Kurashima Shinichi, Amaki Makoto, Fujita Tomoyuki, Kitai Takeshi, Izumi Chisato
Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka 564-8565, Japan.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka 564-8565, Japan.
Eur Heart J Case Rep. 2025 May 26;9(6):ytaf265. doi: 10.1093/ehjcr/ytaf265. eCollection 2025 Jun.
Left ventricular (LV) rupture is an extremely rare but possible complication after mitral transcatheter edge-to-edge repair (M-TEER). We describe a delayed LV rupture after M-TEER that was successfully treated with surgical repair.
An 83-year-old Asian male with congestive heart failure was referred for treatment of severe mitral regurgitation (MR) due to A1/A2 segment prolapse with abnormally hypertrophied anterior papillary muscle. The patient was at high surgical risk, and M-TEER with MitraClip (Abbott Vascular, Minneapolis, MN, USA) was performed. During the procedure, an NT clip became entangled between the hypertrophied papillary muscle and the LV inferolateral wall. After disentangling the clip, we aimed the clip for a second attempt slightly towards the medial side and inserted it into the LV, avoiding interference with the subvalvular apparatus or LV wall. Grasping in this position significantly reduced MR to mild. The patient was initially stable, but sudden cardiac arrest occurred 75 min post-procedure, and subsequent echocardiography revealed massive pericardial effusion. Emergent sternotomy revealed a tear at the LV basal inferolateral wall just behind the anterior papillary muscle. Surgical patch repair and mitral valve replacement were performed, and the patient was discharged without neurological sequelae.
The entrapment of the clip between the hypertrophied papillary muscle and the hypercontractile LV wall may have caused a crack in the LV wall, disrupting the endocardium. In elderly patients with primary MR, especially those with commissural lesions and limited LV space, clinicians should be cautious of LV rupture even after the procedure.
左心室破裂是二尖瓣经导管缘对缘修复术（M-TEER）后一种极其罕见但可能出现的并发症。我们描述了1例M-TEER术后延迟发生的左心室破裂，该患者通过手术修复获得成功治疗。
一名83岁的亚洲男性，患有充血性心力衰竭，因A1/A2段脱垂伴异常肥厚的前乳头肌导致严重二尖瓣反流（MR）而前来接受治疗。该患者手术风险高，遂行使用MitraClip（美国雅培血管公司，明尼阿波利斯，明尼苏达州）的M-TEER手术。术中，一枚NT夹子缠绕在肥厚的乳头肌与左心室下外侧壁之间。解开夹子后，我们将夹子稍向内侧再次尝试并插入左心室，避免干扰瓣下结构或左心室壁。在此位置夹合显著将MR降至轻度。患者最初情况稳定，但术后75分钟突然发生心脏骤停，随后超声心动图显示大量心包积液。急诊胸骨切开术发现前乳头肌后方的左心室基底下外侧壁有一处撕裂。进行了手术补片修复和二尖瓣置换术，患者出院时无神经后遗症。
夹子夹在肥厚的乳头肌与收缩力过强的左心室壁之间可能导致左心室壁出现裂缝，破坏了心内膜。对于原发性MR的老年患者，尤其是那些有连合处病变且左心室空间有限的患者，临床医生即使在术后也应警惕左心室破裂。
