El Tahlawy Walid, Bader Feras, Traina Mahmoud Idris, Edris Ahmad
Cardiology Department, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Swing Wing | Level 8 | Room C 08-289, Al Maryah Island, PO BOX 112412, Abu Dhabi, United Arab Emirates.
Eur Heart J Case Rep. 2022 Mar 14;6(3):ytac101. doi: 10.1093/ehjcr/ytac101. eCollection 2022 Mar.
Cardiogenic shock (CS) is associated with significant morbidity and mortality (27-51%). Little is known about the feasibility and safety of emergency transcatheter aortic valve replacement (TAVR) for critical aortic stenosis (AS) in acute myocardial infarction (AMI) with CS.
A 57-year-old male with history of tobacco dependence and diabetes mellitus presented with acute posterior ST-segment elevation myocardial infarction and CS. The patient initially underwent successful primary percutaneous intervention to an anomalous circumflex artery coming off the right cusp. It was noted to have advanced CS out of proportion to his coronary anatomy. Echocardiographic assessment noted critical AS. Heart team decided to perform percutaneous aortic balloon valvuloplasty under support of extracorporeal membrane oxygenation. Percutaneous aortic balloon valvuloplasty was performed and was complicated by severe aortic regurgitation (AR). A balloon-expandable transcatheter heart valve was then placed with resolution of AR and stabilization of the patient. Then, the patient was subsequently decannulated within a week then was able to go home after 47 days (32 days intensive care unit). His course was notable for a minor stroke due to initial period of hypotension and CS. He was extubated and remained hospitalized for several weeks participating in rehabilitation. Follow-up echo showed a well-seated and functioning transcatheter heart valve. His left ventricular systolic function improved from 21% to 45%.
Emergency TAVR is feasible and can be performed in a patient with AMI and CS. Early initiation of mechanical support allowed the patient to receive definitive treatment. The multidisciplinary heart team is essential and reflected in the ultimate outcome of our patient.
心源性休克（CS）与显著的发病率和死亡率（27%-51%）相关。对于急性心肌梗死（AMI）合并CS的严重主动脉瓣狭窄（AS）患者，急诊经导管主动脉瓣置换术（TAVR）的可行性和安全性知之甚少。
一名57岁男性，有烟草依赖和糖尿病史，因急性后壁ST段抬高型心肌梗死和CS就诊。患者最初对发自右冠瓣的异常回旋支成功进行了直接经皮介入治疗。发现其CS进展程度与冠状动脉解剖结构不符。超声心动图评估显示为严重AS。心脏团队决定在体外膜肺氧合支持下进行经皮主动脉球囊瓣膜成形术。进行了经皮主动脉球囊瓣膜成形术，但出现了严重主动脉瓣反流（AR）的并发症。随后植入了球囊扩张型经导管心脏瓣膜，AR得到缓解，患者病情稳定。然后，患者在一周内拔管，47天后（在重症监护病房32天）出院。其病程中因初期低血压和CS发生了一次轻度中风。他拔管后住院数周进行康复治疗。随访超声心动图显示经导管心脏瓣膜位置良好且功能正常。他的左心室收缩功能从21%提高到了45%。
急诊TAVR是可行的，可在AMI合并CS的患者中进行。早期启动机械支持使患者能够接受确定性治疗。多学科心脏团队至关重要，这在我们患者的最终结局中得到了体现。
