Koizumi Shigeki, Ehara Natsuhiko, Nishiya Kenta, Koyama Tadaaki
Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuoku, Kobe, Hyogo, 650-0047, Japan.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
Gen Thorac Cardiovasc Surg. 2018 May;66(5):291-293. doi: 10.1007/s11748-017-0791-z. Epub 2017 Jun 24.
Late transcatheter heart valve embolization is a rare but life-threatening complication of transcatheter aortic valve implantation. Surgical intervention is performed for most cases, but some cases were treated by valve-in-valve transcatheter aortic valve implantation. We describe a patient in whom a 29-mm Edwards SAPIEN XT valve migrated into the left ventricular outflow tract 41 days after the initial implantation. We tried to perform valve-in-valve transcatheter aortic valve implantation using a transfemoral approach. As soon as the second transcatheter heart valve touched the first implanted valve, it fell into the left ventricle. Immediate surgical intervention was required. The first valve was removed, and surgical aortic valve replacement was successfully performed. In conclusion, we should choose surgical aortic valve replacement for late transcatheter heart valve embolization. Even if we need to treat by catheter intervention, transapical approach may be better.
晚期经导管心脏瓣膜栓塞是经导管主动脉瓣植入术罕见但危及生命的并发症。大多数病例需进行外科干预，但部分病例采用瓣中瓣经导管主动脉瓣植入术治疗。我们描述了一名患者，其在初次植入29毫米爱德华兹SAPIEN XT瓣膜41天后瓣膜迁移至左心室流出道。我们尝试经股动脉途径进行瓣中瓣经导管主动脉瓣植入术。当第二个经导管心脏瓣膜接触到第一个植入瓣膜时，它落入了左心室。需要立即进行外科干预。取出了第一个瓣膜，并成功进行了外科主动脉瓣置换术。总之，对于晚期经导管心脏瓣膜栓塞，我们应选择外科主动脉瓣置换术。即使需要通过导管介入治疗，经心尖途径可能更好。
