Spiro Jon, Nadeem Asif, Doshi Sagar N
Department of Interventional Cardiology, Queen Elizabeth University Hospital, Birmingham, United Kingdom.
J Invasive Cardiol. 2012 May;24(5):224-8.
Acute coronary artery obstruction at the time of device implantation is a recognized, albeit rare, complication of TAVI and is most frequently managed by emergency percutaneous intervention. This complication usually manifests with circulatory collapse due to compromising left ventricular ischemia and is most often observed immediately following valve deployment in the catheter laboratory or in theater. Immediate circulatory support is often necessary. We describe the first report of delayed left main stem obstruction 3.5 hours after successful deployment of a 26 mm Edwards SAPIEN XT valve via transfemoral implantation, with sudden development of circulatory collapse on the ward. Circulatory support was rapidly and effectively instituted with an automated non-invasive cardiac massage device, AutoPulse, that delivers continuous chest compressions. Successful emergency percutaneous intervention was then undertaken to the left main stem to displace a calcified nodule during automated external cardiac massage with the AutoPulse.
在经导管主动脉瓣植入术（TAVI）中，装置植入时急性冠状动脉阻塞是一种已被认识到的并发症，尽管罕见，且最常通过紧急经皮介入治疗来处理。这种并发症通常因左心室缺血受损而表现为循环衰竭，最常在导管室或手术室瓣膜置入后立即出现。常常需要立即进行循环支持。我们描述了首例经股动脉植入一枚26毫米爱德华兹SAPIEN XT瓣膜成功置入3.5小时后发生延迟性左主干阻塞的报告，并伴有病房内循环衰竭的突然发生。使用自动无创心脏按摩装置AutoPulse迅速有效地实施了循环支持，该装置可进行持续胸外按压。然后在使用AutoPulse进行自动体外心脏按压期间，对左主干成功进行了紧急经皮介入治疗，以移位一个钙化结节。
