Ozden Ozge, Kemal Hatice, Bingöl Gülsüm, Göktekin Ömer
Cardiology Department, Memorial Bahçelievler Hospital, Bahçelievler Merkez, Adnan Kahveci Blv. No. 227, 34180 Bahçelievler, İstanbul, Turkey.
Cardiology Department, Near East University Hospital, Nicosia, Turkish Republic of Northern Cyprus.
Eur Heart J Case Rep. 2022 Jun 16;6(7):ytac242. doi: 10.1093/ehjcr/ytac242. eCollection 2022 Jul.
Paravalvular leak (PVL) is a common, serious complication related with prosthetic valve replacement. Although surgical closure reoperation is the choice of treatment, percutaneous device closure is a good alternative with good results in patients with very high surgical risk.
In this case report, we present the percutaneous closure of PVL of mitral valve replacement (MVR), in a patient with cardiogenic shock who failed conservative medical treatment and was deemed inoperable due to recurrent operations. Successful closure of the PVL with the use of the four consecutive PVL closure devices was performed under general anaesthesia with guidance of 2D and 3D transoesophageal echocardiography. The procedure was performed with no complications and the patient has remained asymptomatic after 10 months following the PVL closure procedure with marked improvement in her NYHA class and echocardiographic values.
Percutaneous PVL closure is a very challenging and high clinical skills requiring procedure, but has a good success and low complication rate in high-risk patients. It is not a standard procedure and the type and size of device should be tailored for each patient with a good 2D and 3D echocardiographic guidance.
瓣周漏（PVL）是与人工瓣膜置换相关的一种常见且严重的并发症。尽管外科手术闭合再手术是治疗选择，但经皮器械闭合对于手术风险极高的患者而言是一种良好的替代方法，且效果良好。
在本病例报告中，我们呈现了一名因心源性休克而药物保守治疗失败且因多次手术被认为无法进行手术的二尖瓣置换（MVR）患者的瓣周漏经皮闭合情况。在二维和三维经食管超声心动图引导下，于全身麻醉下使用四个连续的瓣周漏闭合装置成功闭合了瓣周漏。该手术无并发症发生，在瓣周漏闭合术后10个月，患者一直无症状，纽约心脏协会（NYHA）心功能分级及超声心动图数值有显著改善。
经皮瓣周漏闭合是一项极具挑战性且需要高超临床技能的操作，但在高危患者中成功率高且并发症发生率低。这并非标准操作，器械的类型和尺寸应在良好的二维和三维超声心动图引导下为每位患者量身定制。
