Chi Lam Simon Cheung, Bertog Stefan, Sievert Horst
CardioVascular Center Frankfurt, Frankfurt, Germany.
Catheter Cardiovasc Interv. 2014 Apr 1;83(5):817-21. doi: 10.1002/ccd.25171. Epub 2014 Jan 3.
We report a challenging case of transcatheter aortic valve-in-valve implantation in an elderly patient with failed surgical bioprosthesis. The transthoracic echocardiogram demonstrated a severe stenosis with a peak gradient of 142 mm Hg. The patient was a high-risk candidate for reoperative valve replacement; therefore, transfemoral implantation of a CoreValve (Medtronic Inc, Minneapolis, MN) was decided. During the procedure, we were unable to introduce the delivery catheter system across the bioprosthesis due to its poor alignment with the aortic annulus and the severity of the stenosis. With strategies involving transseptal puncture and externalization of a guidewire in an antegrade manner, the CoreValve was successfully positioned and deployed. This case illustrated the utility of transseptal strategies in challenging retrograde transcatheter aortic valve-in-valve implantation.
我们报告了一例具有挑战性的经导管主动脉瓣中瓣植入病例，该病例为一名手术生物瓣膜功能失效的老年患者。经胸超声心动图显示严重狭窄，峰值压差为142毫米汞柱。该患者再次进行瓣膜置换手术的风险很高；因此，决定经股动脉植入CoreValve（美敦力公司，明尼阿波利斯，明尼苏达州）。在手术过程中，由于生物瓣膜与主动脉瓣环的对齐不佳以及狭窄的严重程度，我们无法将输送导管系统穿过生物瓣膜。通过采用经房间隔穿刺和顺行方式将导丝引出体外等策略，CoreValve成功定位并展开。该病例说明了经房间隔策略在具有挑战性的逆行经导管主动脉瓣中瓣植入中的作用。
