Dardas Sotirios, Dardas Petros, Mezilis Nikolaos, Tsikaderis Dimitrios, Kofidis Theodoros
Department of Interventional Cardiology, St Luke's Hospital, Panorama, Thessaloniki, 55236, Greece.
Department of Cardiology, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Uttoxeter Rd, Derby, DE22 3NE, UK.
Eur Heart J Case Rep. 2024 Jul 11;8(7):ytae333. doi: 10.1093/ehjcr/ytae333. eCollection 2024 Jul.
Mitral annular calcification (MAC) is common in the elderly. Extensive calcification has been historically challenging for the cardiac surgeons, with traditional surgical approaches carrying significant risks. Less invasive approaches have recently been explored in an attempt to reduce this risk.
We report the case of a 75-year-old woman who presented with recurrent pulmonary oedema, due to severe MAC and mitral regurgitation. Her past medical history included bioprosthetic aortic valve replacement 5 years ago. Given the extensive MAC and the patient's frailty, a minimally invasive hybrid approach with direct implantation of a transcatheter balloon expandable Sapien 3 valve was selected to manage her. Although the post-surgical result was initially excellent with elimination of the mitral regurgitation, the patient's post-operative course was marked by two serious complications, namely, acute severe aortic regurgitation, due to rupture of the bioprosthetic valve's right cusp, and severe paravalvular leak of the Sapien valve, due to posterior migration towards the left atrium. These were managed successfully with emergency valve-in-valve implantation using the 'double chimney' technique for the bioprosthetic aortic valve, as well as transeptal valve-in-valve implantation of a 2nd Sapien valve in the mitral valve, which sealed the gap between the 1st Sapien and the calcified mitral annulus.
This case illustrates a less invasive approach for the management of severe MAC. Complications can still occur in this high-risk group of patients, and therefore, such cases should be managed with close collaboration between cardiac surgeons and cardiologists, in centres with high expertise.
二尖瓣环钙化（MAC）在老年人中很常见。广泛钙化一直是心脏外科医生面临的挑战，传统手术方法存在重大风险。最近人们探索了侵入性较小的方法以降低这种风险。
我们报告一例75岁女性患者，因严重MAC和二尖瓣反流出现反复肺水肿。她的既往病史包括5年前进行生物瓣主动脉瓣置换术。鉴于广泛的MAC和患者的虚弱状况，选择了一种微创杂交方法，直接植入经导管球囊扩张式Sapien 3瓣膜来治疗她。尽管术后最初效果极佳，二尖瓣反流消失，但患者术后病程出现了两个严重并发症，即生物瓣右瓣叶破裂导致急性严重主动脉反流，以及Sapien瓣膜向后向左心房移位导致严重瓣周漏。通过使用“双烟囱”技术对生物瓣主动脉瓣进行紧急瓣中瓣植入，以及在二尖瓣中经房间隔瓣中瓣植入第二个Sapien瓣膜成功处理了这些并发症，该操作封闭了第一个Sapien瓣膜与钙化二尖瓣环之间的间隙。
本病例说明了一种用于治疗严重MAC的侵入性较小的方法。在这类高危患者中仍可能发生并发症，因此，此类病例应由心脏外科医生和心脏病专家在专业水平较高的中心密切合作进行管理。
