Ferrari Enrico, Gronchi Fabrizio, Qanadli Salah Dine, von Segesser Ludwig Karl
Department of Cardiovascular Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland.
Interact Cardiovasc Thorac Surg. 2012 Mar;14(3):367-9. doi: 10.1093/icvts/ivr039. Epub 2011 Dec 7.
Transapical aortic valve replacement through an apical aneurysm is traditionally contraindicated because of the risk of severe systemic embolization when thrombi are present. However, a chronic fibrotic aneurysm without apical thrombi carries a low risk of distal embolization and can be safely employed for a transapical transcatheter aortic valve replacement in case of absence of an alternative access site (severe vascular disease, small vascular sizes and diseased calcified aorta). We illustrate our experience with a 73-year-old patient suffering from symptomatic aortic valve stenosis, coronary artery disease with occluded left anterior descending artery, left ventricular apical aneurysm and severe peripheral vascular disease, who successfully underwent a transapical 26 mm Sapien™ XT stent-valve implantation through the fibrotic thin akinetic apical wall.
传统上，经心尖途径通过心尖部动脉瘤进行主动脉瓣置换术是禁忌的，因为存在血栓时会有严重全身栓塞的风险。然而，没有心尖部血栓的慢性纤维化动脉瘤发生远端栓塞的风险较低，在没有其他替代入路部位（严重血管疾病、血管直径小和病变钙化主动脉）的情况下，可安全用于经心尖经导管主动脉瓣置换术。我们阐述了对一名73岁患者的治疗经验，该患者患有有症状的主动脉瓣狭窄、左前降支闭塞的冠状动脉疾病、左心室心尖部动脉瘤和严重外周血管疾病，通过纤维化变薄且运动减弱的心尖壁成功进行了经心尖26毫米Sapien™ XT支架瓣膜植入术。
