■经导管二尖瓣置换术(TMVR)正在发展;然而,限制包括二尖瓣小叶严重钙化和二尖瓣环钙化(MAC),这可能与不完全的阀门膨胀有关。冲击波血管内碎石术(IVL)辅助经皮二尖瓣成形术治疗钙化性二尖瓣狭窄已有报道。我们描述了人类首次使用IVL辅助的经间隔TMVR和Intrepid瓣膜治疗严重狭窄和反流患者的严重钙化的二尖瓣。
■一名83岁患有风湿性心脏病和严重MAC(MAC评分,10;钙体积评分,7756cm3)合并二尖瓣狭窄和反流(瓣膜面积,1.5cm2;3二尖瓣反流[MR])和药物难治性心力衰竭症状,并被纳入APOLLO(重度症状性二尖瓣反流患者的Medtronic无畏TMVR系统经导管二尖瓣置换术)无畏瓣TMVR试验。通过在植入前穿过二尖瓣环放置的两个8.0×60-mmM5球囊递送的冲击波IVL促进了48-mmIntrepid瓣膜的经中隔植入。IVL和瓣膜植入期间的脑栓塞保护由Sentinel装置和左锁骨下球囊闭塞提供。
■尽管最初的植入后瓣膜框架变形和中央MR适中,后扩张实现了瓣膜框架的扩张并降低了MR。出院前和30天进行的超声心动图和计算机断层扫描显示前后尺寸的瓣膜框架进行性扩张。增加阀门面积,和先生的决议。
■在自我扩张TMVR之前对重度MAC进行血管内碎石可能会增强环形顺应性,减轻纤维弹性反冲,并最大限度地减少TMVR阀框架的变形。虽然很有希望,在重度MAC中,IVL被认为是TMVR的常规辅助治疗之前,需要进一步研究.
UNASSIGNED: Transcatheter mitral valve replacement (TMVR) is evolving; however, limitations include severe calcification of the mitral valve leaflets and mitral annular calcification (MAC), which may be associated with incomplete valve expansion. Shockwave intravascular
lithotripsy (IVL)-assisted percutaneous mitral valvuloplasty to treat calcific mitral stenosis has been reported. We describe the first human use of IVL-assisted transseptal TMVR with the Intrepid valve to treat a severely calcified mitral valve in a patient with severe stenosis and regurgitation.
UNASSIGNED: An 83-year-old man with rheumatic heart disease and severe MAC (MAC score, 10; calcium volume score, 7756 cm3) presented with combined mitral stenosis and regurgitation (valve area, 1.5 cm2; 3+ mitral regurgitation [MR]) and medically refractory heart failure symptoms and was enrolled into the APOLLO (Transcatheter Mitral Valve Replacement With the Medtronic Intrepid TMVR System in Patients With Severe Symptomatic Mitral Regurgitation) trial of Intrepid valve TMVR. Transseptal implantation of a 48-mm Intrepid valve was facilitated by Shockwave IVL delivered via two 8.0 × 60-mm M5+ balloons placed across the mitral annulus before implantation. Cerebral embolic protection during IVL and valve implant was provided by a Sentinel device and left subclavian balloon occlusion.
UNASSIGNED: Despite initial postimplant valve frame deformation and moderate central MR, postdilation achieved valve frame expansion and reduced MR. Echocardiography and computed tomography performed before hospital discharge and at 30 days show progressive valve frame expansion in the anteroposterior dimension, increased valve area, and resolution of MR.
UNASSIGNED: Intravascular
lithotripsy of severe MAC before self-expanding TMVR may enhance annular compliance, mitigate fibroelastic recoil, and minimize TMVR valve frame deformation. Although promising, further study is required before IVL is considered a routine adjunct for TMVR in severe MAC.