Azzola Guicciardi Nicolò, Ascione Guido, Alfieri Ottavio, Maisano Francesco, De Bonis Michele
Department of Cardiac Surgery-Valve Center-IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
Eur Heart J Case Rep. 2024 Jun 26;8(7):ytae305. doi: 10.1093/ehjcr/ytae305. eCollection 2024 Jul.
Some patients affected by mitral valve (MV) prolapse (MVP) are at higher risk of ventricular arrhythmias (VAs), but the underlying pathogenesis, as well as the effects of surgery on VA, remain not fully understood. Mitral valve repair, however, represents a privileged point of view to deepen the understanding of arrhythmogenesis in this context. Hence, we report an interesting case of MV re-repair.
A 52-year-old man was referred to our institution for severe mitral regurgitation (MR) due to P2 prolapse in the context of myxomatous MV degeneration. Pre-operative imaging showed systolic mitral annular disjunction, left ventricular (LV) wall curling, Pickelhaube's sign, and a prolapsing tricuspid valve (TV) with only mild regurgitation. Twenty-four-hour electrocardiogram (ECG) Holter revealed a significant burden of premature ventricular contractions (PVCs), most of them originating from anterior papillary muscle (APM), posterior papillary muscle (PPM), and mitral annulus (MA). Quadrangular resection of P2 and mitral annuloplasty were performed. One year later, relapse of severe MR due to a residual P2M1 prolapse occurred. Twenty-four-hour ECG Holter showed no PVCs from PPM and MA, while those from APM persisted. A central edge-to-edge repair was effectively used to fix the residual prolapse. After 1 year from REDO surgery, a third ECG Holter confirmed the absence of any remaining LV PVCs, but still few ectopic beats originating from TV were recorded.
Here, we report a case of VA resolution after specific, anatomical triggers addressing surgical gestures. Our experience confirms that MV surgery may have a role in MVP patients' arrhythmias correction.
一些患有二尖瓣脱垂（MVP）的患者发生室性心律失常（VA）的风险较高，但潜在的发病机制以及手术对VA的影响仍未完全明确。然而，二尖瓣修复术为深入了解这种情况下的心律失常发生机制提供了一个独特的视角。因此，我们报告了一例有趣的二尖瓣再次修复病例。
一名52岁男性因黏液瘤样二尖瓣退变导致P2脱垂引起严重二尖瓣反流（MR）而转诊至我院。术前影像学检查显示收缩期二尖瓣环分离、左心室（LV）壁卷曲、Pickelhaube征以及三尖瓣（TV）脱垂伴轻度反流。24小时心电图（ECG）动态监测显示室性早搏（PVC）负担较重，其中大多数起源于前乳头肌（APM）、后乳头肌（PPM）和二尖瓣环（MA）。进行了P2四边形切除术和二尖瓣环成形术。一年后，由于残留的P2M1脱垂导致严重MR复发。24小时ECG动态监测显示PPM和MA未出现PVC，而APM起源的PVC仍然存在。采用中央缘对缘修复有效地修复了残留的脱垂。再次手术后1年，第三次ECG动态监测证实左心室未再出现PVC，但仍记录到少数起源于TV的异位搏动。
在此，我们报告了一例在针对手术操作的特定解剖触发因素后VA消失的病例。我们的经验证实二尖瓣手术可能在MVP患者心律失常的纠正中发挥作用。
