Key result
The Alfieri Stitch (edge to edge) successfully resolved systolic anterior motion and severe mitral regurgitation that developed after aortic valve replacement, allowing for easy weaning from cardiopulmonary bypass.
Case Report (n=1)
No
The Alfieri stitch is a rapid and effective surgical rescue technique for unexpected systolic anterior motion of the mitral valve following aortic valve replacement.
Alfieri stitch resolved refractory post-AVR SAM in one case; leaves open optimal surgical strategies for this complication.
症例は79歳男性．重症大動脈弁狭窄症を指摘され手術加療の方針となった．術前の経胸壁超音波検査では，左室流出路狭窄や僧帽弁収縮期前方運動Systolic anterior motion (以下SAM) の指摘はなかった．手術は生体弁 (INSPIRIS RESILIA 23 mm，Edwards Lifesciences) をsupra annular positionで縫着．大動脈弁遮断解除までは特に問題なく進めることができたが，人工心肺からの離脱が困難となり，経食道超音波検査にて僧帽弁収縮期前方運動SAM，severe MR, 左室流出路狭窄 (LVOTO) が認められた．ボリューム負荷，カテコールアミン中止，β-Blocker投与などの内科的治療で対応するも持続性はなく血行動態は不安定で，second pumpにて僧帽弁に対して外科的処置を追加する方針となった．手術はAlfieri Stitch (edge to edge) を施行し，リークテストでリークなし．遮断解除後の経食道超音波検査にてSAMとLVOTOともに消失しMRはmildで制御できており，人工心肺からの離脱を開始した．離脱は容易に行うことができ，手術は終了となった．その後の血行動態は良好で，術後2週間後の経胸壁超音波検査でも問題なく術後20日目に退院となった．退院後もSAM再発やMRの悪化なく順調に経過している．
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Sato et al. (2023) conducted a case report in Systolic anterior motion (SAM) of the mitral valve after aortic valve replacement (n=1). Alfieri Stitch (edge to edge) was evaluated on Resolution of SAM and MR. The Alfieri Stitch (edge to edge) successfully resolved systolic anterior motion and severe mitral regurgitation that developed after aortic valve replacement, allowing for easy weaning from cardiopulmonary bypass.
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