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球囊瓣膜成形术时导丝意外穿过流出道支架导致球囊卡在自膨式主动脉瓣支架内。

Valvuloplasty balloon entrapment in a self-expanding aortic valve stent frame after inadvertent wire passage through the outflow struts.

机构信息

Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany.

出版信息

Catheter Cardiovasc Interv. 2019 Jan 1;93(1):174-177. doi: 10.1002/ccd.27858. Epub 2018 Sep 23.

Abstract

Transcatheter aortic valve replacement (TAVR) is a leading-edge therapy option for patients with severe aortic stenosis (AS) and high surgical risk. However, this minimally invasive procedure is associated with specific complications that may be life-threatening. Valvuloplasty balloon entrapment during postdilatation in transcatheter self-expanding aortic valve stent frames has not yet been a focus of interest in this context. Although it is a rare event, it may critically influence outcome, and different management strategies can be considered. Hereafter, we present the case of a 67-year-old male who underwent transfemoral TAVR and subsequent postdilatation. The valvuloplasty balloon was entrapped in the self-expanding aortic valve stent frame after inadvertent wire passage through the outflow struts. Since surgical risk was high, we preferred a percutaneous approach and extracted the entrapped balloon with high traction force under rapid pacing after valve stabilization with another balloon, which was placed in the annular position.

摘要

经导管主动脉瓣置换术(TAVR)是严重主动脉瓣狭窄(AS)和高手术风险患者的前沿治疗选择。然而,这种微创程序与特定的并发症相关,这些并发症可能危及生命。在经导管自膨式主动脉瓣支架框架的后扩张期间,球囊扩张器被卡在其中尚未成为该背景下的关注焦点。尽管这是一种罕见的事件,但它可能会严重影响结果,并且可以考虑不同的管理策略。此后,我们介绍了一位 67 岁男性的病例,他接受了经股 TAVR 和随后的后扩张。在球囊扩张器意外穿过流出道支架后,球囊扩张器被卡在自膨式主动脉瓣支架框架中。由于手术风险很高,我们选择了经皮入路,并在另一个球囊稳定瓣膜后,在快速起搏下以高牵引力将被困的球囊取出,该球囊放置在瓣环位置。

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