Murata Naoki, Endo Daisuke, Hayashi Hidemori, Tabata Minoru
Department of Cardiovascular Surgery, Juntendo University School of Medicine, 2-2-1, Hongo, Bunkyo, Tokyo, 113-8431, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University School of Medicine, 2-2-1, Hongo, 113-8431, Bunkyo, Tokyo, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 May 28;4(1):26. doi: 10.1186/s44215-025-00210-9.
Arrhythmic mitral regurgitation (MR), characterized by mitral valve prolapse accompanied by ventricular arrhythmias, poses diagnostic and therapeutic challenges. Treatment decisions, including the necessity for concomitant surgical ablation and the identification of specific ablation points, are highly case-specific and lack a consensus approach. Once determined, high-definition endoscopes and adaptable cryoablation tools facilitate simultaneous mitral valve repair and targeted surgical ablation via a minimally invasive approach, ensuring optimal visualization.
The patient was a 49-year-old female with an episode of ventricular fibrillation. Severe MR was diagnosed at that time; however, surgery was not selected due to the absence of symptoms and left ventricular dysfunction. An implantable cardioverter-defibrillator was subsequently placed, which activated twice. Over the last 6 months, she developed dyspnea and was referred to us, where she was diagnosed with symptomatic arrhythmic MR. Subsequently, she underwent totally endoscopic minimally invasive mitral valve repair and papillary muscle cryoablation. Postoperative echocardiography showed trivial MR, with a mean pressure gradient of 1 mmHg, and an ejection fraction of 56%. She was discharged home on the fifth postoperative day. The Holter electrocardiogram performed 6 months after surgery showed no ventricular arrhythmias originating from the papillary muscles.
We successfully diagnosed and treated a patient with symptomatic arrhythmic MR. Simultaneous mitral valve repair and papillary muscle cryoablation, performed through a totally endoscopic minimally invasive approach, was found to be effective in managing this complex condition.
节律失常性二尖瓣反流（MR），其特征为二尖瓣脱垂伴有室性心律失常，带来了诊断和治疗方面的挑战。治疗决策，包括是否有必要同时进行手术消融以及确定具体的消融点，高度依赖具体病例，且缺乏共识性方法。一旦确定，高清内窥镜和可适配的冷冻消融工具有助于通过微创方法同时进行二尖瓣修复和靶向手术消融，确保最佳可视化效果。
该患者为一名49岁女性，曾发生一次心室颤动。当时诊断为严重MR；然而，由于无症状且无左心室功能障碍，未选择手术治疗。随后植入了植入式心律转复除颤器，该装置两次激活。在过去6个月里，她出现呼吸困难，遂转诊至我院，被诊断为有症状的节律失常性MR。随后，她接受了全内镜微创二尖瓣修复和乳头肌冷冻消融术。术后超声心动图显示微量MR，平均压力阶差为1 mmHg，射血分数为56%。术后第5天她出院回家。术后6个月进行的动态心电图显示未出现源自乳头肌的室性心律失常。
我们成功诊断并治疗了一名有症状的节律失常性MR患者。通过全内镜微创方法同时进行二尖瓣修复和乳头肌冷冻消融，被发现对处理这种复杂病情有效。
