经导管主动脉瓣植入术后因传导障碍导致二尖瓣反流暂时加重。
Temporary worsening of mitral regurgitation due to conduction disturbance after transcatheter aortic valve implantation.
作者信息
Sajima Takeyuki, Onimaru Taichi, Sawamura Shigehito
机构信息
Department of Anesthesia, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
出版信息
JA Clin Rep. 2021 Dec 18;7(1):87. doi: 10.1186/s40981-021-00491-3.
BACKGROUND
Mitral regurgitation after transcatheter aortic valve implantation (TAVI) can be caused by various etiologies.
CASE PRESENTATION
An 81-year-old woman with mild mitral regurgitation and complete right bundle branch block was scheduled to undergo TAVI under general anesthesia. After the deployment of the prosthetic valve, electrocardiography depicted a wide QRS wave and bradycardia, suggestive of complete atrioventricular block. Although there was no lesion indicative of tissue injury to the valve itself, worsening of mitral regurgitation was identified on transesophageal echocardiography. The hemodynamic condition was stable, and no additional procedure was performed. Electrocardiography depicted a return to a narrow QRS wave 3 days after surgery, and the mitral regurgitation appeared comparable to the preoperative grade. We assumed that the worsening of mitral regurgitation was caused by dyssynchrony in the left ventricle due to the conduction disorder.
CONCLUSIONS
Mitral regurgitation after TAVI needs observation, including the determination of the etiology and treatment principle.
背景
经导管主动脉瓣植入术（TAVI）后二尖瓣反流可由多种病因引起。
病例介绍
一名81岁女性，有轻度二尖瓣反流和完全性右束支传导阻滞，计划在全身麻醉下接受TAVI。人工瓣膜置入后，心电图显示宽QRS波和心动过缓，提示完全性房室传导阻滞。尽管没有病变表明瓣膜本身存在组织损伤，但经食管超声心动图显示二尖瓣反流加重。血流动力学状况稳定，未进行额外手术。术后3天心电图显示QRS波恢复变窄，二尖瓣反流程度与术前相当。我们推测二尖瓣反流加重是由于传导障碍导致左心室不同步所致。
结论
TAVI术后二尖瓣反流需要观察，包括病因的确定和治疗原则。
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