Okuyama Kazuaki, Izumo Masaki, Akashi Yoshihiro J
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Japan.
Eur Heart J Case Rep. 2018 Jul 2;2(3):1-5. doi: 10.1093/ehjcr/yty073. eCollection 2018 Sep.
A stuck leaflet and frozen cusp are reported complications following transcatheter aortic valve implantation (TAVI). These complications are rare but can drastically change haemodynamics and be potentially life-threatening; thus, their awareness during TAVI is indispensable. Leaflet malfunction generally presents in one of the three leaflets of a prosthetic valve; however, we encountered a case where all three leaflets were simultaneously stuck.
A 94-year-old woman was referred to our cardiology department with severe aortic stenosis. She underwent transfemoral TAVI. After a 20 mm balloon was inflated, a 23 mm Sapien 3 valve was deployed. Since the delivery balloon slipped into the ventricle, the valve top was not fully expanded. Post-dilatation using a 23 mm balloon was performed, which led to cardiogenic shock. Immediate cardiopulmonary resuscitation and venoarterial extracorporeal membrane oxygenation were provided. Since aortography and haemodynamics indicated severe aortic regurgitation and transoesophageal echocardiography depicted no leaflets inside the Sapien 3, we confirmed that all leaflets were stuck. The valve-in-valve procedure using the second 23 mm valve was successfully performed, and her haemodynamics dramatically improved. The patient was discharged 20 days later.
Only a handful of cases have been reported on a stuck leaflet following post-dilatation. Root rupture is a major concern of the abrupt change after post-dilatation, but a stuck leaflet should also be considered even when the new-generation balloon-expandable valve, Sapien 3, is used. Here we report the first case in which all three leaflets were stuck.
经导管主动脉瓣植入术（TAVI）后有瓣叶粘连和瓣叶固定的并发症报道。这些并发症虽罕见，但可显著改变血流动力学，且有潜在生命危险；因此，在TAVI过程中对其保持警惕必不可少。瓣叶功能障碍通常出现在人工瓣膜的三个瓣叶之一；然而，我们遇到了一例三个瓣叶同时粘连的病例。
一名94岁女性因严重主动脉瓣狭窄被转诊至我院心内科。她接受了经股动脉TAVI。在20mm球囊扩张后，植入了一枚23mm的Sapien 3瓣膜。由于输送球囊滑入心室，瓣膜顶端未完全展开。使用23mm球囊进行了后扩张，导致心源性休克。立即进行了心肺复苏和静脉-动脉体外膜肺氧合。由于主动脉造影和血流动力学显示严重主动脉瓣反流，经食管超声心动图显示Sapien 3瓣膜内无瓣叶，我们确认所有瓣叶均粘连。成功实施了使用第二枚23mm瓣膜的瓣中瓣手术，患者的血流动力学显著改善。患者于20天后出院。
关于后扩张后瓣叶粘连的病例报道较少。根部破裂是后扩张后突然变化的主要问题，但即使使用新一代球囊扩张瓣膜Sapien 3，也应考虑瓣叶粘连的情况。在此我们报道首例三个瓣叶均粘连的病例。
