经导管缘对缘修复治疗房性功能性二尖瓣、三尖瓣重度反流1例  

A case of transcatheter edge-to-edge repair performed on a patient with severe atrial functional mitral and tricuspid regurgitation

作　　者：周逸蒋[1] 夏炜聪 王凯 李军 崔亚薇 王开立 牟芸[2] 库沙尼·热依汉 郭晓纲[1] ZHOU Yi-jiang;XIA Wei-cong;WANG Kai;LI Jun;CUI Ya-wei;WANG Kai-li;MOU Yun;Kushani·Reyihan;GUO Xiao-gang(Department of Cardiology,the First Affiliated Hospital,Zhejiang University,Hangzhou 310006,China;Echocardiography and Vascular Ultrasound Centre,the First Affiliated Hospital,Zhejiang University,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属第一医院心血管内科,浙江杭州310006 [2]浙江大学医学院附属第一医院心血管超声中心,浙江杭州310006

出　　处：《中国介入心脏病学杂志》2025年第4期236-240,共5页Chinese Journal of Interventional Cardiology

基　　金：国家重点研发计划项目(2023YFC3606500);浙江省自然科学基金项目(LY21H020007);江西省自然科学基金资助项目(20242BAB25431);江西省重点研发计划项目(20243BBI91021)。

摘　　要：持续性心房颤动等因素可致二尖瓣、三尖瓣瓣环扩张及瓣叶对合不全,诱发房性功能性二尖瓣和三尖瓣重度反流,患者常出现明显心力衰竭症状且预后不良。对外科手术高危或禁忌的单纯二尖瓣或三尖瓣重度反流患者,经导管缘对缘修复(TEER)是重要的替代疗法,可有效减轻瓣膜反流并改善心功能;虽缺乏针对房性功能性反流的大规模数据,现有经验仍显示TEER可显著减少反流、提高患者的生活质量。然而,双瓣介入治疗存在挑战,特别是双瓣同期联合TEER修复技术更复杂、时间更长,且风险更高。国外数据表明,同期或者分期双瓣介入修复均可有效改善心功能并提高生存率,但最佳的介入策略仍待进一步研究。我国因三尖瓣TEER器械尚未上市,目前只能采取分期处理。本病例报道1例房性功能性二尖瓣、三尖瓣重度反流的患者,成功行分期TEER。1年随访,双瓣反流持续改善,表明了分期行TEER双房室瓣反流是一种可行且有效的治疗方案。Persistent atrial fibrillation and other factors can cause mitral and tricuspid annular dilation and leaflet regurgitation,leading to severe functional mitral and tricuspid regurgitation.Patients often experience significant heart failure symptoms and poor prognosis.For patients with severe mitral or tricuspid regurgitation who are at high risk or contraindicated for surgical procedures,transbronchial repair(TEER)is an important alternative therapy that can effectively reduce valve regurgitation and improve cardiac function;Although there is a lack of large-scale data on atrial functional reflux,existing experience still shows that TEER can significantly reduce reflux and improve patients'quality of life.However,double valve intervention therapy poses challenges,especially when combined with TEER repair,which is technically more complex,time-consuming,and carries higher risks.Foreign data shows that simultaneous or staged double valve intervention can safely improve cardiac function and increase survival rates,but the optimal intervention strategy still needs further research.Due to the fact that tricuspid TEER devices have not yet been launched in China,only staged treatment can 4be adopted at present.This case report shows a patient with severe atrial functional mitral and tricuspid regurgitation who underwent staged transcatheter edge to edge repair surgery successfully.During a 1-year follow-up,bilateral valve regurgitation continued to improve,indicating that staged repair of bilateral atrioventricular valve regurgitation through the catheter margin is a feasible and effective treatment option.

关 键 词：经导管缘对缘修复 二尖瓣反流 三尖瓣反流 

分 类 号：R54[医药卫生—心血管疾病]