Department of Vascular surgery, University Hospital, LMU Munich, Munich, Germany.
Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany.
J Endovasc Ther. 2021 Jun;28(3):388-392. doi: 10.1177/15266028211002506. Epub 2021 Mar 31.
To present a novel technique to successfully cross a mechanical aortic valve prosthesis.
A 55-year-old female patient with genetically verified Marfan syndrome presented with a 5-cm anastomotic aneurysm of the proximal aortic arch after previous ascending aortic replacement due to a type A aortic dissection in 2007. The patient also underwent mechanical aortic valve replacement in 1991. A 3-stage hybrid repair was planned. The first 2 steps included debranching of the supra-aortic vessels. In the third procedure, a custom-made double branched endovascular stent-graft with a short 35-mm introducer tip was implanted. The mechanical valve was passed with the tip of the dilator on the lateral site of the leaflet, without destructing the valve and with only mild symptoms of aortic insufficiency, as one leaflet continued to work. This allowed the implantation of the stent-graft directly distally of the coronary arteries. Postoperative computed tomography angiography showed no endoleaks and patent coronary and supra-aortic vessels.
Passing a mechanical aortic valve prosthesis at the proper position is feasible and allows adequate endovascular treatment in complex arch anatomy. However, caution should be taken during positioning of the endovascular graft as the tip may potentially damage the valve prosthesis.
介绍一种成功跨机械主动脉瓣假体的新技术。
一名 55 岁女性患者，患有遗传性马凡综合征，2007 年因 A 型主动脉夹层行升主动脉置换术后出现近端主动脉弓 5cm 吻合口动脉瘤。该患者于 1991 年还接受了机械主动脉瓣置换术。计划进行 3 期杂交修复。前 2 步包括主动脉弓上血管的分支。在第 3 步中，植入了一个带有短 35mm 导入尖端的定制双分支血管内支架移植物。通过扩张器尖端在瓣叶的外侧位置穿过机械瓣，而不会破坏瓣膜，并且只有轻微的主动脉瓣关闭不全症状，因为一个瓣叶继续工作。这允许支架移植物直接在冠状动脉远端植入。术后计算机断层血管造影显示无内漏，冠状动脉和主动脉弓上血管通畅。
在适当的位置通过机械主动脉瓣假体是可行的，并允许在复杂的弓部解剖结构中进行充分的血管内治疗。然而，在放置血管内移植物时应小心，因为尖端可能会潜在地损坏瓣膜假体。
