Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia.
Heart Lung Circ. 2022 May;31(5):711-715. doi: 10.1016/j.hlc.2021.10.010. Epub 2021 Nov 24.
Problematic mitral regurgitation (MR) may develop following lung transplantation (LTx). There is limited information on the management of MR in LTx patients, as such we sought to evaluate our centre's experience.
From 2000 to 2019, 1,054 patients underwent LTx at our centre (896 bilateral, 158 single). We identified patients in whom significant MR developed at any point post-LTx. The aetiology of MR, management and outcome were retrospectively analysed.
Eight (8) patients developed severe MR post-LTx, six following bilateral LTx and two following single LTx. Lung transplantation indications included interstitial lung disease (n=5), chronic obstructive pulmonary disease (n=2) and pulmonary arterial hypertension (n=1). Severe MR occurred intraoperatively (n=1), postoperative day 1 (n=1) with the remaining six cases between 80 and 263 days post-LTx. The aetiology was noted to be due to severe left ventricular dysfunction following unmasking of a chronically pulmonary hypertension-related under-preloaded left ventricle in one case, and in the remaining seven patients causes included myxomatous degeneration, ischaemic MR, and functional MR due to annular dilatation. In the patient with intraoperative severe MR, the MR became mild with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and in the remaining seven patients a variety of procedures were used, including mitral valve repair, valve replacement and transcatheter edge-to-edge mitral valve repair. All patients survived the mitral procedure. Two (2) deaths occurred at 12.9 years (stroke) and 5 years (cancer) from mitral valve surgery.
Development of significant mitral valve regurgitation is a rare but morbid complication after lung transplantation. This may represent the progressive natural history of pre-existing degenerative mitral valve disease and rarely, early after transplantation may be related to changes in ventricular geometry. Management of severe MR can follow the same management approach as in the non-transplant community, with the expectation of similarly good results.
肺移植（LTx）后可能会出现有问题的二尖瓣反流（MR）。由于缺乏 LTx 患者 MR 管理方面的信息，我们评估了本中心的经验。
从 2000 年到 2019 年，我们中心有 1054 名患者接受了 LTx（896 例双侧，158 例单侧）。我们确定了任何时候在 LTx 后出现明显 MR 的患者。回顾性分析了 MR 的病因、治疗和结果。
8 名患者在 LTx 后出现严重的 MR，6 例为双侧 LTx 后，2 例为单侧 LTx 后。LTx 的适应证包括间质性肺疾病（n=5）、慢性阻塞性肺疾病（n=2）和肺动脉高压（n=1）。严重 MR 发生在手术中（n=1），术后第 1 天（n=1），其余 6 例发生在 LTx 后 80 至 263 天。在 1 例患者中，由于慢性肺动脉高压相关的左心室低前负荷左心室的暴露，导致严重左心室功能障碍，在其余 7 例患者中，病因包括黏液瘤变性、缺血性 MR 和由于瓣环扩张引起的功能性 MR。在手术中出现严重 MR 的患者中，MR 在体外膜肺氧合（VA-ECMO）下转为轻度，而在其余 7 例患者中，使用了多种手术方法，包括二尖瓣修复、瓣膜置换和经导管边缘对边缘二尖瓣修复。所有患者的二尖瓣手术均存活。2 例患者（2 例）在二尖瓣手术后 12.9 年（中风）和 5 年（癌症）死亡。
严重二尖瓣反流的发生是肺移植后一种罕见但病态的并发症。这可能代表了先前存在的退行性二尖瓣疾病的自然病史进展，并且很少在移植后早期与心室几何形状的变化有关。严重 MR 的治疗可以遵循与非移植社区相同的治疗方法，预计结果也相似。
