Farhang Yazdchi , Gilbert H.L. Tang , Tom C. Nguyen , Tsuyoshi Kaneko
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引用次数: 0
摘要
外科二尖瓣修复一直是治疗严重退行性二尖瓣反流的金标准。然而,由于年龄和/或合并症,一部分患者被认为手术风险太高。在过去的十年中,基于导管的干预措施已经发展起来,以解决高危手术患者的二尖瓣反流。MitraClip系统(Abbott Vascular, Santa Clara, CA, USA)被FDA批准用于符合某些标准的原发性或继发性二尖瓣反流的高风险患者。本文简要介绍了经导管边缘到边缘二尖瓣修复(TEER)的适应症,并着重描述了使用MitraClip设备执行TEER的程序步骤。这些步骤包括术前评估和规划TEE图像,经鼻中隔进入二尖瓣,引入经鼻中隔鞘,可操纵导尿管(SGC)和夹送系统(CDS),穿过二尖瓣,在所需位置抓住小叶,并部署。在一个简短的视频中还演示了程序步骤。
Transcatheter Edge to Edge Mitral Valve Repair (MitraClip) Step by Step Guide
Surgical mitral valve repair has been the gold standard treatment for severe degenerative mitral regurgitation. However, a segment of patient population is considered too high risk for surgery because of their age and/or comorbidities.Catheter-based interventions have been developed during the last decade to address mitral regurgitation in high surgical risk patients. MitraClip System (Abbott Vascular, Santa Clara, CA, USA) is FDA approved in high risk patients with primary or secondary mitral regurgitation who meet certain criteria. This article touches briefly on indications for transcatheter edge to edge mitral valve repair (TEER) and focuses on describing procedural steps to perform TEER usig MitraClip device. These steps include preoperative assessment and planning using TEE images, transseptal access to mitral valve, introducing transseptal sheath, steerable guide catheter (SGC), and clip delivery system (CDS), crossing the mitral valve, grasping the leaflets in desired location, and deployment. Procedural steps are also demonstrated in a brief video.
期刊介绍:
Operative Techniques in Thoracic and Cardiovascular Surgery provides richly illustrated articles on techniques in thoracic and cardiovascular surgery written by renowned surgeons. Each issue presents cardiothoracic topics in adult cardiac, congenital, and general thoracic surgery. Each specialty of interest to the thoracic and cardiovascular surgeon is explored through two different approaches to a specific surgical challenge. Each article is thoroughly illustrated with original line drawings, actual intraoperative photos, and supporting tables and graphs.