Chezar-Azerrad Chava, Assali Abid, Vaknin-Assa Hanna, Shapira Yaron, Eisen Alon, Kornowski Ran
Department of Cardiology, Cardiac Catheterization Laboratories, Rabin Medical Center, Petah Tikva & The "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Cardiac Catheterization Laboratories, Rabin Medical Center, Petah Tikva & The "Sackler" Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cardiovasc Revasc Med. 2018 Dec;19(8S):82-85. doi: 10.1016/j.carrev.2018.06.010. Epub 2018 Jun 15.
A 75 year-old female with symptomatic severe mitral regurgitation of a bio-prosthetic valve secondary to valve leaflet perforation due to endocarditis underwent a mitral valve in valve replacement in an existing Hancock 27 mm valve using a trans-femoral/trans-septal approach. The procedure was complicated by an iatrogenic atrial septal defect post trans-septal puncture causing a severe right-to-left shunt due, possibly, to the combination of severe pulmonary hypertension and moderate tricuspid regurgitation the patient had suffered from at base line. Once the sheath was removed an immediate desaturation was observed which required emergent closure with an AMPLATZER ASD Occluder device (St. Jude Medical/Abbott Structural, St. Paul, Minnesota, MN). This stabilized the patient and returned her blood oxygen levels to normal. The case brings forth a rare but important complication that may occur during trans-septal procedures especially when using large sheaths. It emphasizes the importance of proper echocardiographic and hemodynamic evaluation prior to such procedures in order to be prepared for such complications.
一名75岁女性，因心内膜炎导致生物瓣膜小叶穿孔，出现症状性严重二尖瓣反流，采用经股动脉/经房间隔途径，在现有的27毫米汉考克瓣膜中进行二尖瓣瓣中瓣置换。该手术因经房间隔穿刺后医源性房间隔缺损而复杂化，可能由于患者基线时存在的严重肺动脉高压和中度三尖瓣反流的共同作用，导致严重的右向左分流。一旦移除鞘管，立即观察到血氧饱和度下降，这需要使用AMPLATZER房间隔缺损封堵器（圣犹达医疗/雅培结构，明尼苏达州圣保罗）进行紧急封堵。这使患者病情稳定，血氧水平恢复正常。该病例提出了一种在经房间隔手术过程中可能发生的罕见但重要的并发症，尤其是在使用大鞘管时。它强调了在进行此类手术前进行适当的超声心动图和血流动力学评估的重要性，以便为这类并发症做好准备。
