Enta Yusuke, Munehisa Yoshiko, Satomi Natsuko, Hayatsu Yukihiro, Tada Norio
Department of Cardiovascular Medicine, Sendai Kousei Hospital, 1-20 Tsutsumidori-amamiya, Aoba Ward, Sendai, Miyagi 9810914, Japan.
Department of Laboratory Medicine, The Jikei University School of Medicine, 3-19-18 Nishi-Shimbashi, Minato Ward, Tokyo 1058471, Japan.
Eur Heart J Case Rep. 2024 Dec 18;9(1):ytae668. doi: 10.1093/ehjcr/ytae668. eCollection 2025 Jan.
Transcatheter edge-to-edge mitral valve repair (M-TEER) using the MitraClip system is primarily performed using the transfemoral approach. However, when this approach is not feasible, the transjugular approach can be used as an alternative.
A 57-year-old man presented with heart failure and persistent New York Heart Association class IV symptoms, refractory to guideline-directed medical therapy, intravenous therapy, and intra-aortic balloon pumping. His medical history included pulmonary embolism secondary to deep vein thrombosis, which occluded the inferior vena cava (IVC). Transthoracic echocardiography (TTE) revealed severe functional mitral regurgitation (FMR). The IVC occlusion made the transfemoral approach impossible; hence, transjugular M-TEER was planned. Transseptal puncture was performed via the right internal jugular (RIJ), 32 mm above the mitral annulus. A Confida wire was positioned in the left ventricle, and a steerable guiding catheter was introduced with 180° clockwise rotation of the +knob for septal crossing through the stiff wire. The MitraClip XTW was inserted into the catheter with a 90° counterclockwise rotation. After adjusting to a straddle position to move the clip laterally, additional knob rotations were performed to position the clip at A2/P2. Once the clip was placed, only trivial mitral regurgitation (MR) remained. No complications occurred, and the patient improved, allowing discharge. Transthoracic echocardiography at 1-year post-procedure demonstrated sustained MR reduction.
We have described the successful completion of M-TEER using the RIJ approach in a patient with severe FMR. Technical considerations in M-TEER require special attention because of limited reports on the M-TEER procedure via the RIJ.
使用MitraClip系统进行经导管二尖瓣缘对缘修复术（M-TEER）主要采用经股动脉途径。然而，当该途径不可行时，经颈静脉途径可作为替代方法。
一名57岁男性因心力衰竭就诊，纽约心脏协会心功能分级持续为IV级，对指南指导的药物治疗、静脉治疗和主动脉内球囊反搏均无效。他的病史包括继发于深静脉血栓形成的肺栓塞，该血栓阻塞了下腔静脉（IVC）。经胸超声心动图（TTE）显示严重功能性二尖瓣反流（FMR）。IVC阻塞使经股动脉途径无法实施；因此，计划行经颈静脉M-TEER。经右颈内静脉（RIJ）在二尖瓣环上方32 mm处进行房间隔穿刺。将Confida导丝置于左心室，并通过将 +旋钮顺时针旋转180°引入可操控的引导导管，使其穿过硬导丝进入房间隔。将MitraClip XTW逆时针旋转90°后插入导管。调整至跨瓣位置以横向移动夹子后，再进行额外的旋钮旋转操作，将夹子置于A2/P2位置。夹子放置好后，仅残留微量二尖瓣反流（MR）。未发生并发症，患者病情改善并得以出院。术后1年的经胸超声心动图显示MR持续减轻。
我们描述了在一名严重FMR患者中使用RIJ途径成功完成M-TEER的病例。由于关于经RIJ途径的M-TEER手术的报道有限，因此M-TEER的技术要点需要特别关注。
