Yagasaki Hiroto, Suzuki Takeki, Watanabe Keitaro, Oshima Yoshitake, Noda Toshiyuki
Cardiology, Gifu Prefectural General Medical Center, Gifu, JPN.
Medicine, Indiana University School of Medicine, Indianapolis, USA.
Cureus. 2024 Oct 18;16(10):e71793. doi: 10.7759/cureus.71793. eCollection 2024 Oct.
Mitral valve transcatheter edge-to-edge repair (M-TEER), a minimally invasive procedure that uses a clip to join the mitral valve leaflets, has emerged as an established treatment for severe mitral regurgitation (MR) in drug-refractory heart failure (HF). This case report presents an 80-year-old cardiac resynchronization therapy (CRT) non-responder with a complex cardiac history who underwent successful M-TEER. Despite optimal therapy, including CRT, she experienced recurrent HF symptoms. While resting echocardiography showed mild MR, exercise stress echocardiography (ESE) revealed severe MR. The M-TEER procedure resulted in trivial residual MR and significant symptom improvement. The patient's New York Heart Association (NYHA) functional class improved from III to I, with sustained benefits for three years post procedure. This case highlights the importance of comprehensive MR assessment, including ESE, in complex scenarios. It also underscores the potential long-term benefits of M-TEER in carefully selected CRT non-responders, even with borderline right ventricular function, when supported by thorough multidisciplinary evaluation.
二尖瓣经导管缘对缘修复术（M-TEER）是一种微创手术，通过夹子连接二尖瓣叶，已成为药物难治性心力衰竭（HF）中重度二尖瓣反流（MR）的既定治疗方法。本病例报告介绍了一名80岁的心脏再同步治疗（CRT）无反应者，其有复杂的心脏病史，成功接受了M-TEER治疗。尽管接受了包括CRT在内的最佳治疗，但她仍反复出现HF症状。静息超声心动图显示轻度MR，而运动负荷超声心动图（ESE）显示重度MR。M-TEER手术导致微量残余MR，并显著改善症状。患者的纽约心脏协会（NYHA）功能分级从III级改善到I级，术后三年持续受益。本病例强调了在复杂情况下进行包括ESE在内的全面MR评估的重要性。它还强调了M-TEER在经过精心挑选的CRT无反应者中潜在的长期益处，即使右心室功能处于临界状态，在经过全面的多学科评估支持下也是如此。
