Valve-in-Ring TMVR Following Antegrade Base-to-Tip LAMPOON With ELASTIC on VA-ECMO Support: A Case Report

Journal of the Society for Cardiovascular Angiography & Interventions Pub Date : 2026-07-01 Epub Date: 2026-05-14 DOI:10.1016/j.jscai.2026.105394

Chantal Y. Asselin MD, MSc, Mostafa Naguib MD, Christopher Song MD, Konstantinos Koulogiannis MD, Robert M. Kipperman MD, Howard Axelrod MD, Linda D. Gillam MD, MPH, Philippe Généreux MD, Gennaro Giustino MD

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Abstract

Transcatheter mitral valve replacement (TMVR) in failed surgical rings with an Alfieri stich represents a therapeutic challenge. A 70-year-old man with prior robotic surgical mitral valve repair with an incomplete ring and an Alfieri stich presented with acute decompensated heart failure and was found to have severe mitral regurgitation and pulmonary hypertension. He was deemed not to be suitable for redo surgery. Preprocedural computed tomography demonstrated anterior mitral leaflet length of 29 mm, indicative of high-risk for dynamic left ventricular outflow tract obstruction. This case described the successful combination of antegrade laceration of the anterior mitral valve leaflet to prevent outflow obstruction and electrosurgical laceration of Alfieri stitch to facilitate valve-in-ring TMVR while on venoarterial extracorporeal membrane oxygenation support to prevent hemodynamic compromise during high-risk valve-in-ring TMVR.

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带弹性VA-ECMO支架的环内阀式TMVR: 1例报告

经导管二尖瓣置换术（TMVR）在失败的手术环与Alfieri针代表了治疗的挑战。一名70岁男性患者，先前接受机器人二尖瓣手术修复不完整环和Alfieri针，表现为急性失代偿性心力衰竭，发现有严重的二尖瓣反流和肺动脉高压。他被认为不适合重做手术。术前计算机断层扫描显示二尖瓣前叶长度为29mm，提示动态左室流出道梗阻的高危。本病例描述了成功结合二尖瓣前小叶顺行撕裂术以防止流出梗阻和电刀Alfieri针撕裂术以促进环内瓣TMVR，同时在静脉动脉体外膜氧合支持下防止高危环内瓣TMVR中血流动力学损害。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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