Liang Kae-Woei, Yu Chu-Leng, Lin Wei-Wen, Lee Wen-Lieng
Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
CJC Open. 2021 May 1;3(9):1182-1185. doi: 10.1016/j.cjco.2021.04.013. eCollection 2021 Sep.
We report the case of an octogenarian with severe aortic valve stenosis, chronic kidney disease (CKD) and heart failure. Due to advanced CKD, we used a 3-dimensional transesophageal echocardiogram for sizing the device before transcatheter aortic valve replacement (TAVR). Noncontrast computed tomography found complex aortic dissection involving the arch, descending thoracic aorta, and abdominal aorta. TAVR was approached via the right carotid artery using a CoreValve. There was no cerebral vascular event. Renal function was well preserved. Transcarotid TAVR can be performed safely with complex type B aortic dissection. Three-dimensional transesophageal echocardiogram provides an alternative sizing solution in advanced CKD.
我们报告了一例患有严重主动脉瓣狭窄、慢性肾脏病（CKD）和心力衰竭的八旬老人病例。由于CKD晚期，我们在经导管主动脉瓣置换术（TAVR）前使用三维经食管超声心动图来确定器械尺寸。非增强计算机断层扫描发现复杂的主动脉夹层累及主动脉弓、胸降主动脉和腹主动脉。采用CoreValve经右颈动脉进行TAVR。未发生脑血管事件。肾功能得到良好保留。对于复杂的B型主动脉夹层，经颈动脉TAVR可以安全进行。三维经食管超声心动图为CKD晚期提供了一种替代的尺寸确定解决方案。
