近日,广东省人民医院郭惠明、刘健、谢年谨教授团队成功为一名主动脉瓣及二尖瓣双瓣生物瓣衰败患者完成TAVR+TMVR VIV瓣中瓣植入,分别于患者二尖瓣植入J-Valve、主动脉瓣植入VenusA-Plus。由于患者双瓣生物瓣衰败,如何同期有效处理主动脉瓣和二尖瓣问题存在挑战。术前,手术团队仔细评估各项数据,多次进行“头脑风暴”,为保证术后血流动力学表现,最终制定了“双瓣、双路径”策略,首先经右侧股动脉入路进行TAVR,随后立即展开经心尖入路TMVR;手术圆满成功体现了团队丰富的手术经验和成熟的技术水平,而本次手术策略从制定到成功实施,也是此类病例在华南地区的首次突破尝试。
病例特点
主动脉瓣、二尖瓣生物瓣衰败。超声提示患者二尖瓣置换术后,人工生物瓣退行性变,重度狭窄并轻度反流;主动脉瓣置换术后,人工生物瓣退行性变,中-重度反流;重度三尖瓣反流,重度肺高压。右室收缩功能减低。
病史简介
CT分析
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/0465745a039e4f0c9ab7ee8cfe4e1b21.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/0552c697d8b44ed3b5a58a37af50d908.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/95f08b858254409e8e22a482635ecf7c.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/7957ae25588b442bb833125e4aa75ff9.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/1d0ba787638d4bb78df19a1e35e12062.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/4dc9e1e955c44e2cb04d0d1399cd30ed.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/e5167e49d17e4b12b2e90d01152221ca.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/1dae4eeb4d6f4d1791a26e76f6480544.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/e76240df44344f00afae019827075077.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/a1a5819b3c694f10b01754b9b037e387.png)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/28b30b4a52304415b098cc7aa4aafd73.png)
手术策略
手术步骤
直头导丝跨瓣
输送系统过弓
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/b91af67924204359984b181937e0f104.gif)
释放至80%造影
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/9333fa8903374d06852759061248f735.gif)
释放完成
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/0408e9d5a8f9454f95099c0c0a133d14.gif)
二尖瓣导丝跨瓣
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/5b143e94f7d941afa5f177c62736f2fa.gif)
球囊预扩张
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/ebb984c7817149dabbfc5ed5ba169f06.gif)
瓣膜定位后,完成释放
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/7aa38ebbdb1b428e974d9d5e54036c71.gif)
球囊后扩张
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/eaf37083bebe41db93cbf6d5e33bc92c.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/9a56048ac23940c7ae337a67897565ec.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/a989f389174a4b11b2def4d55076be24.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/1a6d3a2d706c4076b1f24f95212dc069.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/20f9c0748ec044d5a6c3adb24b0ecc67.jpg)
主动脉瓣术后
术后即刻超声心动图评估显示主动脉瓣膜位置良好,平均流速1.61m/s,平均压差13mmHg
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/646f255067324d2ab785c0bcabb4783b.gif)
![](https://drvoicedev.oss-cn-beijing.aliyuncs.com/drvoice/server/uploadfile/2023/06/20/0b1f69ae94164541ab4467d2c3db4542.jpg)
二尖瓣术前
术后即刻超声心动图评估显示二尖瓣膜位置良好,平均流速1.1m/s,平均压差5mmHg
术前郭惠明、刘健、谢年谨教授团队充分评估患者情况及各项评估数据,制定了详细手术流程;术中成员紧密配合,通过高超的操作技巧顺利植入瓣膜,释放位置良好;术后复查各项指标正常,主动脉瓣中瓣植入后达到最佳血流动力学效果,患者症状得到有效改善。本例手术取得圆满成功,体现了团队应对复杂病例的专业实力及丰富经验,未来,团队还将孜孜以求,不断突破,为本地区患者提供更加优质的医疗服务,始终致力于为生物瓣衰败患者提供最佳治疗选择。