Nuis Rutger-Jan, Benitez Luis M, Nader Carlos A, Perez Sergio, de Marchena Eduardo J, Dager Antonio E
Erasmus ThoraxCenter, 3015 CE, Rotterdam, The Netherlands.
Tex Heart Inst J. 2013;40(3):323-5.
Transcatheter aortic valve implantation for aortic stenosis has evolved as an alternative treatment for patients who are at high or excessive surgical risk. We report the case of an 84-year-old man with a degenerated surgically implanted valve in a subaortic position (9 mm below the native annulus) who underwent "valve-in-valve" transcatheter aortic valve implantation with use of a Medtronic CoreValve system. We planned to deploy the CoreValve at a conventional depth in the left ventricular outflow tract; we realized that this might result in paravalvular regurgitation, but it would also afford a "deep" landing site for a second valve, if necessary. Ultimately, we implanted a second CoreValve deep in the left ventricular outflow tract to seal a paravalvular leak. The frame of the first valve--positioned at the conventional depth--enabled secure anchoring of the second valve in a deeper position, which in turn effected successful treatment of the failing subaortic surgical prosthesis without paravalvular regurgitation.
经导管主动脉瓣植入术已发展成为手术风险高或过高的主动脉瓣狭窄患者的一种替代治疗方法。我们报告了一例84岁男性患者，其主动脉瓣下位置（比天然瓣环低9毫米）有一个退化的外科植入瓣膜，该患者接受了使用美敦力CoreValve系统的“瓣中瓣”经导管主动脉瓣植入术。我们计划将CoreValve部署在左心室流出道的常规深度；我们意识到这可能会导致瓣周反流，但如果有必要，这也将为第二个瓣膜提供一个“深”着陆点。最终，我们在左心室流出道深处植入了第二个CoreValve以封堵瓣周漏。位于常规深度的第一个瓣膜的框架使得第二个瓣膜能够在更深的位置牢固锚定，从而成功治疗了失败的主动脉瓣下外科假体，且无瓣周反流。
