PDF(Pubmed)
Abstract：
UNASSIGNED: Transcatheter mitral valve replacement (TMVR) is a valuable treatment option in patients with severe mitral regurgitation. Prior transapical transcatheter aortic valve replacement (TA-TAVR) may complicate the procedure and is therefore considered a relative contraindication. In this case report, the authors describe the successful TMVR as a tertiary cardiac surgery and transapical redo procedure.
UNASSIGNED: An 83-year-old male patient, suffering from dyspnoea and angina, was diagnosed with severe mitral valve regurgitation (MR). He had already undergone cardiac surgery in the form of coronary artery bypass grafting at the age of 64 and TA-TAVR at 79 years. After a failed attempt at mitral valve transcatheter edge-to-edge repair, he opted for TMVR. Pre-TMVR computed tomography simulation was used to analyse possible interactions between the prostheses and to predict the neo-left ventricular outflow tract (neo-LVOT). The operation was carried out without complications. There was no bleeding and the LV function remained unchanged. On MRI, the valves were perfectly aligned without any signs of paravalvular leakage or LVOT obstruction. The patient was discharged seven days postoperatively. At the one-year follow up, there was no need for rehospitalisation and the patient had clinically improved (from NYHA IV to II). Echocardiography demonstrated a mean transvalvular gradient of under 5 mmHg and no residual MR.
UNASSIGNED: A redo transapical access for TMVR as a tertiary cardiac operation can be easily performed. Pre-operative CT suggested good alignment of the aortic and mitral valved stent which was confirmed postoperatively.
UNASSIGNED: An 83-year-old male patient, suffering from dyspnoea and angina, was diagnosed with severe mitral valve regurgitation (MR). He had already undergone cardiac surgery in the form of coronary artery bypass grafting at the age of 64 and TA-TAVR at 79 years. After a failed attempt at mitral valve transcatheter edge-to-edge repair, he opted for TMVR. Pre-TMVR computed tomography simulation was used to analyse possible interactions between the prostheses and to predict the neo-left ventricular outflow tract (neo-LVOT). The operation was carried out without complications. There was no bleeding and the LV function remained unchanged. On MRI, the valves were perfectly aligned without any signs of paravalvular leakage or LVOT obstruction. The patient was discharged seven days postoperatively. At the one-year follow up, there was no need for rehospitalisation and the patient had clinically improved (from NYHA IV to II). Echocardiography demonstrated a mean transvalvular gradient of under 5 mmHg and no residual MR.
UNASSIGNED: A redo transapical access for TMVR as a tertiary cardiac operation can be easily performed. Pre-operative CT suggested good alignment of the aortic and mitral valved stent which was confirmed postoperatively.
摘要：
■经导管二尖瓣置换术（TMVR）是重度二尖瓣反流患者的一种有价值的治疗选择。先前的经心尖经导管主动脉瓣置换术（TA-TAVR）可能会使手术复杂化，因此被认为是相对禁忌症。在这个案例报告中,作者将成功的TMVR描述为三级心脏手术和经心尖重做手术.
■一名83岁的男性患者,患有呼吸困难和心绞痛，被诊断为严重的二尖瓣反流（MR）。他已经在64岁时接受了冠状动脉旁路移植术的心脏手术，在79岁时接受了TA-TAVR的手术。二尖瓣经导管边缘到边缘修复失败后，他选择了TMVR。使用TMVR前计算机断层扫描模拟来分析假体之间可能的相互作用并预测新左心室流出道（neo-LVOT）。手术无并发症。没有出血，LV功能保持不变。核磁共振成像,瓣膜完全对齐,没有任何瓣周漏或LVOT阻塞的迹象.患者术后7天出院。在为期一年的随访中，无需再住院,患者的临床症状有所改善(从NYHAIV至II).超声心动图显示平均跨瓣梯度低于5mmHg，没有残留MR。
■将TMVR重做经心尖入路作为三级心脏手术可以很容易地进行。术前CT提示主动脉和二尖瓣支架对准良好，术后证实。
■一名83岁的男性患者,患有呼吸困难和心绞痛，被诊断为严重的二尖瓣反流（MR）。他已经在64岁时接受了冠状动脉旁路移植术的心脏手术，在79岁时接受了TA-TAVR的手术。二尖瓣经导管边缘到边缘修复失败后，他选择了TMVR。使用TMVR前计算机断层扫描模拟来分析假体之间可能的相互作用并预测新左心室流出道（neo-LVOT）。手术无并发症。没有出血，LV功能保持不变。核磁共振成像,瓣膜完全对齐,没有任何瓣周漏或LVOT阻塞的迹象.患者术后7天出院。在为期一年的随访中，无需再住院,患者的临床症状有所改善(从NYHAIV至II).超声心动图显示平均跨瓣梯度低于5mmHg，没有残留MR。
■将TMVR重做经心尖入路作为三级心脏手术可以很容易地进行。术前CT提示主动脉和二尖瓣支架对准良好，术后证实。
