经导管二尖瓣植入术治疗严重二尖瓣环钙化：一例报告
Transcatheter mitral valve implantation in severe mitral annular calcification: a case report.
作者信息
Russo Giulio, Maffi Valerio, Massaro Gianluca, Chiricolo Gaetano, Sangiorgi Giuseppe Massimo, Moschovitis Aris, Taramasso Maurizio
机构信息
Department of Biomedicine and Prevention, Cardiology Unit, Policlinico Tor Vergata, University of Rome, 00100 Rome, Italy.
HerzZentrum Hirslanden, 8032 Zurich, Switzerland.
出版信息
Eur Heart J Case Rep. 2024 Dec 31;9(1):ytae669. doi: 10.1093/ehjcr/ytae669. eCollection 2025 Jan.
BACKGROUND
Mitral annular calcification (MAC) is characterized by severe calcification of mitral annulus and might be associated with both mitral regurgitation and stenosis. It is technically challenging for both surgical and percutaneous approach and is burdened by high mortality.
CASE SUMMARY
The present case report describes a complex case of mitral steno-insufficiency (baseline transvalvular gradient = 5 mmHg, effective regurgitant orifice area 0.45 cm, vena contracta 0.8 cm), due to MAC in an 83-year-old lady. In consideration of the clinical context (MAC) and patient's several comorbidities and history of previous surgical interventions, she was deemed not suitable for surgery and a percutaneous treatment was selected (valve-in-MAC). Due to significant paravalvular leak, further implantation of a plug was required.
CONCLUSION
The MAC represents a clinical and technical challenge for surgery. Transcatheter mitral valve implantation in MAC is a feasible alternative although it is technically challenging and burdened by high mortality. Detailed procedural planning is of utmost importance to achieve successful outcomes.
背景
二尖瓣环钙化（MAC）的特征是二尖瓣环严重钙化，可能与二尖瓣反流和狭窄均相关。对于外科手术和经皮治疗方法而言，它在技术上都具有挑战性，且死亡率很高。
病例摘要
本病例报告描述了一名83岁女性因MAC导致二尖瓣狭窄伴关闭不全的复杂病例（基线跨瓣压差 = 5 mmHg，有效反流口面积0.45 cm，反流束颈宽0.8 cm）。考虑到临床情况（MAC）以及患者的多种合并症和既往手术干预史，认为她不适合手术，因此选择了经皮治疗（MAC内瓣膜植入）。由于存在明显的瓣周漏，需要进一步植入封堵器。
结论
MAC对外科手术而言是一项临床和技术挑战。尽管经导管二尖瓣植入术在技术上具有挑战性且死亡率很高，但它是一种可行的替代方法。详细的手术规划对于取得成功的结果至关重要。
Zotero 插件