Furuta Akira, Shimizu Hideyuki, Hachiya Takashi, Ohno Yohei, Kawajiri Hiroyuki, Kawamura Akio, Kokaji Kiyokazu, Yozu Ryohei, Fukuda Keiichi
Department of Cardiology, Kawasaki Municipal Hospital, Shinkawa-dori 12-1, Kawasaki-ku, Kawasaki-shi, Kanagawa, 210-0013, Japan.
Heart Vessels. 2013 May;28(3):397-400. doi: 10.1007/s00380-012-0268-z. Epub 2012 Jul 25.
Recently there has been a noticeable resurgence in the usage of percutaneous balloon aortic valvuloplasty (BAV) by the development of less invasive endovascular therapies including transcatheter aortic valve implantation (TAVI). We performed BAV in a 91-year-old man with end-stage severe symptomatic aortic stenosis (AS) and an impending abdominal aortic aneurysm (AAA) rupture who had been refused surgical treatment because of the comorbidities with stage V chronic kidney disease (CKD) and severe left ventricular dysfunction. Improvement in hemodynamics and kidney function was observed after BAV. Subsequently, we performed endovascular aneurysm repair (EVAR) successfully for AAA using iodinated contrast. No deterioration of kidney function was confirmed after the procedure. The patient was discharged without any adverse events. At present, the possibilities of TAVI or surgical aortic valve replacement (s-AVR) are under consideration as the definitive therapy for the upcoming aortic valve restenosis. In conclusion, this inoperable patient with multiple comorbidities was successfully treated, at lower risk, by catheter-based two-stage therapy.
近年来，随着包括经导管主动脉瓣植入术（TAVI）在内的侵入性较小的血管内治疗方法的发展，经皮球囊主动脉瓣成形术（BAV）的使用明显复苏。我们对一名91岁男性进行了BAV，该患者患有终末期严重症状性主动脉瓣狭窄（AS）且腹主动脉瘤（AAA）即将破裂，因合并V期慢性肾脏病（CKD）和严重左心室功能障碍而被拒绝手术治疗。BAV术后观察到血流动力学和肾功能改善。随后，我们使用碘化造影剂成功对AAA进行了血管内动脉瘤修复（EVAR）。术后未证实肾功能恶化。患者出院时无任何不良事件。目前，正在考虑将TAVI或外科主动脉瓣置换术（s-AVR）作为即将出现的主动脉瓣再狭窄的确定性治疗方法。总之，这名患有多种合并症的无法手术的患者通过基于导管的两阶段治疗成功得到了低风险治疗。
