Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Catheter Cardiovasc Interv. 2013 Nov 1;82(5):E754-9. doi: 10.1002/ccd.25059. Epub 2013 Jul 19.
Coronary artery occlusion during transcatheter aortic valve replacement is a rare complication. However, it is a very severe and life-threatening event. Although there are some possible causes of this phenomenon, definite etiologies and predictors are unknown because of the small number. We describe one case of left main coronary artery occlusion immediately after deployment of a prosthetic valve. The patient became hypotensive and developed cardiopulmonary arrest. However, the coronary artery was successfully stented with a help of cardiopulmonary bypass and he recovered well. In this case, pre-procedural computed tomography (CT) showed the adequately high coronary height and no other significant conventional predictor for coronary occlusion. The examinations were retrospectively reviewed and the CT showed a long leaflet compared to the coronary sinus complex. The fluoroscopy appeared to show the long leaflet covering the left main coronary artery ostium immediately after the valve deployment. The height of the coronary artery ostium from the aortic annulus appeared sufficiently high in this case and did not explain the coronary compromise; leaflet length in relation to the coronary sinus dimension seemed more relevant. The ratio between leaflet length and curved coronary sinus height (L/C) may be one novel predictor for coronary artery occlusion.
经导管主动脉瓣置换术中发生冠状动脉闭塞是一种罕见的并发症。然而，这是一种非常严重且危及生命的事件。尽管这种现象有一些可能的原因，但由于数量较少，其明确的病因和预测因素尚不清楚。我们描述了一例在人工瓣膜植入后立即发生左主干冠状动脉闭塞的病例。患者出现低血压并发生心肺骤停。然而，在体外循环的帮助下成功地对冠状动脉进行了支架置入，他恢复良好。在这种情况下，术前计算机断层扫描（CT）显示出足够高的冠状动脉高度，并且没有其他明显的冠状动脉闭塞的常规预测因素。对检查结果进行了回顾性分析，CT 显示与冠状窦复合体相比，其叶片较长。透视检查显示，在瓣膜植入后，长瓣叶立即覆盖左主干冠状动脉开口。在这种情况下，冠状动脉开口距主动脉瓣环的高度似乎足够高，并未导致冠状动脉受压；瓣叶长度与冠状窦尺寸的关系似乎更为重要。瓣叶长度与弯曲冠状窦高度的比值（L/C）可能是冠状动脉闭塞的一个新的预测因素。
