First percutaneous Micra leadless pacemaker implantation and tricuspid valve repair with MitraClip NT for lead-associated severe tricuspid regurgitation.
First percutaneous Micra leadless pacemaker implantation and tricuspid valve repair with MitraClip NT for lead-associated severe tricuspid regurgitation.
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DOI：
10.4244/eij-d-17-00023
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发表时间：
2017-02-03
期刊：
影响因子：
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通讯作者：
Lansman, Steven
中科院分区：
文献类型：
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作者：
Tang, Gilbert H L;Kaple, Ryan;Lansman, Steven
目的：起搏器导联相关的严重三尖瓣反流（TR）可导致右心衰和不良预后。这些患者的手术具有显著的发病率。方法和结果：一名71岁体弱女性，功能状态不佳，慢性心房颤动，2012年植入永久性起搏器，表现为症状性中重度二尖瓣反流（MR）和严重的TR，起搏器导联是罪魁祸首。她被认为是双瓣膜手术的高危患者，由于她对起搏器的依赖，我们决定对她进行干预，首先是经导管二尖瓣修复，然后是激光铅提取和无铅起搏器植入，以解除电视的系带，然后是电视修复。在使用MitraClip NT进行二尖瓣修复时，发现并治疗了阻塞性LAD病变。Micra无铅起搏器植入和随后使用MitraClip NT进行TV修复均取得成功，患者的MR分别改善至轻度，TR改善至中度。结论：我们在此报告了首个通过无导线起搏器和MitraClip成功治疗铅相关严重TR的经导管策略。去除起搏器导线缓解了叶栓，提高了电视的可修复性。
AIMS: Pacemaker lead-associated severe tricuspid regurgitation (TR) can lead to right heart failure and poor prognosis. Surgery in these patients carries significant morbidities. We describe a successful treatment of symptomatic severe TR by leadless pacemaker implantation followed by tricuspid valve (TV) repair with the MitraClip NT.METHODS AND RESULTS: A 71-year-old frail female with poor functional status, chronic atrial fibrillation and permanent pacemaker implantation in 2012 presented with symptomatic moderate-severe mitral regurgitation (MR) and severe TR with the pacemaker lead as the culprit. She was deemed extreme risk for double valve surgery and, because of her pacemaker dependency, the decision was to stage her interventions first with transcatheter mitral repair, then laser lead extraction and leadless pacemaker implantation to free the TV from tethering, then TV repair. An obstructive LAD lesion was identified and treated during mitral repair with the MitraClip NT. The Micra leadless pacemaker implantation and subsequent TV repair with the MitraClip NT were successful and the patient's MR improved to mild and TR to moderate, respectively.CONCLUSIONS: We report here a first successful transcatheter strategy to treat lead-associated severe TR by leadless pacemaker and MitraClip. Removing the pacemaker lead relieved leaflet tethering and improved the reparability of the TV.