经导管主动脉瓣和二尖瓣置换术同期进行
Concomitant Transcatheter Aortic and Mitral Valve Replacement.
作者信息
Echarte-Morales Julio, Caneiro-Queija Berenice, Barreiro-Pérez Manuel, Estévez-Cid Francisco, González-Ferreiro Rocío, Piñón-Esteban Miguel, Baz-Alonso José Antonio, Estévez-Loureiro Rodrigo, Iñiguez-Romo Andrés
机构信息
Department of Cardiology, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo (CHUVI), Sergas, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Servizo Galego de Saude, University of Vigo, Vigo, Spain.
Department of Cardiology, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo (CHUVI), Sergas, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Servizo Galego de Saude, University of Vigo, Vigo, Spain.
出版信息
JACC Case Rep. 2025 Jun 25;30(16):103772. doi: 10.1016/j.jaccas.2025.103772. Epub 2025 May 10.
BACKGROUND
Multivalvular heart disease is a highly prevalent condition that causes significant morbidity and mortality.
CASE SUMMARY
A 75-year-old man presented with worsening functional class and asthenia. A transthoracic echocardiogram showed severe aortic stenosis and severe mitral stenosis. The patient underwent transcatheter aortic and mitral valve replacement in the same procedure.
DISCUSSION
There is a lack of solid evidence regarding the management of multivalvular disease. Severe mitral stenosis can influence aortic stenosis, potentially leading to a low-flow, low-gradient profile. Establishing a streamlined workflow between transesophageal echo and cardiac tomography optimizes procedural safety, efficiency, and outcomes in patients with concomitant mitral and aortic disease.
TAKE-HOME MESSAGES: This case highlights the relevance of multimodality imaging for procedural planning in complex multivalvular disease. Concomitant transcatheter implantation of transcatheter aortic valve replacement for aortic stenosis followed by a transcatheter mitral valve replacement in mitral stenosis is a feasible option for patients at high surgical risk.
背景
多瓣膜心脏病是一种高度流行的疾病，可导致严重的发病率和死亡率。
病例摘要
一名75岁男性因功能分级恶化和乏力就诊。经胸超声心动图显示严重主动脉瓣狭窄和严重二尖瓣狭窄。该患者在同一次手术中接受了经导管主动脉瓣和二尖瓣置换术。
讨论
关于多瓣膜疾病的管理缺乏确凿证据。严重二尖瓣狭窄可影响主动脉瓣狭窄，可能导致低流量、低梯度情况。在经食管超声心动图和心脏断层扫描之间建立简化的工作流程可优化伴有二尖瓣和主动脉疾病患者的手术安全性、效率和结果。
要点
本病例强调了多模态成像在复杂多瓣膜疾病手术规划中的相关性。对于手术风险高的患者，先经导管植入主动脉瓣置换术治疗主动脉瓣狭窄，随后经导管植入二尖瓣置换术治疗二尖瓣狭窄是一种可行的选择。
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