Ishizu Kenichi, Isotani Akihiro, Shirai Shinichi, Ando Kenji
Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan.
Eur Heart J Case Rep. 2021 Oct 23;5(10):ytab216. doi: 10.1093/ehjcr/ytab216. eCollection 2021 Oct.
Late post-operative systolic anterior motion (SAM) is a rare but challenging issue. The feasibility of percutaneous mitral valve edge-to-edge repair (PMVR) using the MitraClip to treat late refractory SAM after surgical mitral valve repair has rarely been reported in the literature.
An 88-year-old woman with a history of mitral valve repair for a P2 prolapse 14 years before, presented with signs of congestive heart failure. Transoesophageal echocardiogram (TOE) demonstrated significant SAM of the anterior mitral leaflet, resulting in the detachment from the posterior mitral leaflet in mid-to-late systole and severe mitral regurgitation (MR). The heart team decided to perform PMVR using the MitraClip to simultaneously address the issues of SAM and MR, considering the patient's high surgical risk. TOE after the clip deployment at the medial edge of the mitral valve, where the most severe SAM was detected, confirmed resolution of SAM with marked reduction of MR. The patient was discharged home with good haemodynamic compensation.
Post-operative SAM typically occurs immediately after the reparative surgery and resolves with conservative treatment; however, persistent SAM requiring repeat surgery remains a serious concern. As an alternative strategy, the MitraClip has some advantages, including low procedural risk, immediately observable results, and the ability to relocate the clip. Meanwhile, the greater risk of post-procedural mitral stenosis, particularly in patients undergoing mitral repair, should be taken into account. In our case, the clip deployment at the medial edge of the valve could minimize the progression of mitral stenosis with a satisfactory reduction of MR.
术后晚期收缩期前向运动（SAM）是一个罕见但具有挑战性的问题。使用MitraClip进行经皮二尖瓣缘对缘修复（PMVR）治疗二尖瓣修复术后晚期难治性SAM的可行性在文献中鲜有报道。
一名88岁女性，14年前因P2脱垂接受二尖瓣修复手术，现出现充血性心力衰竭症状。经食管超声心动图（TOE）显示二尖瓣前叶存在明显的SAM，导致收缩中晚期与二尖瓣后叶分离及严重二尖瓣反流（MR）。考虑到患者手术风险高，心脏团队决定使用MitraClip进行PMVR，以同时解决SAM和MR问题。在二尖瓣内侧边缘（检测到最严重SAM的部位）部署夹子后，TOE证实SAM消失，MR显著减少。患者出院时血流动力学代偿良好。
术后SAM通常在修复手术后立即出现，并通过保守治疗得以解决；然而，持续的SAM需要再次手术仍然是一个严重问题。作为一种替代策略，MitraClip具有一些优势，包括手术风险低、结果可立即观察到以及能够重新定位夹子。同时，应考虑到术后二尖瓣狭窄的风险增加，尤其是在接受二尖瓣修复的患者中。在我们的病例中，在瓣膜内侧边缘部署夹子可使二尖瓣狭窄进展最小化，同时MR得到满意的减少。
