Cardiovascular Division, Reading Hospital - Tower Health, West Reading, PA, USA.
Department of Internal Medicine, Reading Hospital - Tower Health, West Reading, PA, USA.
Am J Case Rep. 2021 Jan 30;22:e928003. doi: 10.12659/AJCR.928003.
BACKGROUND Paravalvular leaks (PVL) are becoming more commonly experienced in clinical practice due to the increasing number of mitral valve replacements performed. There are about 182 000 valve replacements performed annually, with a 5-15% prevalence rate of paravalvular leaks. Due to increased mortality associated with surgical repair, percutaneous transcatheter closure procedures are increasingly being performed as an alternative to repeat surgery. CASE REPORT We present the case of a 52-year-old woman with past medical history of mitral valve endocarditis who developed worsening acute heart failure 1 month after surgical bioprosthetic mitral valve replacement. Transesophageal echocardiography at the time revealed dehiscence of the bioprosthetic mitral valve and severe mitral regurgitation. She subsequently had emergent surgical bioprosthetic mitral valve replacement and annular reconstruction. The post-operative course was complicated by increasing dyspnea and lower-extremity edema, with recurrent pericardial tamponade requiring placement of a pericardial window. Based on her multiple comorbidities, most notably the concomitant right ventricular failure with severe pulmonary hypertension and prior pericardial patch repair with compromise of her mitral valve annulus, she was deemed inoperable for re-do surgery and eventually underwent a successful percutaneous closure of the mitral paravalvular leak with a ventricular septal defect (VSD) Amplatzer occluder device. The patient made good recovery and was discharged home a few days after the procedure. CONCLUSIONS Although use of the Amplatzer VSD occluder device for this indication currently remains off-label, our report supports the use of the VSD occluder device in this subset of patients considering the high mortality rates associated with repeat surgical procedure.
由于二尖瓣置换术数量的增加，瓣周漏（PVL）在临床实践中越来越常见。每年约有 182000 例瓣膜置换术，瓣周漏的患病率为 5-15%。由于与手术修复相关的死亡率增加，经皮经导管闭合术越来越多地被用作重复手术的替代方法。
我们报告了一位 52 岁女性的病例，她有二尖瓣心内膜炎的既往病史，在手术后 1 个月出现进行性急性心力衰竭。当时的经食管超声心动图显示生物瓣二尖瓣裂开和严重二尖瓣反流。随后她紧急进行了生物瓣二尖瓣置换和环重建手术。术后过程复杂，出现呼吸困难和下肢水肿加重，并反复出现心包填塞，需要放置心包窗。鉴于她的多种合并症，尤其是合并右心衰竭、严重肺动脉高压和先前心包补片修复导致二尖瓣环受损，她被认为不能再进行手术，最终成功地使用室间隔缺损（VSD）Amplatzer 封堵器进行了二尖瓣瓣周漏的经皮封堵。患者恢复良好，在手术后几天出院回家。
虽然目前该适应证使用 Amplatzer VSD 封堵器仍为超适应证用药，但鉴于重复手术相关的高死亡率，我们的报告支持在这部分患者中使用 VSD 封堵器。
