经导管二尖瓣修复术治疗重度二尖瓣反流的初步经验

摘要

目的 评估运用MitraClip系统行经导管二尖瓣修复术(TMVR)治疗重度二尖瓣反流的安全性及有效性,并对初步的手术经验做一总结.方法 2012年5月,使用MitraClip系统对3例重度二尖瓣反流患者实施TMVR.其中,二尖瓣脱垂(器质性)1例,功能性二尖瓣反流2例.分析3例患者的手术效果及并发症,总结相关的手术经验.结果 3例患者均完成TMVR,顺利出院.介入治疗后,2例患者的纽约心脏学会心功能分级提高1级,1例患者的纽约心脏学会心功能分级提高2级.手术时间(105 ±38)min,X线曝光时间(10 ±4) min.二尖瓣夹合器释放即刻,主动脉平均压由(62 ±18) mm Hg(1 mm Hg=0.133 kPa)升至(75±14)mm Hg,左心房平均压由(15±10) mm Hg降至(9 5)mm Hg.术后第3天,左心室舒张末内径由(63±11) mm降至(59±10)mm,左心房内径由(59 ±11)mm降至(51±8)mm,N末端B型利钠肽原由(4292 ± 1137) mmol/L降至(1187±489) mmol/L.3例患者均未发生并发症.结论 初步经验显示,使用MitraClip系统对经过选择的重度二尖瓣反流患者行TMVR安全、有效,但中长期效果需要进一步随访.%Objective To evaluate the safety and efficacy and summarize the initial experience of transcatheter mitral valve repair (TMVR) for treating Chinese patients with severe mitral regurgitation.Methods In May 2012,TMVR using MitraClip system was applied in 3 patients with severe mitral regurgitation.One patient suffered from with mitral valve prolapse and two with functional mitral regurgitation.The efficacy and complications of the procedure were analyzed.Results TMVR procedure was successful in all 3 cases.NYHA classification improved by 1 grade in 2 patients and 2 grades in one patient.The mean operation time was (105 ± 38) minutes and X-ray exposure time was (10 ± 4) minutes.Mean arotic pressure was increased from (62 ± 18)mm Hg (1 mm Hg =0.133 kPa) to (75 ± 14)mm Hg,and mean left atrial pressure was significantly reduced from (15 ± 10)mm Hg to (9 ±5)mm Hg immediately after the deployment of MitraClip.Three days after the procedure,left ventricular diastolic dimension decreased from (63 ± 11) mm to (59 ± 10) mm,left atrial dimension declined from (59 ± 11)mm to (51 ± 8) mm,and NT-ProBNP was reduced from (4292 ± 1137) mmo]/L to (1187 ± 489) mmol/L.No complications occurred in all three cases.Conclusions Our initial experience showed that TMVR using MitraClip system is safe and effective for patients with severe mitral regurgitation.However,the long term benefit of the procedure should be validated through follow up.