在复杂的临床情况下，一个具有挑战性的重做二尖瓣夹手术

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105240

Abed Qadan MD , Shemy Carasso MD , Mony Shuvy MD

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引用次数: 0

摘要

背景：经导管边缘到边缘修复（TEER）是高危、严重二尖瓣返流的关键。重做TEER仍然具有挑战性，特别是先前的结构性干预，如房间隔缺损（ASD）关闭，使其进入和可操作性复杂化。病例总结：一名患有严重功能性二尖瓣反流和非缺血性扩张型心肌病的60岁男性，在先前手术后临床恶化后接受了重做TEER。先前植入的ASD封堵器在解剖学上存在重大挑战，然而，在没有穿过或损坏ASD封堵器的情况下，成功地在ASD封堵器附近进行了跨间隔穿刺。这种新颖的入路可以完成无并发症的手术。本病例强调了先前有ASD闭塞的患者重做TEER的可行性，并强调了仔细的术前计划，精确的跨间隔穿刺和细致的设备处理对于优化手术成功的重要性。在先进的成像、计划和多学科合作下，预先使用ASD闭塞器的eredo TEER是可行的。

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A Challenging Redo Mitral Clip Procedure in a Complex Clinical Scenario

Background

Transcatheter edge-to-edge repair (TEER) is pivotal for high-risk, severe mitral regurgitation. Redo TEER remains challenging, particularly with prior structural interventions such as atrial septal defect (ASD) closure complicating access and maneuverability.

Case Summary

A 60-year-old man with severe functional mitral regurgitation and nonischemic dilated cardiomyopathy underwent redo TEER following clinical deterioration after a previous procedure. A previously implanted ASD occluder posed a significant anatomical challenge, however trans-septal puncture was successfully achieved adjacent to the ASD occluder without traversing or damaging it. The novel access approach allowed completion of the procedure without complications.

Discussion

This case highlights the feasibility of redo TEER in patients with prior ASD occluder and underscores the critical importance of careful preprocedural planning, precise trans-septal puncture, and meticulous device handling to optimize procedural success.