Hartnett Jack, Brandon Lisa, Waterhouse Deirdre, Murphy Ross T, Walsh Kevin P, Spence Mark S, Maree Andrew O
Department of Cardiology, St James's Hospital, James's Street, Dublin 8 D08 W9RT, Ireland.
Department of Cardiology, Blackrock Clinic, Rock Road, Blackrock, Co Dublin A94 E4X7, Ireland.
Eur Heart J Case Rep. 2021 Oct 5;5(10):ytab387. doi: 10.1093/ehjcr/ytab387. eCollection 2021 Oct.
Transcatheter aortic valve implantation (TAVI) has proven efficacy in the treatment of aortic stenosis (AS). Understandably, there is increasing enthusiasm for its use to treat aortic regurgitation (AR). However, there are significant anatomical differences between AS and AR which make TAVI for AR more complex.
We present the case of technically challenging TAVI for severe AR, which was complicated by a traumatic ventricular septal defect (VSD) that required percutaneous closure. To our knowledge, this is the first published case of VSD post-TAVI for AR.
This unanticipated complication highlights anatomical differences between TAVI use in AS and AR. Lack of aortic valve calcification and excessive annular compliance made stable deployment of a self-expanding valve extremely challenging. Despite device oversizing, repeated embolization of the prosthesis into the left ventricular outflow tract traumatized the interventricular septum.
经导管主动脉瓣植入术（TAVI）已被证明在治疗主动脉狭窄（AS）方面有效。可以理解的是，人们越来越热衷于使用它来治疗主动脉反流（AR）。然而，AS和AR之间存在显著的解剖学差异，这使得用于AR的TAVI更加复杂。
我们报告了一例技术上具有挑战性的严重AR的TAVI病例，该病例并发创伤性室间隔缺损（VSD），需要经皮闭合。据我们所知，这是第一例发表的AR的TAVI术后VSD病例。
这种意外的并发症凸显了TAVI用于AS和AR时的解剖学差异。缺乏主动脉瓣钙化和过度的瓣环顺应性使得自膨胀瓣膜的稳定部署极具挑战性。尽管器械尺寸过大，但人工瓣膜反复栓塞至左心室流出道，损伤了室间隔。
