Quintana Eduard, Mestres Carlos A, Congiu Stefano, Josa Miguel, Cartañá Ramon
Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.
J Heart Valve Dis. 2009 Nov;18(6):717-9.
Aortic valve perforation is an extremely rare complication after percutaneous coronary intervention. The case is presented of a 49-year-old male with aortic valve regurgitation secondary to the intra-aortic protrusion of a right coronary stent. The patient had undergone an apparently successful rescue percutaneous transluminal coronary angioplasty with a drug-eluting stent following failed fibrinolysis, but one month later was readmitted for acute pulmonary edema. Further investigations demonstrated new-onset aortic regurgitation. Medical stabilization was achieved and an elective aortic valve replacement and coronary revascularization performed. Intraoperatively, the stent was found to be partially deployed within the aortic lumen, causing perforation to the non-coronary cusp.
主动脉瓣穿孔是经皮冠状动脉介入治疗后极为罕见的并发症。本文报道了一例49岁男性患者,因右冠状动脉支架向主动脉腔内突出继发主动脉瓣反流。该患者在溶栓失败后接受了一次表面上成功的药物洗脱支架补救性经皮腔内冠状动脉成形术,但一个月后因急性肺水肿再次入院。进一步检查发现新发主动脉瓣反流。病情稳定后,择期进行了主动脉瓣置换和冠状动脉血运重建。术中发现支架部分展开在主动脉腔内,导致无冠瓣穿孔。