经导管二尖瓣瓣中瓣置换术治疗二尖瓣生物瓣假体衰败一例  

Valve-in-valve transcatheter mitral valve replacement for the treatment of degenerated mitral bioprostheses:a case report

作　　者：晏梦云 冯沅[1] 陈飞[1] 朱中凯 赵振刚[1] 陈茂[1] YAN Mengyun;FENG Yuan;CHEN Fei;ZHU Zhongkai;ZHAO Zhengang;CHEN Mao(Department of Cardiology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院心脏内科,成都610041

出　　处：《华西医学》2024年第9期1371-1374,共4页West China Medical Journal

基　　金：国家自然科学基金(81901825);四川大学华西医院学科卓越发展1·3·5工程项目(2024HXFH038)。

摘　　要：外科二尖瓣生物瓣置换术后瓣膜多在10~15年发生衰败,需再次进行二尖瓣手术。既往此类患者只能选择再次进行外科开胸二尖瓣置换,尽管再次心内直视手术的风险更高。近年来,通过“瓣中瓣”植入实现经导管二尖瓣置换的介入治疗方式已成为再次外科开胸手术的合理替代方案。该文报道了1例二尖瓣生物瓣衰败的81岁女性患者,尽管因双侧巨大心房伴小心室腔等解剖原因介入操作难度高,但基于完善的术前CT评估,最终成功地经股静脉-房间隔途径实施了经导管二尖瓣置换术。Surgical bioprosthetic valve in the mitral position typically degenerates in 10-15 years,when intervention is required again.In the past,redo surgical mitral valve replacement has been the only treatment choice for such patients suffering from bioprosthetic valve failure,despite the even higher risk associated with redo open-heart surgery.In recent years,transcatheter valve-in-valve implantation in the mitral position has evolved as an reasonable alternative to redo surgery for the treatment of surgical mitral bioprosthetic valve failure.Here we report an 81-year-old female patient with surgical mitral bioprosthetic valve failure,who successfully underwent valve-in-valve transcatheter mitral valve replacement via the transfemoral-transseptal approach.The procedure was successful owing to comprehensive CT imaging work-up,despite the technical challenges associated with bilateral giant atria and small left ventricle.

关 键 词：二尖瓣置换 生物瓣衰败 经导管 经房间隔 瓣中瓣 

分 类 号：R654.2[医药卫生—外科学]