Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.
German Heart Center Munich, Department of Cardiovascular Surgery, TUM, Munich, Germany.
Catheter Cardiovasc Interv. 2020 Mar 1;95(4):859-862. doi: 10.1002/ccd.28644. Epub 2019 Dec 3.
Transcatheter heart valve implantation into degenerated bioprosthetic valves (ViV-THV implantation) has become an established procedure for high risk patients. In general, paravalvular leak (PVL) is a contraindication for valve-in-valve-TAVR (ViV-TAVR). Herein, we report on a 81-year-old patient presenting with acute heart failure for a failing aortic bioprosthesis (Medtronic Mosaic 27 mm). Intraoperative transesophageal echocardiography during urgent ViV-TAVR revealed a PVL previously not detected. After transfemoral implantation of a 26 mm-Evolut-R, balloon-fracturing of the bioprosthetic ring was performed using a 24 mm True Dilatation balloon for treatment of the PVL. Afterward, left ventricular to aortic peak-to-peak pressure gradient measured 2-4mmHg. Transesophageal echocardiography merely revealed trace PVL. Aortic root angiography showed no PVL. At discharge, echocardiography measured a transprosthetic mean gradient of 5mmHg detecting no PVL. Intentional ring-fracturing of an aortic valve prostheses may prove not only to be effective in lowering transvalvular gradients after valve-in-valve-TAVR, but may also be a tool to treat PVL alongside degenerated surgical aortic bioprostheses in certain patients.
经导管心脏瓣膜植入术（ViV-THV 植入术）已成为高危患者的一种成熟手术方法。一般来说，瓣周漏（PVL）是经导管瓣中瓣置换术（ViV-TAVR）的禁忌症。在此，我们报告了一例 81 岁患者，因主动脉生物瓣（美敦力 Mosaic 27mm）功能衰竭而出现急性心力衰竭。在紧急 ViV-TAVR 过程中，术中经食管超声心动图显示了先前未发现的 PVL。在经股动脉植入 26mm-Evolut-R 后，使用 24mm True Dilatation 球囊对生物瓣环进行球囊破裂，以治疗 PVL。之后，左心室至主动脉峰峰值压力梯度为 2-4mmHg。经食管超声心动图仅显示微量 PVL。主动脉根部造影未见 PVL。出院时，超声心动图测量跨瓣平均梯度为 5mmHg，未发现 PVL。对主动脉瓣假体进行有意的环破裂不仅可能在经导管瓣中瓣置换术后降低跨瓣梯度，而且对于某些患者，在治疗退行性外科主动脉生物瓣的同时，也可能成为一种治疗 PVL 的手段。
