1 Department of Vascular Surgery, Aortic Center, Heart and Lung Institute, University Hospital of Lille, France.
2 Department of Cardiac Surgery, Aortic Center, Heart and Lung Institute, University Hospital of Lille, France.
J Endovasc Ther. 2017 Oct;24(5):656-660. doi: 10.1177/1526602817719880. Epub 2017 Jul 10.
To report emergent transcatheter aortic valve implantation (TAVI) to treat acute severe aortic regurgitation caused by valve cusp dysfunction following proximal migration of an endograft implanted in the ascending aorta during endovascular arch repair.
A 65-year-old man had been previously treated with thoracic and fenestrated endografts in a 2-stage procedure for a chronic type B dissection. At 2-year follow-up, aneurysmal evolution of the distal arch led to development of a proximal type Ia endoleak. The patient was deemed unfit for open repair because of severe nonrevascularizable coronary artery disease. A custom-made endograft was designed consisting of a double inner branch arch endograft with a proximal component to reline the ascending aorta to avoid iatrogenic type A dissection. The first component was successfully deployed. However, this device migrated toward the aortic valve when the delivery system of the branch device was advanced through the aortic valve. Aortography and transesophageal echography showed acute aortic regurgitation due to obstruction of the left coronary valve cusp. An emergency bailout TAVI procedure was performed to successfully treat the aortic regurgitation.
TAVI can be used as a bailout procedure for acute aortic valve dysfunction during endovascular arch or ascending aorta repair.
报告 1 例经导管主动脉瓣植入术（TAVI）治疗升主动脉内移植物近端迁移导致主动脉瓣瓣叶功能障碍引起的急性重度主动脉瓣反流的病例。
1 例 65 岁男性，曾行分期胸主动脉和开窗覆膜支架腔内修复术治疗慢性 B 型夹层。2 年后随访发现，远端弓部瘤样扩张导致近端 Ia 型内漏。因严重不可再血管化的冠状动脉疾病，患者不适合开放修复。设计了一种定制的覆膜支架，包括一个双内分支弓覆膜支架，近端部分用于重新覆盖升主动脉，以避免医源性的 A 型夹层。第 1 个支架组件成功植入。然而，当分支装置的输送系统通过主动脉瓣推进时，该装置向主动脉瓣迁移。主动脉造影和经食管超声心动图显示由于左冠状动脉瓣叶阻塞引起的急性主动脉瓣反流。紧急行 TAVI 治疗，成功治疗主动脉瓣反流。
TAVI 可作为治疗腔内主动脉弓或升主动脉修复术中急性主动脉瓣功能障碍的紧急抢救措施。
