Hiltrop Nick, Adriaenssens Tom, Herijgers Paul, Dubois Christophe
Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven.
Department of Cardiovascular Sciences, KU Leuven, Leuven.
J Heart Valve Dis. 2016 Mar;25(2):182-184.
Transcatheter aortic valve replacement (TAVR) is a valuable alternative in surgical high-risk patients with symptomatic aortic valve stenosis. Here, the case is presented of very early transcatheter heart valve degeneration, probably caused by a 'Venturi effect' of a severe paravalvular regurgitant jet. This ultimately led to a leaflet being in the open position, creating severe valvular regurgitation that necessitated classical surgical revision. The occurrence of paravalvular regurgitation, and its known relationship with an adverse prognosis after TAVR, demonstrates the clear need for innovative alterations in valve design to prevent this complication. Video 1: Angiography immediately after implantation of an Edwards SAPIEN 23 mm transcatheter heart valve, showing severe paravalvular aortic valve regurgitation. The implantation position is rather low. Video 2: Transesophageal echocardiography with 2-D color imaging showing aortic valve long-axis view at 131°, three days after implantation of an Edwards SAPIEN 23 mm transcatheter heart valve. Severe eccentric paravalvular aortic valve regurgitation is shown without a significant valvular component. The implantation position is rather low. Video 3: Transesophageal echocardiography with 2-D color imaging showing aortic valve long-axis view at 120°, one month after implantation of an Edwards SAPIEN 23 mm transcatheter heart valve. Severe combined valvular and paravalvular aortic valve regurgitation (grade 4/4) is shown.
经导管主动脉瓣置换术（TAVR）是有症状的主动脉瓣狭窄外科手术高危患者的一种有价值的替代治疗方法。本文介绍了一例非常早期的经导管心脏瓣膜退变病例，可能是由严重的瓣周反流喷射的“文丘里效应”引起的。这最终导致一个瓣叶处于开放位置，造成严重的瓣膜反流，需要进行传统的外科修复。瓣周反流的发生及其与TAVR术后不良预后的已知关系，表明显然需要对瓣膜设计进行创新性改变以预防这种并发症。视频1：植入爱德华兹SAPIEN 23毫米经导管心脏瓣膜后立即进行的血管造影，显示严重的瓣周主动脉瓣反流。植入位置相当低。视频2：植入爱德华兹SAPIEN 23毫米经导管心脏瓣膜三天后，经食管超声心动图二维彩色成像显示主动脉瓣长轴视图，角度为131°。显示严重的偏心瓣周主动脉瓣反流，无明显的瓣膜成分。植入位置相当低。视频3：植入爱德华兹SAPIEN 23毫米经导管心脏瓣膜一个月后，经食管超声心动图二维彩色成像显示主动脉瓣长轴视图，角度为120°。显示严重的瓣膜和瓣周主动脉瓣联合反流（4/4级）。
