Karimi Ashkan, Pourafshar Negiin, Park Ki E, Choi Calvin Y, Mogali Kiran, Stinson Wade W, Manning Eddie W, Bavry Anthony A
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL, USA.
Cardiol Ther. 2017 Jun;6(1):133-138. doi: 10.1007/s40119-016-0077-z. Epub 2017 Jan 2.
A 79-year-old man underwent trans-catheter aortic valve replacement for symptomatic severe aortic stenosis with a 26-mm Edwards SAPIEN XT valve. Immediately after valve deployment there was moderate amount of paravalvular leak. Post-dilation was performed with an additional 2 cc of volume, and the paravalvular leak was reduced to trace. Nine months later, trans-thoracic echocardiography revealed moderate to severe paravalvular leak and possible aortic migration of the valve. The patient was brought back for the treatment of the paravalvular leak which was suspected to be due to valve migration. However, fluoroscopy and trans-esophageal echocardiography showed good valve position. Measurement of late valve recoil in the Coplanar view using cine-angiographic analysis software showed that the lower third of the valve had the greatest late recoil (-1.74 mm, 6.55%), which presumably accounted for the progression of the paravalvular leak. Valve-in-valve trans-catheter aortic valve replacement was performed with a 26-mm SAPIEN 3 valve and the paravalvular leak was reduced to trace. This case displays late recoil as a likely mechanism for development of paravalvular leak after SAPIEN XT valve implantation. Our case illustrates that late recoil needs to be systematically evaluated in future studies, especially when trans-catheter aortic valve replacement is being expanded to lower risk and younger patients for whom the longevity and long-term performance of these valves is of critical importance.
一名79岁男性因症状性严重主动脉瓣狭窄接受了经导管主动脉瓣置换术，植入一枚26毫米的爱德华兹SAPIEN XT瓣膜。瓣膜植入后即刻出现中度瓣周漏。额外注入2毫升造影剂进行后扩张，瓣周漏减少至微量。九个月后，经胸超声心动图显示中度至重度瓣周漏，且瓣膜可能出现主动脉移位。患者因疑似瓣膜移位导致的瓣周漏而再次入院治疗。然而，荧光透视和经食管超声心动图显示瓣膜位置良好。使用电影血管造影分析软件在共面视图中测量瓣膜晚期回弹，结果显示瓣膜下三分之一处晚期回弹最大（-1.74毫米，6.55%），这可能是瓣周漏进展的原因。遂采用一枚26毫米的SAPIEN 3瓣膜进行瓣中瓣经导管主动脉瓣置换术，瓣周漏减少至微量。该病例显示晚期回弹可能是SAPIEN XT瓣膜植入后瓣周漏发生的机制。我们的病例表明，在未来的研究中需要系统地评估晚期回弹，尤其是在经导管主动脉瓣置换术扩展至低风险和年轻患者时，这些患者中瓣膜的使用寿命和长期性能至关重要。
