Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Catheter Cardiovasc Interv. 2019 Feb 15;93(3):555-558. doi: 10.1002/ccd.27870. Epub 2018 Oct 30.
Transcatheter aortic valve replacement has become a mainstay alternative to surgical aortic valve replacement in patients with severe aortic stenosis at high and intermediate surgical risk. Two commercially approved valves are available in the United States: balloon-expandable and self-expanding. We report here a rare complication of a self-expanding Evolut PRO (Medtronic, Minneapolis, Minnesota) valve failing to expand due to nitinol frame infolding. This results in a malopposed valve with a severe paravalvular leak, even though treated successfully with balloon valvuloplasty. It is important to recognize the characteristic angiographic signature of this complication-the "straight line" sign-and how to avoid this potentially serious complication by balloon valvuloplasty or by recapture and deployment of a new valve.
经导管主动脉瓣置换术已成为高、中度手术风险的严重主动脉瓣狭窄患者外科主动脉瓣置换术的主要替代方法。美国有两种获得商业批准的瓣膜：球囊扩张式和自扩张式。我们在此报告一种自扩张 Evolut PRO（美敦力，明尼苏达州明尼阿波利斯）瓣膜的罕见并发症，由于镍钛诺框架内折，该瓣膜无法扩张。这导致瓣膜对合不良，出现严重瓣周漏，尽管球囊瓣膜成形术治疗成功。重要的是要认识到这种并发症的特征性血管造影特征-“直线”征-以及如何通过球囊瓣膜成形术或重新捕获和部署新瓣膜来避免这种潜在的严重并发症。
