Kaneko Umihiko, Koshima Ryuji, Doi Hirosato, Fujita Tsutomu
Tex Heart Inst J. 2020 Feb 1;47(1):30-34. doi: 10.14503/THIJ-17-6497. eCollection 2020 Feb.
Coronary obstruction, a rare complication of transcatheter aortic valve replacement, can be fatal. Few data exist on this phenomenon, and, to date, authors have reported only single coronary lesions. We present a case in which 2 coronary arteries obstructed immediately after transapical transcatheter aortic valve replacement. The patient was an 81-year-old woman with symptomatic severe aortic stenosis who underwent transapical transcatheter aortic valve replacement. Immediately after an Edwards Sapien XT valve was deployed, she experienced sudden cardiogenic shock resulting from obstruction of the left main coronary artery ostium and the distal left anterior descending coronary artery. The left main obstruction was caused by direct compression from a large calcified mass and the valve frame. The left anterior descending coronary artery obstruction was caused by ambient myocardial tightening and external compression around the apical sutures. Revascularization was achieved through coronary stent placement and suture removal, respectively. Our patient's case highlights the risk for coronary obstructions after transapical transcatheter aortic valve replacement, and we discuss how they can be managed.
冠状动脉阻塞是经导管主动脉瓣置换术的一种罕见并发症，可能会致命。关于这一现象的数据很少，而且迄今为止，作者仅报告过单个冠状动脉病变。我们报告一例经心尖经导管主动脉瓣置换术后立即出现两条冠状动脉阻塞的病例。该患者为一名81岁有症状的严重主动脉瓣狭窄女性，接受了经心尖经导管主动脉瓣置换术。在植入爱德华兹Sapien XT瓣膜后，她立即因左冠状动脉主干开口和左前降支冠状动脉远端阻塞而发生心源性休克。左主干阻塞是由一个大的钙化团块和瓣膜框架直接压迫所致。左前降支冠状动脉阻塞是由心尖缝线周围的心肌收紧和外部压迫引起的。分别通过冠状动脉支架置入和缝线拆除实现了血运重建。我们患者的病例突出了经心尖经导管主动脉瓣置换术后冠状动脉阻塞的风险，并且我们讨论了如何对其进行处理。
