Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), Bordeaux, France.
IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.
Catheter Cardiovasc Interv. 2021 Jul 1;98(1):E108-E114. doi: 10.1002/ccd.29681. Epub 2021 Apr 1.
A 48-year-old who underwent a Mustard operation in 1972 followed by a second cardiac intervention in 1996 for pulmonary venous baffle enlargement and residual baffle leak closure, complicated by recurrent atrial flutter, was admitted to our institution for severe systemic atrio-ventricular valve regurgitation (SAVVR) associated with severely impaired systemic right ventricular (RV) function. After careful preoperative anatomic assessment including three-dimensional transesophageal echocardiography (3DTEE) to define the clipping strategy and computed tomography to optimize the transvenous baffle puncture site, the intervention was performed under general anesthesia, fluoroscopic, and 3DTEE guidance. One XTR MitraClip was successfully implanted, achieving a significant reduction in regurgitation and immediate clinical improvement. The transbaffle puncture was closed using an 8 mm atrial septal defect (ASD) device without residual shunt or obstruction of the venous baffle. Post-operative clinical evaluation showed immediate improvement in the NYHA functional class (from III to II), but the patient presented with recurrent flutter at 1 week after the procedure, which was successfully treated by catheter ablation with another transbaffle approach next to the ASD device. Clinical improvement was maintained at 1- and 6-month follow-up with significant reduction in SAVVR, reduced systemic RV volumes and improved RV ejection fraction. This case demonstrates the feasibility of percutaneous treatment of systemic SAVV in patients with systemic RV after atrial redirection.
一位 48 岁的患者，1972 年接受了 Mustard 手术，1996 年因肺静脉分流道扩大和残余分流道漏关闭进行了第二次心脏介入治疗，并发复发性心房扑动，因严重的系统性房室瓣反流（SAVVR）和严重受损的系统性右心室（RV）功能而入院。在进行手术前，我们进行了仔细的解剖评估，包括三维经食管超声心动图（3DTEE）来确定夹合策略，以及计算机断层扫描来优化经静脉分流道穿刺部位。在全身麻醉、荧光透视和 3DTEE 引导下进行了干预。成功植入了一个 XTR MitraClip，显著减少了反流并立即改善了临床症状。通过使用 8mm 的房间隔缺损（ASD）装置关闭了分流道穿刺口，没有残余分流或静脉分流道阻塞。术后临床评估显示 NYHA 心功能分级立即改善（从 III 级到 II 级），但患者在手术后 1 周出现复发性房扑，通过在 ASD 装置旁边进行另一种经分流道的导管消融术成功治疗。在 1 个月和 6 个月的随访中，临床症状得到了持续改善，SAVVR 显著减少，系统性 RV 容积减少，RV 射血分数提高。该病例证明了经皮治疗系统性 RV 后经心房重定向的系统性 SAVV 的可行性。
