Zou Jieru, Zhang Xiaoxin, Yuan Jie, Geng Qingshan, Liu Jingjin
The Second Clinical Medical College, Jinan University, 1017 Dongmen North Road, Shenzhen, Guangdong 518020, China.
Department of Cardiology, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology, 1017 Dongmen North Road, Shenzhen, Guangdong 518020, China.
Eur Heart J Case Rep. 2023 Dec 11;8(1):ytad621. doi: 10.1093/ehjcr/ytad621. eCollection 2024 Jan.
The positive role of rehabilitation programmes for some cardiac patient populations (e.g. coronary artery disease, heart failure, transcatheter aortic valve replacement, and heart transplantation) is now well-known. However, the feasibility and outcomes of rehabilitation, prior to or immediately after percutaneous mitral valve reconstruction, using a clamping procedure have been poorly reported, especially among frail elderly patients.
An 85-year-old woman with acute heart failure symptoms (New York Heart Association functional class III), who had acute myocardial infarction 3 months ago, was hospitalized. An ultrasound cardiogram showed severe mitral regurgitation, and after a multidisciplinary discussion, transcatheter edge-to-edge repair (TEER) was considered the safest treatment option. Even then, though, due to her poor health status, it was still too risky for the patient to undergo without significant prior preparation. Thus, we decided to begin pre- and post-surgery cardiac rehabilitation (CR) to prepare her for TEER, comprising medicinal, nutritional, and psychological support, as well as exercise and smoking cessation. After pre-operative assessment and rehabilitation, the patient underwent TEER, followed by post-operative reassessment, and continued rehabilitation.
Our case study demonstrates that CR, both pre- and post-TEER, aids in improving the conditions of elderly patients with poor health, to minimize their risk for developing TEER-related complications. This case provides one possible CR regimen for those patients.
康复计划对某些心脏病人群（如冠状动脉疾病、心力衰竭、经导管主动脉瓣置换术和心脏移植）的积极作用现已广为人知。然而，关于在经皮二尖瓣重建术前或术后立即采用钳夹术进行康复治疗的可行性和结果，尤其是在体弱老年患者中的报道较少。
一名85岁女性，有急性心力衰竭症状（纽约心脏协会心功能分级III级），3个月前发生急性心肌梗死，入院治疗。超声心动图显示严重二尖瓣反流，经多学科讨论后，经导管缘对缘修复术（TEER）被认为是最安全的治疗选择。即便如此，由于她健康状况不佳，在没有充分术前准备的情况下进行手术对患者来说风险仍然太大。因此，我们决定在手术前后开展心脏康复（CR），为她接受TEER做准备，包括药物、营养和心理支持，以及运动和戒烟。经过术前评估和康复治疗后，患者接受了TEER，随后进行术后重新评估，并继续康复治疗。
我们的案例研究表明，TEER术前和术后的CR有助于改善健康状况较差的老年患者的情况，将他们发生TEER相关并发症的风险降至最低。本病例为这些患者提供了一种可能的CR方案。
