Vanek Trey W, Hayanga Jeremiah, Ellison Matthew, Puette Jeffrey, Wei Lawrence, Hayanga Heather K
Department of Anesthesiology, West Virginia University, Morgantown, WV, USA.
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA.
Case Rep Anesthesiol. 2020 Nov 5;2020:8820948. doi: 10.1155/2020/8820948. eCollection 2020.
A 61-year-old male with severe aortic valve stenosis was scheduled for a minimally invasive bioprosthetic aortic valve replacement. Intraoperative transesophageal echocardiography (TEE) showed a unicuspid aortic valve and extensive aortic atheromatous disease. A large atheroma with mobile components existed near the distal aortic arch. A 17-French aortic cannula was successfully placed using TEE guidance with the tip proximal to the mobile atheroma to avoid inadvertent disruption and subsequent embolic sequelae. The patient had no evidence of perioperative stroke or other complications postoperatively. This case demonstrates one strategy to manage severe atheromatous disease intraoperatively. We also review additional management options.
一名61岁患有严重主动脉瓣狭窄的男性计划进行微创生物人工主动脉瓣置换术。术中经食管超声心动图（TEE）显示为单叶主动脉瓣和广泛的主动脉粥样硬化疾病。在主动脉弓远端附近存在一个带有可移动成分的大的动脉粥样硬化斑块。在TEE引导下成功放置了一根17号法国主动脉插管，插管尖端位于可移动动脉粥样硬化斑块近端，以避免意外破裂及随后的栓塞后遗症。患者围手术期无卒中证据，术后也无其他并发症。该病例展示了一种术中处理严重动脉粥样硬化疾病的策略。我们还回顾了其他处理选项。
