Department of Internal Medicine, Division of Cardiology, Detroit Medical Center/Wayne State University, Detroit, Michigan 48201.
Tex Heart Inst J. 2020 Aug 1;47(4):306-310. doi: 10.14503/THIJ-18-6901.
Acute mitral regurgitation is a life-threatening complication of acute myocardial infarction. We present the case of a 70-year-old woman who had acute myocardial infarction complicated by severe mitral regurgitation and cardiogenic shock. Although current guidelines recommend mitral valve surgery for such patients, surgery often carries prohibitive risk of morbidity and mortality. Thus, in certain patients, percutaneous repair may be the only viable treatment option. In this case, we used a 3-step percutaneous approach involving coronary artery revascularization with a drug-eluting stent in the left circumflex coronary artery, mechanical circulatory support with an Impella CP pump for cardiogenic shock, and mitral valve repair with the MitraClip system for severe mitral regurgitation. After successful intervention, our patient regained hemodynamic stability and showed clinical improvement at one-month follow-up.
急性二尖瓣反流是急性心肌梗死的一种危及生命的并发症。我们报告了 1 例 70 岁女性,因急性心肌梗死并发严重二尖瓣反流和心原性休克。尽管目前的指南建议对这类患者进行二尖瓣手术,但手术往往存在极高的发病率和死亡率风险。因此,在某些患者中,经皮修复可能是唯一可行的治疗选择。在本例中,我们采用了 3 步经皮方法,包括左回旋支冠状动脉药物洗脱支架冠状动脉血运重建、Impella CP 泵机械循环支持治疗心原性休克、MitraClip 系统治疗严重二尖瓣反流。成功干预后,患者血流动力学稳定,并在 1 个月随访时临床改善。