Total Thoracoscopic Surgery for Late Mitral Paravalvular Leakage Repair in A Beating Heart

Abstract Paravalvular leakage (PVL) after mitral valve replacement is a troublesome complication that may lead to severe symptoms and reoperation. Previous case reports on total thoracoscopic cardiac surgery without aortic cross-clamping for repairing late PVL are rare. We describe a 64-year-old man who had undergone aortic and mitral valve replacement via median sternotomy eight years earlier, and who recently developed cardiac failure due to severe tricuspid regurgitation (TR) and PVL in the posterior mitral annulus. During total thoracoscopic surgery with using the beating heart technique, direct closure of the PVL was achieved via pledgeted mattress sutures, and tricuspid valvuloplasty was routinely performed to treat TR. This case indicated that total thoracoscopic surgery on a beating heart may be an excellent option for treating PVL concomitant with TR.

摘要：二尖瓣置换术后瓣周漏（Paravalvular Leakage, PVL）是一种棘手的并发症，可引发严重临床症状并需接受再次手术。既往针对迟发性瓣周漏开展无主动脉阻断全胸腔镜心脏手术的病例报道较为罕见。本文报告1例64岁男性患者：该患者8年前经正中胸骨切开术完成主动脉瓣与二尖瓣置换术，近期因二尖瓣后瓣环重度瓣周漏合并三尖瓣反流（Tricuspid Regurgitation, TR）出现心力衰竭。术中采用不停跳全胸腔镜手术技术，通过带垫片褥式缝合直接闭合瓣周漏，并常规实施三尖瓣成形术治疗三尖瓣反流。本病例表明，不停跳全胸腔镜手术可作为治疗合并三尖瓣反流的瓣周漏的优良方案。