Department of Cardiovascular Surgery, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
J Artif Organs. 2020 Dec;23(4):383-387. doi: 10.1007/s10047-020-01191-y. Epub 2020 Jul 6.
We experienced a case of aortic regurgitation secondary to tear in the non-coronary cusp of the aortic valve after percutaneous mechanical circulatory support by Impella 2.5 placement, which was resolved with aortic valve replacement. Our patient, a 72-year-old man, developed non-ST elevation myocardial infarction and cardiogenic shock, which was treated with the implantation of Impella 2.5 prior to percutaneous coronary intervention. He eventually required prosthetic valve replacement for progressive aortic regurgitation after removing the Impella device. From intraoperative photographs, multiple lacerations were confirmed in the non-coronary aortic cusp. One year after prosthetic valve replacement, he was asymptomatic as per the New York Heart Association functional class II; additionally, echocardiography showed a mean prosthetic valve gradient of 7 mmHg, an effective orifice area of 1.87 cm, and no aortic regurgitation. A rare complication of aortic regurgitation due to aortic valve injury should be considered when hemodynamic deterioration is observed after Impella implantation.
我们遇到了一例在经皮机械循环支持后，因主动脉瓣无冠状动脉瓣撕裂导致的主动脉瓣反流，经主动脉瓣置换后得到解决。我们的患者是一名 72 岁男性，因非 ST 段抬高型心肌梗死和心源性休克，在经皮冠状动脉介入治疗前植入了 Impella 2.5。在移除 Impella 装置后，他最终因进行性主动脉瓣反流需要进行人工瓣膜置换。术中照片显示，非冠状动脉瓣有多处撕裂。人工瓣膜置换 1 年后，他根据纽约心脏协会功能分级 II 级无症状；此外，超声心动图显示平均人工瓣膜梯度为 7mmHg，有效瓣口面积为 1.87cm，无主动脉瓣反流。当观察到 Impella 植入后血流动力学恶化时，应考虑因主动脉瓣损伤导致的罕见主动脉瓣反流并发症。
