Nogales Eliú D P, Cabrera Francisco J, Del Mar Ávila Maria, Reyes Elisabet V
Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas, Spain.
Catheter Cardiovasc Interv. 2025 Jan;105(1):181-183. doi: 10.1002/ccd.31312. Epub 2024 Nov 25.
This case report shows a valve in valve procedure in pulmonary position of a 19-year-old male with a repaired Tetralogy of Fallot. After initial correction, a Mitroflow 23 mm bioprosthetic valve was implanted in pulmonary position. Nine years later severe degeneration of the valve occurred. He underwent percutaneous Melody valve implantation after balloon valvuloplasty and controlled rupture of the Mitroflow prosthesis. A fragment from the fractured prosthesis migrated to the right pulmonary artery without clinical consequences. Postimplantation echocardiography revealed improved hemodynamics. Percutaneous valve implantation on a degenerated bioprosthetic valve is a rising technique with some concerns such as prosthetic-patient mismatch and potential debris embolization. This report emphasizes the successful use of balloon fracture to achieve larger diameters for the newly implanted valve and notes that debris embolization does not appear to have a clinical impact.
本病例报告展示了一名19岁法洛四联症修复术后男性患者肺动脉位置的瓣中瓣手术。初次矫正后，在肺动脉位置植入了一枚23毫米的Mitroflow生物瓣。九年后，瓣膜发生严重退变。他在球囊瓣膜成形术及Mitroflow人工瓣膜可控破裂后接受了经皮Melody瓣膜植入术。破裂人工瓣膜的一个碎片迁移至右肺动脉，但未产生临床后果。植入术后超声心动图显示血流动力学得到改善。在退变生物瓣上进行经皮瓣膜植入是一项不断兴起的技术，但存在一些问题，如人工瓣膜与患者不匹配以及潜在的碎片栓塞。本报告强调了成功使用球囊破裂以获得更大直径的新植入瓣膜，并指出碎片栓塞似乎未产生临床影响。
