Goto Yoshihiro, Takagi Sho, Yanagisawa Junji, Yamamoto Masanori
Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobutori, Oyamacho, Toyohashi 441-8530, Japan.
Department of Cardiology, Toyohashi Heart Center, 21-1 Gobutori, Oyamacho, Toyohashi 441-8530, Japan.
Eur Heart J Case Rep. 2025 Aug 23;9(9):ytaf420. doi: 10.1093/ehjcr/ytaf420. eCollection 2025 Sep.
Mitral regurgitation (MR) may rarely worsen after transcatheter aortic valve implantation (TAVI) due to mechanical interference from the transcatheter heart valve (THV). Standard surgical approaches in these cases are often challenging due to anatomical constraints. Thus, there is a need for the development of effective alternatives to address this issue.
We present a case of a 79-year-old male on chronic haemodialysis who developed acute decompensated heart failure following implantation of a self-expanding THV. Transoesophageal echocardiography revealed anterior mitral leaflet (AML) restriction due to direct contact with the THV stent frame. A totally endoscopic mitral valve replacement (MVR), without robotic assistance, was performed via a right mini-thoracotomy. The AML was partially resected, and a 25 mm bioprosthetic valve was successfully implanted in a supra-annular position. The postoperative course was uneventful, and the patient was discharged on Day 6.
Worsening of MR after TAVI is rare but may occur due to physical interference with mitral valve leaflets. Self-expanding THVs, such as Evolut-FX, may cause leaflet restriction, especially when implanted deep or in patients with small left ventricular outflow tracts. In the present case, the stent protruded beyond the annulus, preventing leaflet motion and leading to symptomatic MR. It was demonstrated that totally endoscopic MVR is a viable minimally invasive approach for post-TAVI MR due to THV interference, even in high-risk patients.
经导管主动脉瓣植入术（TAVI）后，二尖瓣反流（MR）可能因经导管心脏瓣膜（THV）的机械干扰而罕见地加重。由于解剖学限制，这些病例的标准手术方法通常具有挑战性。因此，需要开发有效的替代方法来解决这个问题。
我们报告一例79岁男性慢性血液透析患者，在植入自膨胀式THV后发生急性失代偿性心力衰竭。经食管超声心动图显示，由于与THV支架框架直接接触，前叶二尖瓣（AML）受限。通过右胸小切口进行了完全内镜二尖瓣置换术（MVR），未使用机器人辅助。部分切除AML，并在瓣环上位置成功植入25毫米生物瓣膜。术后过程顺利，患者于第6天出院。
TAVI后MR恶化很少见，但可能由于对二尖瓣叶的物理干扰而发生。自膨胀式THV，如Evolut-FX，可能导致瓣叶受限，尤其是当植入较深或左心室流出道较小的患者中时。在本病例中，支架突出到瓣环之外，阻止瓣叶运动并导致有症状的MR。结果表明，即使在高危患者中，完全内镜MVR也是一种可行的微创方法，用于治疗因THV干扰导致的TAVI后MR。
