Hamdeh Yousef M, Goldhammer Jordan E, Ruggiero Nicholas J, Entwistle John W
From the Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
A A Case Rep. 2017 Nov 15;9(10):300-304. doi: 10.1213/XAA.0000000000000599.
A 79-year-old woman with severe mitral annular calcification was scheduled for mitral valve replacement. A SAPIEN 3 valve was implanted in mitral position using an open surgical approach. Immediately after cardiopulmonary bypass, bleeding from an unidentified source was encountered. Cardiopulmonary bypass was emergently resumed and a laceration of the left ventricular apex due to the valve delivery system was detected. Risk factors specific to the open surgical approach include a decompressed ventricle, decreased annulus to apical distance, and the absence of continuous fluoroscopic and echocardiographic imaging. These create a clinical scenario where risk of ventricular perforation is increased compared with traditional intravascular transcatheter valve delivery.
一名79岁重度二尖瓣环钙化女性计划行二尖瓣置换术。采用开放手术方法在二尖瓣位置植入了一枚SAPIEN 3瓣膜。体外循环后立即出现不明来源出血。紧急恢复体外循环，发现是瓣膜输送系统导致左心室尖部撕裂。开放手术方法特有的危险因素包括心室减压、瓣环至心尖距离减小以及缺乏连续的荧光透视和超声心动图成像。这些因素造成了一种临床情况，与传统血管内经导管瓣膜输送相比，心室穿孔风险增加。
