经导管主动脉瓣置换术中急性重度二尖瓣反流：一例报告
Acute torrential mitral regurgitation during transcatheter aortic valve replacement: a case report.
作者信息
Yamashita Yoshiyuki, Sonoda Hiromichi, Ushijima Tomoki, Shiose Akira
机构信息
Department of Cardiovascular Surgery, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
出版信息
Surg Case Rep. 2018 Apr 18;4(1):35. doi: 10.1186/s40792-018-0446-z.
Abstract
BACKGROUND
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to aortic valve replacement. However, critical cardiovascular collapse can occur during the procedure for various reasons.
CASE PRESENTATION
A 90-year-old man with severe aortic stenosis and left circumflex artery stenosis developed acute torrential mitral regurgitation (MR) during TAVR. The valve deployment process induced left ventricular dyssynchrony due to left bundle-branch block and myocardial ischemia in the left circumflex artery region with torrential MR. Transesophageal echocardiography clearly demonstrated the mechanisms of MR, which was successfully bailed out by left ventricular pacing and intra-aortic balloon pumping.
CONCLUSIONS
MR can be seriously exaggerated by various and complicated mechanisms during TAVR and should be rapidly assessed and appropriately managed depending on its mechanisms.
摘要
背景
经导管主动脉瓣置换术（TAVR）是一种主动脉瓣置换的微创方法。然而，在手术过程中可能由于各种原因发生严重的心血管崩溃。
病例介绍
一名90岁男性，患有严重主动脉瓣狭窄和左旋支动脉狭窄，在TAVR期间发生急性重度二尖瓣反流（MR）。瓣膜植入过程因左束支传导阻滞和左旋支动脉区域心肌缺血伴重度MR导致左心室不同步。经食管超声心动图清楚地显示了MR的机制，通过左心室起搏和主动脉内球囊反搏成功缓解。
结论
在TAVR期间，MR可因各种复杂机制而严重加重，应根据其机制迅速评估并适当处理。
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