Steinecker Matthieu, Benvenuti Christophe, Digne Franck, Nejjari Mohammed
Centre Cardiologique du Nord, 32-36 Rue des Moulins Gémeaux, 93200 Saint-Denis, France.
Eur Heart J Case Rep. 2020 Dec 20;5(1):ytaa457. doi: 10.1093/ehjcr/ytaa457. eCollection 2021 Jan.
Transcatheter aortic valve implantation (TAVI) has become a first-line therapeutic option in patients with severe, symptomatic aortic stenosis at increased surgical risk. Despite its success, the TAVI procedure has been associated with acute life-threatening complications as myocardial infarction secondary to periprocedural coronary occlusion, annular rupture, or vascular injury.
A 79-year-old woman with a dysfunctional bioprosthetic valve following previous surgical valve replacement was hospitalized in our institution to perform a Valve-in-Valve Transcatheter Aortic Valve Replacement (ViV TAVR). Shortly after the implantation of an Evolut R valve (without complication), left ventricle dysfunction with apical akinesia and basal hyperkinesia was identified during bedside transthoracic echocardiography, in spite of a good prosthesis implantation and function. A concomitant Troponin elevation was noted, and the day-after resting electrocardiogram showed a lateral T-wave inversion. Coronary computed tomography angiography showed no coronary stenosis or occlusion, cardiac magnetic resonance imaging showed no necrosis or fibrosis, and no argument for myocarditis. The patient remained asymptomatic during her hospital stay, and the aforementioned anomalies spontaneously regressed after an in-hospital 2-week surveillance. In the presence of these transient anomalies and after ruling out myocardial infarction and myocarditis, post-procedural stress cardiomyopathy (takotsubo) was diagnosed.
Post-TAVR stress-related cardiomyopathy seems to be an extremely rare entity. To our knowledge, this is the first case of a takotsubo cardiomyopathy after ViV TAVR. Though the association between the two seems likely to be causal, no clear physiopathological explanation can be formulated.
经导管主动脉瓣植入术（TAVI）已成为手术风险增加的严重症状性主动脉瓣狭窄患者的一线治疗选择。尽管取得了成功，但TAVI手术仍与急性危及生命的并发症相关，如围手术期冠状动脉闭塞、瓣环破裂或血管损伤继发的心肌梗死。
一名79岁女性，此前接受过外科瓣膜置换术，生物瓣膜功能失调，入住我院接受经导管主动脉瓣置换术（ViV TAVR）。在植入Evolut R瓣膜后不久（无并发症），床边经胸超声心动图检查发现左心室功能障碍，心尖运动减弱，基底运动增强，尽管瓣膜植入良好且功能正常。同时发现肌钙蛋白升高，术后第二天静息心电图显示侧壁T波倒置。冠状动脉计算机断层扫描血管造影显示无冠状动脉狭窄或闭塞，心脏磁共振成像显示无坏死或纤维化，也无心肌炎的证据。患者住院期间无症状，在住院2周的监测后，上述异常自发消退。在存在这些短暂异常并排除心肌梗死和心肌炎后，诊断为术后应激性心肌病（应激性心肌病）。
TAVR术后应激相关心肌病似乎是一种极其罕见的疾病。据我们所知，这是ViV TAVR术后第一例应激性心肌病病例。尽管两者之间的关联似乎可能是因果关系，但尚无明确的生理病理解释。
