支撑鞘与圈套导丝平行锚定技术在经导管三尖瓣置换术中的应用1例  

Parallel anchor-supporting sheath and snared wire technique in transcatheter tricuspid valve replacement:a case report

作　　者：方雁行 潘文志 周达新 葛均波 FANG Yan-xing;PAN Wen-zhi;ZHOU Da-xin;GE Jun-bo(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,National Clinical Research Center for Interventional Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心内科、上海市心血管病研究所、国家放射与治疗临床医学研究中心,上海200032

出　　处：《中国介入心脏病学杂志》2024年第8期478-480,共3页Chinese Journal of Interventional Cardiology

摘　　要：经导管三尖瓣置换术(TTVR)创伤小,恢复快,围术期死亡率远低于外科手术,是三尖瓣外科置换术后生物瓣膜衰败患者的首选治疗方式。但是当输送系统体积较大时,由于外科换瓣后瓣口面积减小,瓣架限制操作,可能会出现输送系统推进困难,并且由于右心路径曲折,导丝提供的支撑力有限,操作难度也会有所增加。本病例报道中的患者即为外科三尖瓣置换后生物瓣衰败,在进行TTVR时出现输送系统跨瓣困难,笔者团队及时运用本中心提出的支撑鞘与圈套导丝平行锚定(PASS)技术,使用大尺寸支撑鞘联合圈套器套住主路加硬导丝头端,将曲折路径拉直,为加硬导丝提供额外支撑力,最终成功推进输送系统跨过三尖瓣,为破解TTVR术中跨瓣困难提供了切实有效的借鉴。Transcatheter tricuspid valve replacement(TTVR)is characterized by minimal invasiveness,rapid recovery,and a significantly lower perioperative mortality rate compared to surgical procedures.It is the preferred treatment for patients with bioprosthetic valve failure following surgical tricuspid valve replacement.However,when the delivery system is relatively bulky,challenges can arise due to the reduced orifice area post-surgery and the constraints imposed by the valve frame.These factors may result in difficulties advancing the delivery system.Additionally,the tortuous right heart pathway and limited support provided by the guide wire further increase the complexity of the procedure.In the present case,the patient experienced bioprosthetic valve failure following surgical tricuspid valve replacement.During TTVR,the advancement of the delivery system across the tricuspid valve encountered difficulties.Our team promptly employed the parallel anchoring-supporting sheath and snared wire(PASS)technique,pioneered at our center.Utilizing a large supporting sheath in conjunction with a snare to secure the tip of a extra-stiffguide wire,we straightened the tortuous pathway,providing additional support to the extra-stiffguide wire.This maneuver successfully facilitated the advancement of the delivery system across the tricuspid valve,offering a practical and effective solution for overcoming intraoperative challenges associated with TTVR.

关 键 词：经导管三尖瓣置换术 输送系统 圈套器 支撑鞘 推进技术 

分 类 号：R54[医药卫生—心血管疾病]