经导管穿刺房间隔行二尖瓣瓣中瓣置换治疗二尖瓣生物瓣膜衰败1例Treatment of Mitral bioprosthesis degeneration by transcatheter mitral valve-in-valve replacement via transseptal puncture:a case report
高政,刘伟丽,屈占军,赵庆哲,江磊
摘要(Abstract):
近年来二尖瓣生物瓣膜的应用比例越来越高,发生瓣膜衰败的患者随之增加,严重影响患者生命质量,而再次开胸手术的高风险令许多二尖瓣衰败的患者失去再次手术的机会。随着介入手术在我国快速发展,经导管二尖瓣瓣中瓣置换术逐渐被广大瓣膜衰败患者所接受。本文介绍1例经导管穿刺房间隔路径的二尖瓣瓣中瓣置换术。通过术前CT详细评估制定手术计划,患者手术顺利,术后未发生并发症。对于二尖瓣生物瓣膜衰败的高危患者来说经导管二尖瓣瓣中瓣置换术不失为一种更好的替代方案。
关键词(KeyWords): 二尖瓣置换;瓣中瓣;二尖瓣生物瓣衰败;经导管;经房间隔
基金项目(Foundation):
作者(Author): 高政,刘伟丽,屈占军,赵庆哲,江磊
参考文献(References):
- [1] Regueiro A,Granada JF,Dagenais F,et al. Transcatheter mitral valve replacement:insights from early clinical experience and future challenges[J]. J Am Coll Cardiol,2017,69(17):2175-2192.DOI:10.1016/j.jacc.2017.02.045.
- [2] Alperi A,Granada JF,Bernier M,et al. Current status and future prospects of transcatheter mitral valve replacement[J]. J Am Coll Cardiol,2021,77(24):3058-3078.DOI:10.1016/j.jacc.2021.04.051.
- [3] Otto CM,Nishimura RA,Bonow RO,et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease:executive summary:a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation,2021,143(5):e35-e71. DOI:10.1161/CIR.0000000000000932.
- [4] Bouleti C,Fassa AA,Himbert D,et al. Transfemoral implantation of transcatheter heart valves after deterioration of mitral bioprosthesis or previous ring annuloplasty[J]. JACC Cardiovasc Interv.,2015,8(1 Pt A):83-91.DOI:10.1016/j.jcin.2014.07.026.
- [5] Cohen MG,Singh V,Martinez CA,et al. Transseptal antegrade transcatheter aortic valve replacement for patients with no other access approach-a contemporary experience[J]. Catheter Cardiovasc Interv,2013,82(6):987-993.DOI:10.1002/ccd.25036.
- [6] Asthana N,Mantha A,Yang EH,et al. Myocardial functional changes in transfemoral versus transapical aortic valve replacement[J]. J Surg Res,2018,221:304-310. DOI:10.1016/j.jss.2017.08.036.
- [7] Alkhouli M,Rihal CS,Holmes DR Jr. Transseptal techniques for emerging structural heart interventions[J]. JACC Cardiovasc Interv,2016,9(24):2465-2480.DOI:10.1016/j.jcin.2016.10.035.
- [8]谭明,崔建.经导管二尖瓣缘对缘修复术的精准房间隔穿刺原理及定位[J].中国介入心脏病学杂志,2023,31(8):615-618. DOI:10.3969/j.issn.1004-8812.2023.08.009.
- [9]钟敬泉,龙德勇,马长生,等.心腔内超声心动图中国专家共识[J].中国心脏起搏与心电生理杂志,2022,36(5):377-403. DOI:10.13333/j.cnki.cjcpe.2022.05.001.
- [10] Blanke P,Naoum C,Dvir D,et al. Predicting LVOT obstruction in transcatheter mitral valve implantation[J]. JACC Cardiovasc Imaging,2017,10(4):482-485. DOI:10.1016/j.jcmg.2016.01.005.
- [11]李然犀,范嘉祺,戴晗怡,等.经导管二尖瓣置换术后左心室流出道梗阻风险的术前评估研究进展[J].中国介入心脏病学杂志,2022,30(11):850-854. DOI:10.3969/j.issn.1004-8812.2022.11.009.
- [12]尚小珂,虞奇峰,杨洁琰,等.经导管二尖瓣置换技术难点概述[J].中国介入心脏病学杂志,2023,31(8):609-614.DOI:10.3969/j.issn.1004-8812.2023.08.008.
- [13] Levine RA,Handschumacher M D,Sanfilippo AJ,et al.Three-dimensional echocardiographic reconstruction of the mitral valve,with implications for the diagnosis of mitral valve prolapse[J]. Circulation,1989,80(3):589-598. DOI:10.1161/01.cir.80.3.589.
- [14] Mih?il? S,Muraru D,Piasentini E,et al. Quantitative analysis of mitral annular geometry and function in healthy volunteers using transthoracic three-dimensional echocardiography[J].J Am Soc Echocardiogr,2014,27(8):846-857. DOI:10.1016/j.echo.2014.04.017.
- [15] Foster GP,Dunn AK,Abraham S,et al. Accurate measurement of mitral annular dimensions by echocardiography:importance of correctly aligned imaging planes and anatomic landmarks[J].J Am Soc Echocardiogr,2009,22(5):458-463. DOI:10.1016/j.echo.2009.02.008.
- [16] Yoon SH,Bleiziffer S,Latib A,et al. Predictors of left ventricular outflow tract obstruction after transcatheter mitral valve replacement[J]. JACC Cardiovasc Interv,2019,12(2):182-193. DOI:10.1016/j.jcin.2018.12.001.
- [17] Blanke P,Naoum C,Webb J,et al. Multimodality imaging in the context of transcatheter mitral valve replacement:establishing consensus among modalities and disciplines[J]. JACC Cardiovasc Imaging,2015,8(10):1191-1208. DOI:10.1016/j.jcmg.2015.08.004.