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经胸腔内血管支架移植物修复成功治疗经导管主动脉瓣栓塞

Successful recovery from transcatheter aortic valve embolization by thoracic endovascular stent-graft repair.

作者信息

Ueno Go, Ohno Nobuhisa, Toma Masanao, Kobayashi Taishi, Maeda Toshi, Kato Otohime, Yoshizawa Kosuke, Miyamoto Tadashi, Fujiwara Keiichi

机构信息

Department of Cardiovascular Surgery, Amagasaki General Medical Center, 2-17-77 Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan.

Department of Cardiology, Amagasaki General Medical Center, Amagasaki, Japan.

出版信息

Gen Thorac Cardiovasc Surg. 2020 Aug;68(8):851-854. doi: 10.1007/s11748-019-01225-0. Epub 2019 Oct 17.

Abstract

We report a case of an 84-year-old Japanese female patient with transcatheter valve embolization treated with thoracic endovascular stenting. She was diagnosed with severe aortic stenosis and referred to our hospital. Transapical transcatheter aortic valve implantation (TA-TAVI) was selected because she had multiple comorbidities and peripheral vascular disease. During TA-TAVI, the transcatheter valve (TV) came loose and lodged in the distal aortic arch. The TV was floating and unstable, thereby affecting her hemodynamics. After a second TV was placed in the appropriate position with no trouble, we tried fixing the TV using a thoracic endovascular stent-graft. The procedure was successful, and the patient recovered well. The cause of embolization seemed to be associated with a relatively mild calcification of the native aortic valve. Although this complication is rare, several recovery procedures should be prepared.

摘要

我们报告了一例84岁的日本女性患者,该患者接受经导管瓣膜栓塞术并采用胸段血管腔内支架置入术进行治疗。她被诊断为重度主动脉瓣狭窄并转诊至我院。由于她有多种合并症和外周血管疾病,因此选择了经心尖经导管主动脉瓣植入术(TA-TAVI)。在TA-TAVI过程中,经导管瓣膜(TV)松动并嵌顿于主动脉弓远端。该TV处于漂浮且不稳定状态,从而影响了她的血流动力学。在顺利将第二个TV放置于合适位置后,我们尝试使用胸段血管腔内覆膜支架固定该TV。手术成功,患者恢复良好。栓塞原因似乎与自身主动脉瓣相对较轻的钙化有关。尽管这种并发症很罕见,但仍应准备好几种补救措施。

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