MitraClip®修复因急性二尖瓣返流引起的心源性休克:从濒死到行走。

Q3 Medicine Journal of Heart Valve Disease Pub Date : 2018-01-01
Marco Hernández-Enríquez, Xavier Freixa, Laura Sanchis, Ander Regueiro, Felip Burgos, Ricard Navarro, Mónica Masotti, Marta Sitges, Manel Sabaté
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引用次数: 0

摘要

一位接受再同步化治疗的缺血性心肌病患者因进行性呼吸困难入院。超声心动图显示左心室射血分数(LVEF)为25%,伴有大量二尖瓣反流(MR),继发于前小叶脱垂和后小叶受限。尽管进行了强化治疗,患者仍发生心源性休克,需要机械通气、肌力支持和主动脉内球囊泵送。由于手术风险高,患者被拒绝手术,但随后接受了两个MitraClip®装置的成功经皮修复。干预后立即出现进行性改善,允许患者出院,因此在6个月的随访中临床结果是有利的(NYHA II/IV级)。本病例报告描述了微创治疗在选择手术风险非常高的患者中的益处,尽管处于危重状态和低LVEF,但在大量MR解决后临床改善显著。
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MitraClip® Repair in Cardiogenic Shock Due to Acute Mitral Regurgitation: From Near-Death to Walking.

A patient with ischemic myocardiopathy who had undergone resynchronization therapy was admitted to the authors' institution with progressive dyspnea. Echocardiography demonstrated a left ventricular ejection fraction (LVEF) of 25%, with a massive mitral regurgitation (MR) secondary to anterior leaflet prolapse and posterior leaflet restriction. Despite intensive medical treatment, the patient developed cardiogenic shock and required mechanical ventilation, inotropic support and intra-aortic balloon pumping. The patient was rejected for surgery due to the high operative risk, but subsequently underwent a successful percutaneous repair with two MitraClip® devices. Immediately after the intervention there was a progressive improvement that allowed the patient to be discharged, such that the clinical outcome was favorable at the six-month follow up (NYHA class II/IV). This case report describes the benefits of minimally invasive therapy in selected patients who are at very high surgical risk and who, despite being in a critical condition and with low LVEF, experience an outstanding clinical improvement following the resolution of a massive MR.

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来源期刊
Journal of Heart Valve Disease
Journal of Heart Valve Disease 医学-心血管系统
CiteScore
1.00
自引率
0.00%
发文量
0
审稿时长
4-8 weeks
期刊介绍: The Journal of Heart Valve Disease (ISSN 0966-8519) is the official journal of The Society for Heart Valve Disease. It is indexed/abstracted by Index Medicus, Medline, Medlar, PubMed, Science Citation Index, Scisearch, Research Alert, Biomedical Products, Current Contents/Clinical Medicine. It is issued bi-monthly in one indexed volume by ICR Publishers Ltd., Crispin House, 12A South Approach, Moor Park, Northwood HA6 2ET, United Kingdom. This paper meets the requirements of ANSI standard Z39.48-1992 (Permanence of Paper).
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