Sharma Madan, Tseng Elaine, Schiller Nelson, Moore Phillip, Shunk Kendrick A
Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, California, USA.
J Invasive Cardiol. 2011 Jan;23(1):E250-4.
Aortic paravalvular leaks after aortic valve replacement surgery - though not uncommon as an incidental finding - may become clinically significant in up to 5% of patients. Open surgical correction by either direct suturing or patching of the defect or reoperative valve replacement is associated with significant morbidity and mortality. Relatively few case reports are available in the literature addressing percutaneous closure of aortic paravalvular leaks. We describe the novel use of intracardiac echocardiography and intravascular ultrasound to guide closure strategy selection and subsequent deployment of an Amplatzer duct occluder device. The patient experienced immediate subjective and hemodynamic improvement accompanied by rapid resolution of heart failure symptoms from New York Heart Association (NYHA) class IV to NYHA class II. This marked clinical improvement has been sustained at 9 months to date and 4-month follow-up echocardiography confirmed complete resolution of aortic regurgitation as the mechanism behind this improvement.
主动脉瓣置换术后主动脉瓣周漏——尽管作为偶然发现并不罕见——但在高达5%的患者中可能具有临床意义。通过直接缝合或修补缺损或再次进行瓣膜置换的开放手术矫正与显著的发病率和死亡率相关。文献中关于经皮闭合主动脉瓣周漏的病例报告相对较少。我们描述了使用心内超声心动图和血管内超声来指导闭合策略的选择以及随后部署Amplatzer导管封堵器装置的新方法。该患者立即出现主观和血流动力学改善，同时心力衰竭症状从纽约心脏协会（NYHA）IV级迅速缓解至NYHA II级。这种显著的临床改善至今已持续9个月，4个月的随访超声心动图证实主动脉瓣反流完全消失，这是改善背后的机制。
