經導管二尖瓣置換術之現況

Transcatheter Mitral Valve Replacement

王思翰(Szu-Han Wang) ； 李政翰(Cheng-Han Lee)

《內科學誌》 35卷2期 (2024/04) Pp. 136-142

https://doi.org/10.6314/JIMT.202404_35(2).04

摘要

二尖瓣逆流是現行最常見之心臟瓣膜疾病，而二尖瓣本身也有著特別複雜的結構，致使在外科手術、經導管緣對緣夾合二尖瓣膜修補手術（Transcatheter edge-to-edge mitral valve repair, TEER）都已日漸成熟的今日，仍有未能完滿之處。因此，經導管二尖瓣置換術（Transcatheter mitral valve replacement, TMVR）也因此而生。此技術原是經心尖置放（Transapical），但近日經股靜脈置放（Transfemoral）亦在成熟中。術前、術中與術後都需要精準的影像評估才能將瓣膜準確固定並將血栓出血等風險降到最低。此文將討論TMVR之影像評估、瓣膜種類、常見併發症與未來之展望。

關鍵字

二尖瓣逆流（Mitral regurgitation） ； 外科二尖瓣修復／置換術（Surgical mitral valve repair／replacement） ； 經導管二尖瓣置換術（Transcatheter mitral valve replacement, TMVR） ； 經導管緣對緣夾合二尖瓣膜修補手術（Transcatheter edge-to-edge mitral valve repair, TEER） ； 左心室出口通道阻塞（Left ventricular outflow tract obstruction）

並列摘要

Mitral regurgitation is one of the most dominant valvular heart disease contemporary. However, the complicated structure of mitral valve still leads to treatment difficulties even with the well-developed surgical treatment or transcatheter edge-to-edge mitral valve repair (TEER) technique. Thus, transcatheter mitral valve replacement (TMVR) was developed. This originally transapically technique has transferred to transfemoral ones. Peri-procedure image is necessary to help planning, guiding and following the valve placement, which declines the risk of embolism and other complication. This article discussed about the image evaluation, Tendyne valve and the future of TMVR.