Yagasaki Hiroto, Umeda Yukio, Suzuki Takeki, Watanabe Ryota, Noda Toshiyuki
Department of Cardiology, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu 500-8717, Japan.
Department of Medicine, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202-3082, USA.
Eur Heart J Case Rep. 2025 Apr 29;9(5):ytaf211. doi: 10.1093/ehjcr/ytaf211. eCollection 2025 May.
Management of mitral regurgitation (MR) in patients with hereditary spherocytosis (HS) poses unique challenges due to increased haemolysis risk. While surgical mitral valve repair is the standard treatment, the optimal strategy for recurrent MR after initial repair remains unclear, particularly regarding the safety and durability of transcatheter interventions in this high-risk population.
A 57-year-old woman with HS developed severe recurrent MR 4 years after initial surgical repair that intentionally omitted annuloplasty to minimize haemolysis risk. Given the risks of redo surgery and mechanical valve replacement, mitral valve transcatheter edge-to-edge repair (M-TEER) was performed. The procedure achieved successful MR reduction without causing haemolysis. At the 5-year follow-up, the patient maintained improved functional status with stable moderate MR and no evidence of haemolysis, despite her underlying condition.
This case demonstrates successful long-term outcomes of M-TEER for post-surgical recurrent MR in a patient with HS. The strategic approach-initial ring-less surgical repair followed by M-TEER-suggests a viable treatment pathway for patients with inherited haemolytic disorders, particularly when minimizing prosthetic material exposure is crucial.
由于溶血风险增加，遗传性球形红细胞增多症（HS）患者的二尖瓣反流（MR）管理面临独特挑战。虽然外科二尖瓣修复是标准治疗方法，但初次修复后复发性MR的最佳策略仍不明确，特别是在这个高风险人群中经导管干预的安全性和耐久性方面。
一名57岁的HS女性患者在初次手术修复4年后出现严重复发性MR，初次手术时故意未进行瓣环成形术以尽量降低溶血风险。鉴于再次手术和机械瓣膜置换的风险，实施了二尖瓣经导管缘对缘修复术（M-TEER）。该手术成功降低了MR，且未引起溶血。在5年随访时，尽管患者有基础疾病，但功能状态改善，中度MR稳定，无溶血迹象。
本病例证明了M-TEER对HS患者术后复发性MR的长期成功疗效。这种策略性方法——初次无环手术修复后进行M-TEER——为遗传性溶血性疾病患者提供了一条可行的治疗途径，特别是在尽量减少假体材料暴露至关重要的情况下。
