经皮二尖瓣钳夹术治疗重度功能性二尖瓣反流-东南大学学报医学版

经皮二尖瓣钳夹术治疗重度功能性二尖瓣反流

作者：丁建东¹ 徐荣丰¹ 张晓黎¹ 丁秀霞¹ 王臻² 陆启同³ 章晓国¹ 陈立娟¹ 马根山¹

单位：1. 东南大学附属中大医院心内科, 江苏南京 210009;
2. 东南大学附属中大医院麻醉科, 江苏南京 210009;
3. 东南大学附属中大医院心胸外科, 江苏南京 210009

分类号：R542.51

出版年·卷·期（页码）：2021·40·第五期（569-572）

摘要：

经皮二尖瓣钳夹术（MitraClip）已成为治疗二尖瓣反流（MR）的重要选择。对于有症状的严重MR的高手术风险患者，由于合并疾病的严重程度和相关的高死亡风险，MitraClip是一种替代治疗方法。该手术由三维经食管超声心动图（TEE）和X线引导，在二尖瓣前叶和后叶之间放置一个夹子，以减少二尖瓣反流。其优点是避免胸骨切开和体外循环，心脏不停跳下修复二尖瓣，并减少术后机械通气时间，无须转重症监护病房，并不需要输血。在江苏省内本文作者首次对1例56岁反复出现充血性心力衰竭症状患者应用MitraClip治疗因缺血性心肌病导致的重度功能性MR。

The percutaneous MitraClip system is a transcatheter mitral valve repair system that has become an important option for treating mitral regurgitation(MR). MitraClip deployment is an alternative procedure in patients at high surgical risk with severe symptomatic MR who are not candidates for mitral valve(MV) repair/replacement due to their degree of co-morbidity and associated high mortality risk. The procedure is guided by 3-dimensional (3D) transesophageal echocardiography(TEE) and fluoroscopy. A clip is positioned between the anterior and posterior leaflet to reduce valve regurgitation. The advantages of the management are avoidance of sternotomy and cardiopulmonary bypass, beating-heart repair of the MV and reduction in post-operative duration of mechanical ventilation, intensive care unit stay and need for blood transfusion. We present the first case of a MitraClip deployment in an 56-year-old patient who suffered from recurrent symptoms of congestive heart failure due to ischemic cardiomyopathy and concomitant severe FMR in Jiangsu Province.

参考文献：

[1] 丁建东,马根山.心力衰竭合并瓣膜性心脏病介入治疗研究现状[J].中国实用内科杂志,2020,40(12):990-995.
[2] SORAJJA P,VEMULAPALLI S,FELDMAN T,et al.Outcomes with transcatheter mitral valve repair in the united states:an STS/ACC TVT registry report[J].J Am Coll Cardiol,2017,70(19):2315-2327.
[3] KANEKO H,KIRIYAMA H,KAMON T,et al.Percutaneous mitral valve intervention using MitraClip for functional mitral regurgitation and heart failure[J].Int Heart J,2021,62(1):4-8.
[4] NKOMO V T,GARDIN J M,SKELTON T N,et al.Burden of valvular heart diseases:a population-based study[J].Lancet,2006,368(9540):1005-1011.
[5] HU P,LIU X B,LIANG J,et al.A hospital-based survey of patients with severe valvular heart disease in China[J].Int J Cardiol,2017,231:244-247.
[6] 叶蕴青,许海燕,李喆,等.中国不同区域老年瓣膜性心脏病构成和病因分析[J].中华老年心脑血管病杂志,2019,21(7):676-682.
[7] 王华,李莹莹,柴坷,等.中国住院心力衰竭患者流行病学及治疗现状[J].中华心血管病杂志,2019,47(11):865-874.
[8] LAVALL D,HAGENDORFF A,SCHIRMER S H,et al.Mitral valve interventions in heart failure[J].ESC Heart Fail,2018,5(4):552-561.
[9] 葛均波,周达新,潘文志,等.经导管二尖瓣修复术治疗重度二尖瓣返流的初步经验[J].中华心血管病杂志,2013,41(2):99-102.
[10] WHITLOW P L,FELDMAN T,PEDERSEN W R,et al.Acute and 12-month results with catheter-based mitral valve leaflet repair:the EVEREST II(Endovascular Valve Edge-to-Edge Repair)high risk study[J].J Am Coll Cardiol,2012,59(2):130-139.
[11] SORAJJA P,VEMULAPALLI S,FELDMAN T,et al.Outcomes with transcatheter mitral valve repair in the united states:an STS/ACC TVT registry report[J].J Am Coll Cardiol,2017,70(19):2315-2327.
[12] STONE G W,LINDENFELD J,ABRAHAM W T,et al.Transcatheter mitral-valve repair in patients with heart failure[J].N Engl J Med,2018,379(24):2307-2318.

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