Vogel Julia, Luedike Peter, Mahabadi Amir Abbas, Rassaf Tienush, Michel Lars
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany.
Department of Cardiology and Intensive Care Medicine, Niels-Stensen-Kliniken, Marienhospital Osnabrück, Bischofsstr. 1, 49074 Osnabrück, Germany.
Eur Heart J Case Rep. 2024 Dec 12;8(12):ytae601. doi: 10.1093/ehjcr/ytae601. eCollection 2024 Dec.
Mitral and tricuspid regurgitation in patients with cardiac amyloidosis (CA) pose significant diagnostic and therapeutic challenges due to its non-specific symptoms and limited treatment options. Transcatheter edge-to-edge repair (TEER) is complicated by altered cardiac geometry, advanced restriction, and potential amyloid valve deposits.
We present the case of dual TEER in a 79-year-old male with advanced transthyretin cardiac amyloidosis (ATTR-CA) and severe symptomatic mitral and tricuspid regurgitation. In a staged approach, TEER for both the mitral and tricuspid valves was successfully conducted, resulting in improved valvular function and symptom relief. Transvalvular gradients were 5 mmHg for mitral valve and 2 mmHg for tricuspid valve, each with mild residual regurgitation, improved clinical status, and regressive natriuretic peptides.
This case underscores the feasibility of dual TEER in CA patients with valvular involvement. Further research is necessary to optimize treatment strategies and address the multifaceted nature of this complex disease.
心脏淀粉样变性（CA）患者的二尖瓣和三尖瓣反流因其非特异性症状和有限的治疗选择而带来重大的诊断和治疗挑战。经导管缘对缘修复（TEER）因心脏几何形状改变、严重限制以及潜在的淀粉样瓣膜沉积物而变得复杂。
我们报告了一名79岁男性患有晚期转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）以及严重症状性二尖瓣和三尖瓣反流的双TEER病例。采用分期方法，成功对二尖瓣和三尖瓣进行了TEER，瓣膜功能得到改善，症状缓解。二尖瓣跨瓣压差为5 mmHg，三尖瓣为2 mmHg，均伴有轻度残余反流，临床状况改善，利钠肽水平下降。
该病例强调了双TEER在患有瓣膜受累的CA患者中的可行性。有必要进行进一步研究以优化治疗策略并应对这种复杂疾病的多方面性质。
