echocardiogram revealed that severe MR started at the level of MV leaflets and then passed to the left atrium beside the MV ring. Live 3D showed the severe MR coming through the oval-shaped hole beside the C-shaped MV repair ring. MitraClip implantation was decided, the two leaflets were grasped successfully, the clip was fully closed, and only trace MR remained at the MV leaflets with no flow to the para-ring hole. The patient was extubated after 12 hours and discharged home after 2 days. Follow-up transthoracic echocardiography after 6 months showed the clip in place and trace residual MR.
Implantation of MitraClip in the presence of MV repair ring is feasible and safe. The para-ring defect can be left if the origin of MR from the MV coaptation line is treated successfully with MitraClip. Symptomatic improvement with no rehospitalization was documented in this case.
左心室进行性重塑，伴一侧或双侧乳头肌向外侧和心尖移位，在存在二尖瓣环的情况下可导致严重二尖瓣反流（MR）复发。对于外科手术风险高的患者，若瓣环成形环过大而无法植入Sapien人工瓣膜，MitraClip（美国雅培公司）是唯一的选择。我们报告一例MR射流指向瓣环旁孔，成功使用MitraClip系统治疗严重MR的病例。
一名80岁女性6年前接受冠状动脉搭桥手术及二尖瓣C形环修复术。在过去一年里，她出现严重气短；射血分数降至15%。经食管超声心动图显示，严重MR始于二尖瓣叶水平，然后流向二尖瓣环旁的左心房。实时三维超声心动图显示严重MR通过C形二尖瓣修复环旁的椭圆形孔。决定植入MitraClip，成功夹住两个瓣叶，夹子完全闭合，二尖瓣叶仅残留微量MR，无血流至瓣环旁孔。患者术后12小时拔管，2天后出院。6个月后的随访经胸超声心动图显示夹子在位，残留微量MR。
在二尖瓣修复环存在的情况下植入MitraClip是可行且安全的。如果通过MitraClip成功治疗二尖瓣贴合线处的MR起源，则可保留瓣环缺损。该病例记录了症状改善且未再次住院。
