Patrascu Alexandru, Binder Donat, Schnabel Peter, Weinmann Kai, Ott Ilka
Department of Cardiology, Helios Hospital Pforzheim, Kanzlerstrasse 2-6, 75175 Pforzheim, Germany.
Private University in the Principality of Liechtenstein (UFL), Triesen, Principality of Liechtenstein.
Eur Heart J Case Rep. 2024 Jul 16;8(7):ytae348. doi: 10.1093/ehjcr/ytae348. eCollection 2024 Jul.
Transcatheter edge-to-edge repair (TEER) for the systemic atrioventricular valve has been anecdotally reported as a viable treatment option in symptomatic inoperable adult patients born with congenitally corrected transposition of the great arteries (ccTGA). However, to date, case reports on TEER treatment of both atrioventricular valves are lacking, especially when considering the present availability of specific mitral and tricuspid valve TEER devices.
We present the case of an 84-year-old man with recurrent admissions for acute heart failure due to high-grade regurgitation of both atrioventricular valves. The patient was first diagnosed with ccTGA at this advanced age and underwent a thorough multimodality imaging approach, including transthoracic and transoesophageal echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, and ventriculography of the systemic ventricle. Due to the high symptom burden despite optimal medical therapy and high doses of diuretics, the heart team recommended TEER, first for the systemic tricuspid valve and later on for the non-systemic mitral valve. Both complex procedures were uneventful and led to considerable improvement in quality of life.
Congenitally corrected transposition of the great arteries mostly manifests itself in adulthood and affects both ventricles and atrioventricular valves. In case of anatomical doubts on transthoracic echocardiography, a thorough multimodality imaging work-up is recommended. Transcatheter treatment of both atrioventricular valves seems to be a safe and effective therapeutic option in these often inoperable patients.
经导管缘对缘修复术（TEER）治疗系统性房室瓣，已有报道称这是一种治疗有症状但无法手术的先天性矫正型大动脉转位（ccTGA）成年患者的可行治疗选择。然而，迄今为止，缺乏关于TEER治疗两个房室瓣的病例报告，特别是考虑到目前特定二尖瓣和三尖瓣TEER装置的可用性。
我们报告了一例84岁男性患者，因两个房室瓣严重反流反复入院治疗急性心力衰竭。该患者在高龄时首次被诊断为ccTGA，并接受了全面的多模态成像检查，包括经胸和经食管超声心动图、心脏磁共振成像、心脏计算机断层扫描以及系统性心室造影。尽管进行了最佳药物治疗并使用了高剂量利尿剂，但由于症状负担仍然很重，心脏团队建议进行TEER治疗，首先针对系统性三尖瓣，随后针对非系统性二尖瓣。这两个复杂手术均顺利完成，并使患者生活质量得到显著改善。
先天性矫正型大动脉转位大多在成年期出现，影响两个心室和房室瓣。如果经胸超声心动图存在解剖学疑问，建议进行全面的多模态成像检查。对于这些通常无法手术的患者，经导管治疗两个房室瓣似乎是一种安全有效的治疗选择。
