Joshi Udit, Duvvuri Padmaraj, Barzallo Marco, Mungee Sudhir
Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA.
Cureus. 2020 Dec 30;12(12):e12373. doi: 10.7759/cureus.12373.
Acute coronary obstruction is a relatively rare complication of transcatheter aortic valve replacement (TAVR). Left coronary ostial obstruction is much more common compared to right coronary occlusion due to its relatively lower ostial height from the aortic annulus. We present a case of acute ostial right coronary occlusion immediately upon deployment of a 29-mm Sapien 3 transcatheter aortic valve. The acute right coronary ostial occlusion manifested with ventricular fibrillation, acute right ventricular failure, and right-sided cardiogenic shock. The patient, after undergoing an initial unsuccessful attempt at percutaneous revascularization, was placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This was later transitioned to percutaneous right atrial to pulmonary artery right ventricular support, which led to subsequent recovery.
急性冠状动脉阻塞是经导管主动脉瓣置换术（TAVR）相对罕见的并发症。与右冠状动脉闭塞相比，左冠状动脉开口阻塞更为常见，因为其距主动脉瓣环的开口高度相对较低。我们报告一例在植入29毫米Sapien 3经导管主动脉瓣后立即发生的急性右冠状动脉开口闭塞病例。急性右冠状动脉开口闭塞表现为心室颤动、急性右心室衰竭和右侧心源性休克。该患者在经皮血管重建术初步尝试失败后，接受了静脉-动脉体外膜肺氧合（VA-ECMO）治疗。随后过渡到经皮右心房至肺动脉右心室支持，最终实现康复。
