Aquino-Bruno Heberto, Andrade-Cuellar Elias Noel, Morales-Portano Julieta D, Alcántara-Meléndez Marco Antonio
Interventional Cardiology Service, National Medical Center November 20, Mexico City, Mexico.
Cardiology Service, National Medical Center November 20, Av. Felix Cuevas #540, Col. Del Valle Del. Benito Juarez, Mexico City 03100, Mexico.
Eur Heart J Case Rep. 2023 Oct 5;7(10):ytad488. doi: 10.1093/ehjcr/ytad488. eCollection 2023 Oct.
Patients with end-stage heart failure (HF) and severe pulmonary hypertension (PH) are not eligible for heart transplant due to high mortality risk. Percutaneous interventions as edge-to-edge repair of the mitral/tricuspid valves are a safe and effective therapy as a bridge for transplantation in patients who have contraindications to heart transplantations (HTs).
A 44-year-old man with a previous diagnosis of infection by human immunodeficiency virus (HIV) was admitted at the emergency room for exertional dyspnoea. He was diagnosed with a decompensated heart failure with reduced ejection fraction (HFrEF), severe mitral and tricuspid regurgitation, and high probability of PH. He presented poor response to guided medical treatment, even after implantable cardiac resynchronization therapy defibrillator (CRT-D). He was listed for a cardiac transplant, but after right catheterization, he was not an ideal candidate for transplantation, so it was decided to undergo percutaneous mitral and tricuspid edge-to-edge repair as a bridge to transplantation. The post-operative course was uneventful, with significant improvement in New York Heart Association functional class. The patient underwent a successful heart transplant 10 months after the procedure.
In patients with advanced HF due to HIV, HT is an adequate treatment option. When there are functional mitral and tricuspid regurgitation and severe PH, despite optimal treatment according to current guidelines, percutaneous mitral and tricuspid repair therapy appears to be safe and effective for control of severe PH as a bridge measure for cardiac transplantation.
终末期心力衰竭（HF）和重度肺动脉高压（PH）患者因死亡风险高而不符合心脏移植条件。经皮二尖瓣/三尖瓣缘对缘修复等介入治疗对于有心脏移植（HT）禁忌证的患者而言，作为移植桥梁是一种安全有效的治疗方法。
一名44岁男性，既往诊断为人类免疫缺陷病毒（HIV）感染，因劳力性呼吸困难入住急诊室。他被诊断为射血分数降低的失代偿性心力衰竭（HFrEF）、重度二尖瓣和三尖瓣反流，且极有可能患有肺动脉高压。即使在植入心脏再同步化治疗除颤器（CRT-D）后，他对指导性药物治疗的反应仍不佳。他被列入心脏移植名单，但右心导管检查后，他并非理想的移植候选人，因此决定行经皮二尖瓣和三尖瓣缘对缘修复作为移植桥梁。术后过程顺利，纽约心脏协会心功能分级有显著改善。该患者在手术后10个月成功接受了心脏移植。
对于因HIV导致的晚期HF患者，心脏移植是一种合适的治疗选择。当存在功能性二尖瓣和三尖瓣反流以及重度肺动脉高压时，尽管根据现行指南进行了最佳治疗，但经皮二尖瓣和三尖瓣修复治疗作为心脏移植的桥梁措施，对于控制重度肺动脉高压似乎是安全有效的。
