二尖瓣生物瓣衰败后瓣中瓣治疗  

Valve-in-valve Treatment for Mitral Bioprosthetic Valve Deterioration

作　　者：张本 李叶阔 胡青锟 林曦 毕海跃 颜福欣 郭珺 王显悦 ZHANGBen;LI Yekuo;HU Qingkun;LIN Xi;BI Haiyue;YAN Fuxin;GUO Jun;WANG Xianyue(Department of Cardiothoracic Surgery,General Hospital of Southern Theater Command,Guangzhou Guangdong510010,China)

机构地区：[1]南部战区总医院心胸外科,广东广州510010

出　　处：《联勤军事医学》2024年第2期113-119,共7页Military Medicine of Joint Logistics

基　　金：广东省医学科学技术研究基金项目(A2023472)。

摘　　要：目的二尖瓣生物瓣衰败后再次手术风险高、难度大,本文旨在对二尖瓣生物瓣衰败后经导管瓣中瓣治疗的手术指征、手术方法、手术要点、手术效果及中远期疗效进行阐述。方法总结两例通过瓣中瓣治疗的二尖瓣生物瓣衰败后心力衰竭患者临床资料,并进行文献复习。结果两例患者均通过经心尖入路实施了瓣中瓣治疗的手术,术后恢复顺利,无明显并发症,分别随访8、19个月,效果良好。结论对于外科手术高危或禁忌的患者,二尖瓣生物瓣衰败后瓣中瓣治疗是一种安全有效的方法;术前仔细的影像学评估是手术成功的重要保障;手术入路应根据术者经验和患者特点进行个体化选择;建议瓣中瓣术后给予长期抗凝治疗。Objective To elaborate the indications,methods,key points,effects and medium and long term curative effects of transcatheter valve in valve procedure after mitral bioprosthetic valve deterioration.Conventional operation for bioprosthetic valve deterioration entails great difficulty and high risk,valve in valve might be a reasonable alternative.Methods Two patients with severe heart failure after mitral bioprosthetic valve deterioration were treated by valve in valve.The clinical data were summarized,and the literature were reviewed.Results Both the patients were successfully treated with valve in valve through the transapical approach,and the postoperative recovery was smooth without obvious complications,and the results were good at 8 and 19 months of the follow-up respectively.Conclusion For patients with high risk or contraindications to surgery,valve in valve treatment after mitral bioprosthetic valve deterioration is a safe and effective method;careful preoperative imaging evaluation is an important guarantee for the success of valve in valve;the surgical approach should be selected individually according to the experience of the surgeon and the characteristics of the patient;long-term anticoagulation therapy after valve in valve is recommended.

关 键 词：生物瓣衰败 二尖瓣 瓣中瓣治疗 疗效 

分 类 号：R654.2[医药卫生—外科学]