Dvir Danny, Assali Abid, Porat Eyal, Kornowski Ran
Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
J Invasive Cardiol. 2011 Dec;23(12):E281-3.
Apical complications are considered the "Achilles' heel" of transapical aortic valve implantation, in which laceration and hemorrhage are potentially fatal. We describe the case of a rare complication of the transapical aortic valve implantation procedure, where after apical closure, tension on a distal coronary segment resulted in flow obstruction. Clinicians should be alert to the possibility of distal left anterior descending artery obstruction when ischemia following a transapical procedure is suspected. The exact location of sheath insertion during "transapical" aortic valve implantation is usually apicolateral. A more apical insertion should be avoided since the apex is a relatively weak region and there could be an increased risk of coronary avulsion or apical ventricular septal defect. Nevertheless, a too-lateral insertion could diminish the sheath orientation toward the left ventricular outflow tract and the sheath could also be entrapped with mitral valve chordae. Surgeons should be aware of these factors when deciding on the exact sheath insertion site during tranaspical procedures.
心尖部并发症被认为是经心尖主动脉瓣植入术的“阿喀琉斯之踵”，其中撕裂和出血可能是致命的。我们描述了一例经心尖主动脉瓣植入手术罕见并发症的病例，在心尖部闭合后，远端冠状动脉节段的张力导致血流梗阻。当怀疑经心尖手术后出现缺血时，临床医生应警惕左前降支远端梗阻的可能性。在“经心尖”主动脉瓣植入过程中，鞘管插入的确切位置通常在心尖外侧。应避免更靠近心尖的插入，因为心尖是相对薄弱的区域，冠状动脉撕裂或心尖室间隔缺损的风险可能会增加。然而，过于偏外侧的插入可能会减少鞘管朝向左心室流出道的方向，并且鞘管也可能被二尖瓣腱索卡住。在经心尖手术中决定鞘管的确切插入部位时，外科医生应了解这些因素。
