Sugizaki Yoichiro, Mori Shumpei, Nagamatsu Yuichi, Akita Tomomi, Nagasawa Akira, Toba Takayoshi, Yamamoto Masatsugu, Nishii Tatsuya, Obata Norihiko, Nomura Yoshikatsu, Otake Hiromasa, Shinke Toshiro, Okita Yutaka, Hirata Ken-Ichi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Cardiol Cases. 2018 Aug 17;18(5):171-174. doi: 10.1016/j.jccase.2018.07.005. eCollection 2018 Nov.
An 82-year-old man with severe aortic stenosis and idiopathic pulmonary fibrosis (IPF) underwent transcatheter aortic valve implantation (TAVI) under general anesthesia. However, following a successful TAVI procedure, he developed progressive respiratory failure because of the exacerbation of IPF. Despite the use of immunosuppressants, the patient could not be saved and he died of respiratory failure. Although TAVI is a less invasive procedure compared to conventional surgical aortic valve replacement, it is currently selected for management of severely ill, frail, and elderly patients. This case highlights the potential risk of IPF exacerbation following a TAVI procedure performed under general anesthesia. < Transcatheter aortic valve implantation (TAVI) procedures have been increasingly performed for high-risk patients, including those with high frailty and pulmonary dysfunction. Although TAVI is less invasive compared to open surgery, it may cause critical exacerbation of idiopathic pulmonary fibrosis when performed under general anesthesia. Multidisciplinary care beyond "heart team" would be necessary for prevention, as well as for detecting the early signs of exacerbation of idiopathic pulmonary fibrosis.>.
一名患有严重主动脉瓣狭窄和特发性肺纤维化(IPF)的82岁男性在全身麻醉下接受了经导管主动脉瓣植入术(TAVI)。然而,在TAVI手术成功后,由于IPF加重,他出现了进行性呼吸衰竭。尽管使用了免疫抑制剂,患者仍未能挽救过来,最终死于呼吸衰竭。虽然与传统的外科主动脉瓣置换术相比,TAVI是一种侵入性较小的手术,但目前它被用于治疗病情严重、身体虚弱的老年患者。该病例突出了在全身麻醉下进行TAVI手术后IPF加重的潜在风险。<经导管主动脉瓣植入术(TAVI)已越来越多地用于高危患者,包括那些身体极度虚弱和有肺功能障碍的患者。虽然与开放手术相比,TAVI的侵入性较小,但在全身麻醉下进行时,它可能会导致特发性肺纤维化的严重加重。为了预防以及检测特发性肺纤维化加重的早期迹象,除了“心脏团队”之外,多学科护理是必要的。>