Shah Muhammad Azam, Almahrous Najeeb, Alreshidan Mohammed, Alshehri Halia Zain
King Fahad Medical City, Dabab Street, Sulaymaniyah, PO Box 221124, 11311 Riyadh, Saudi Arabia.
Eur Heart J Case Rep. 2023 Sep 29;7(10):ytad476. doi: 10.1093/ehjcr/ytad476. eCollection 2023 Oct.
The presence of aortic and mitral disease in a patient who is not a suitable candidate for surgical correction poses significant challenges in the diagnostic workup as well as management plans. Percutaneous treatment can be staged to fix the aortic valve with transcatheter aortic valve implantation (TAVI) as a first step, followed by reassessment and percutaneous correction of mitral regurgitation (MR).
A 65-year-old female with multiple co-morbidities presented with acute coronary syndrome and heart failure. She was diagnosed with three-vessel coronary artery disease and degenerative low-flow low-gradient severe aortic stenosis, along with severe degenerative MR with a left ventricular ejection fraction of 35%. Because of the high surgical risk, she underwent multi-vessel percutaneous coronary intervention with stenting. Transcatheter aortic valve implantation was done as a staged procedure, which partially improved her symptoms. Mitral regurgitation was not suitable for percutaneous mitral valve edge-to-edge repair. After a discussion by the heart team, she underwent transcatheter mitral valve implantation, for which the Tendyne mitral valve (Tendyne™; Abbott) was used through a transapical approach. There was no paravalvular leak, and the mean gradient across the valve was 2 mmHg. She was symptomatically better at follow-up and an echocardiogram showed a normally functioning aortic valve and Tendyne mitral valves.
Transapical transcatheter mitral valve implantation using the Tendyne valve is a feasible option for patients with prior TAVI. This can be considered an alternative treatment for MR in patients who are not suitable for edge-to-edge mitral repair.
对于不适合手术矫正的患者，主动脉和二尖瓣疾病的存在在诊断检查以及管理计划方面带来了重大挑战。经皮治疗可分阶段进行，第一步通过经导管主动脉瓣植入术（TAVI）修复主动脉瓣，随后重新评估并经皮矫正二尖瓣反流（MR）。
一名65岁患有多种合并症的女性因急性冠状动脉综合征和心力衰竭就诊。她被诊断为三支血管冠状动脉疾病、退行性低流量低梯度重度主动脉瓣狭窄，以及伴有左心室射血分数为35%的重度退行性二尖瓣反流。由于手术风险高，她接受了多支血管经皮冠状动脉介入治疗并植入支架。经导管主动脉瓣植入术作为分阶段手术进行，部分改善了她的症状。二尖瓣反流不适合经皮二尖瓣缘对缘修复。经过心脏团队讨论，她接受了经导管二尖瓣植入术，通过经心尖途径使用了Tendyne二尖瓣（Tendyne™；雅培公司）。无瓣周漏，瓣膜平均压差为2 mmHg。随访时她的症状明显改善，超声心动图显示主动脉瓣和Tendyne二尖瓣功能正常。
对于先前已接受TAVI的患者，经心尖使用Tendyne瓣膜进行经导管二尖瓣植入术是一种可行的选择。这可被视为不适合二尖瓣缘对缘修复的患者二尖瓣反流的替代治疗方法。
