Soto Jose D Tafur, Betancourt Silvia Patricia Gironza
Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA.
The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA.
Ochsner J. 2021 Spring;21(1):93-98. doi: 10.31486/toj.19.0106.
Aortic stenosis is a common disease of the elderly. Valve replacement with open surgery is the preferred therapy for many patients with low surgical risk. Bioprosthetic valve failure occurs in up to 66% of patients and has a worse prognosis when the mechanism of failure is stenosis compared to regurgitation. An 80-year-old female with a medical history of surgical aortic valve replacement, diabetes, chronic back pain, coronary artery disease, and hypertension was referred to the interventional cardiology clinic for heart failure symptoms. A bioprosthetic valve placement that was small for the patient's size (effective orifice area/body surface area 0.75 cm/m) resulted in symptomatic improvement that lasted for 7 years. The patient underwent an aortic valve-in-valve transcatheter valve replacement with excellent outcomes. Preoperative planning involved a patient-specific 3-dimensional printed patient model. In patients at high surgical risk, transcatheter aortic valve replacement is a fundamental pillar of treatment. However, valve-in-valve procedures have specific anatomic challenges, such as the risk of coronary artery obstruction and the limitation of valve expansion inside a rigid bioprosthetic valve frame. In those difficult cases, interventional cardiologists must make precise decisions regarding the approach. Three-dimensional models can be printed with the patient's specific measurements. This approach represents truly personalized medicine and can serve as a tool for procedural planning, education of the health personnel involved in the case, and patient and family engagement.
主动脉瓣狭窄是一种常见的老年疾病。对于许多手术风险较低的患者，开胸手术进行瓣膜置换是首选治疗方法。生物瓣膜衰竭在高达66%的患者中发生，与反流相比，当衰竭机制为狭窄时预后更差。一名80岁女性，有外科主动脉瓣置换术、糖尿病、慢性背痛、冠状动脉疾病和高血压病史，因心力衰竭症状被转诊至介入心脏病诊所。为该患者尺寸选择过小的生物瓣膜置入（有效瓣口面积/体表面积为0.75 cm/m²）使症状改善持续了7年。该患者接受了经导管主动脉瓣瓣中瓣置换术，效果极佳。术前规划涉及针对患者的三维打印患者模型。对于手术风险高的患者，经导管主动脉瓣置换术是治疗的基本支柱。然而，瓣中瓣手术存在特定的解剖学挑战，如冠状动脉阻塞风险以及刚性生物瓣膜框架内瓣膜扩张的限制。在这些困难病例中，介入心脏病学家必须就手术方法做出精确决策。可以根据患者的具体测量数据打印三维模型。这种方法代表了真正的个性化医疗，可作为手术规划工具、参与该病例的医护人员的教育工具以及患者及其家属参与的工具。
