Haeffele Christiane L, Lui George K, Peng Lynn, Chan Frandics, Sharma Rahul P
Department of Medicine, Division of Cardiovascular Medicine, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA.
Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA.
Eur Heart J Case Rep. 2022 Dec 16;7(1):ytac479. doi: 10.1093/ehjcr/ytac479. eCollection 2023 Jan.
The use of transcatheter edge-to-edge repair (TEER) in patients with advanced heart failure has been shown to reduce hospitalizations and increase survival. As patients with Fontan circulations grow older, a significant proportion of them will develop severe atrioventricular (AV) valve regurgitation in the systemic ventricle. Conventional surgical repair and transplant carry high mortality risk for the adult Fontan patient with progressive heart failure.
A 51-year-old female extracardiac Fontan patient developed severe AV valve regurgitation and progressive functional decline. Based on her operative risk for conventional surgical intervention or transplant, TEER using the Abbott MitraClip device was performed. The degree of mitral regurgitation was decreased from severe to moderate regurgitation.
This is the first known case describing the use of a successful TEER in an adult patient with an extracardiac Fontan. Given the increasing numbers of patients surviving into adulthood with a Fontan circulation, transcatheter interventions may provide an alternative treatment option to conventional surgeries and medical therapies.
经导管缘对缘修复术（TEER）已被证明可减少晚期心力衰竭患者的住院次数并提高生存率。随着接受Fontan循环手术的患者年龄增长，其中很大一部分人将在体循环心室中出现严重的房室（AV）瓣反流。对于患有进行性心力衰竭的成年Fontan患者，传统的手术修复和移植具有很高的死亡风险。
一名51岁的女性心外Fontan患者出现严重的AV瓣反流和进行性功能衰退。鉴于她接受传统手术干预或移植的手术风险，使用雅培MitraClip装置进行了TEER。二尖瓣反流程度从重度降至中度反流。
这是已知的首例描述在成年心外Fontan患者中成功使用TEER的病例。鉴于越来越多接受Fontan循环手术的患者存活至成年，经导管干预可能为传统手术和药物治疗提供替代治疗选择。
