经导管二尖瓣置换术

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105284

Julien Feghaly MD, MPH , Naji Maaliki MD , Yixin Zhang MD , Mohamed Abdul Qader MD , Daniel Soffer MD , Ali Zgheib MD , Thomas Zeyl MD , Erol Belli MD , Valentin Suma MD , Calvin Choi MD, MHA

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引用次数: 0

摘要

背景：左心室流出道（LVOT）梗阻是经导管二尖瓣置换术（TMVR）的潜在致命并发症，特别是在具有解剖高危特征的患者中。LAMPOON（二尖瓣前小叶撕裂术以防止流出梗阻）是一种经导管电外科技术，通过在瓣膜置放前修改二尖瓣前小叶解剖来减轻这种风险。目的：我们描述了我们的机构经验，将LAMPOON作为TMVR病例的预防策略，这些病例具有新lvot阻塞的高预测风险。方法本研究纳入具有高危解剖特征的患者，采用LAMPOON进行TMVR手术。LAMPOON技术的变化，包括使用“飞v”型电刀线配置的顺行和尖端到基部入路，都是根据个人解剖情况采用的。结论所有患者均成功完成二尖瓣前小叶撕裂术，无明显左腔静脉阻塞。在LVOT梗阻高风险患者中，顺行和尖端到基底的LAMPOON技术是TMVR安全有效的辅助手段。

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Transcatheter Mitral Valve Replacement With LAMPOON

Background

Left ventricular outflow tract (LVOT) obstruction is a potentially fatal complication of transcatheter mitral valve replacement (TMVR), particularly in patients with anatomically high-risk features. LAMPOON (laceration of the anterior mitral leaflet to prevent outflow obstruction) is a transcatheter electrosurgical technique developed to mitigate this risk by modifying anterior mitral leaflet anatomy prior to valve deployment.

Objective

We describe our institutional experience with LAMPOON as a preventive strategy in TMVR cases with a high predicted risk for neo-LVOT obstruction.

Methods

This case series includes patients with high-risk anatomical features who underwent TMVR with LAMPOON. Variations of the LAMPOON technique, including antegrade and tip-to-base approaches using the “flying-V” electrosurgical wire configuration, were employed based on individual anatomy.

Conclusions

All patients underwent successful anterior mitral leaflet laceration, with no significant LVOT obstruction. Antegrade and tip-to-base LAMPOON techniques are safe and effective adjuncts to TMVR in patients at high risk of LVOT obstruction.

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