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经导管瓣周漏装置闭合二尖瓣的并发症：文献回顾的更新和一例罕见病例报告。

Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation.

机构信息

Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Firoozgar Clinical Research and Development Center, Iran University of Medical Sciences, Tehran, Iran.

出版信息

Clin Cardiol. 2024 May;47(5):e24272. doi: 10.1002/clc.24272.

DOI:10.1002/clc.24272
PMID:38742736
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11092304/
Abstract

Paravalvular leak (PVL) is an uncommon complication of prosthetic valve implantation, which can lead to infective endocarditis, heart failure, and hemolytic anemia. Surgical reintervention of PVLs is associated with high mortality rates. Transcatheter PVL closure (TPVLc) has emerged as an alternative to surgical reoperation. This method provides a high success rate with a low rate of complications. This article reviews the pathogenesis, clinical manifestation, diagnosis, and management of PVL and complications following TPVLc. Besides, we presented a case of a patient with severe PVL following mitral valve replacement, who experienced complete heart block (CHB) during TPVLc. The first TPVLc procedure failed in our patient due to possible AV-node insult during catheterization. After 1 week of persistent CHB, a permanent pacemaker was implanted. The defect was successfully passed using the previous attempt. Considering the advantages of TPVLc, procedure failure should be regarded as a concern. TPVLc should be performed by experienced medical teams in carefully selected patients.

摘要

瓣周漏（PVL）是人工瓣膜植入术后一种罕见的并发症，可导致感染性心内膜炎、心力衰竭和溶血性贫血。PVL 的手术再干预与高死亡率相关。经导管 PVL 封堵（TPVLc）已成为手术再手术的替代方法。该方法具有较高的成功率和较低的并发症发生率。本文回顾了 PVL 的发病机制、临床表现、诊断和治疗以及 TPVLc 后的并发症。此外，我们还介绍了 1 例二尖瓣置换术后严重 PVL 患者，在 TPVLc 过程中发生完全性心脏阻滞（CHB）。由于可能在导管插入过程中损伤房室结，我们的患者首次 TPVLc 手术失败。在持续 CHB 1 周后，植入了永久性起搏器。使用之前的尝试成功地通过了该缺陷。鉴于 TPVLc 的优势，手术失败应被视为一个关注点。TPVLc 应由经验丰富的医疗团队在精心挑选的患者中进行。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0246/11092304/0067215d5a2e/CLC-47-e24272-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0246/11092304/d7a306c4f53f/CLC-47-e24272-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0246/11092304/97df057513a7/CLC-47-e24272-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0246/11092304/0067215d5a2e/CLC-47-e24272-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0246/11092304/d7a306c4f53f/CLC-47-e24272-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0246/11092304/97df057513a7/CLC-47-e24272-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0246/11092304/0067215d5a2e/CLC-47-e24272-g004.jpg

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