Jin Xinhao, Wang Yonggang
Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Med (Lausanne). 2022 Jun 20;9:915981. doi: 10.3389/fmed.2022.915981. eCollection 2022.
Osmotic demyelination syndrome (ODS) has a low incidence but is a life-threatening neurological disorder whose common cause is rapid overcorrection of chronic hyponatremia. Transcatheter aortic valve replacement (TAVR) is a new and important therapy for patients with aortic valve stenosis. In this article, we discuss the case of a 64-year-old woman who developed ODS after TAVR and provide a literature review.
A 64-year-old female patient was admitted to the hospital with chest tightness, shortness of breath, and fatigue for 2 months, with worsening of symptoms for 3 days prior to presentation. Auscultation revealed crackles in the lung fields, and systolic murmurs could be easily heard in the aortic area. Echocardiography showed severe aortic stenosis. Chest X-ray showed pulmonary oedema. Laboratory examinations showed that her serum sodium was 135 mmol/L. The patient received a diuretic to relieve her symptoms but showed little benefit. Her symptoms worsened, and her blood pressure dropped. Then, she underwent emergency TAVR under extracorporeal membrane oxygenation (ECMO) support. After the operation, her urine output increased markedly, and serum sodium increased sharply from 140 to 172 mmol/L. An MRI scan showed multiple lesions in the pons suggestive of ODS.
To date, this is the first reported case of a patient who developed ODS after receiving TAVR. In current clinical practice, diuretics are often used in aortic stenosis patients because of pulmonary oedema. After a patient receives TAVR, kidney perfusion pressure quickly returns to normal, and with the residual effect of a high-dose diuretic, balances of fluid volume and electrolyte levels in this phase are quite fragile and must be carefully managed. If a patient has neurological symptoms/signs during this phase, ODS should be considered, and MRI might be necessary.
渗透性脱髓鞘综合征（ODS）发病率较低，但却是一种危及生命的神经系统疾病，其常见病因是慢性低钠血症的快速过度纠正。经导管主动脉瓣置换术（TAVR）是治疗主动脉瓣狭窄患者的一种重要新疗法。在本文中，我们讨论了一名64岁女性在接受TAVR后发生ODS的病例并进行文献综述。
一名64岁女性患者因胸闷、气短和乏力2个月入院，就诊前3天症状加重。听诊肺部有湿啰音，主动脉区可闻及收缩期杂音。超声心动图显示严重主动脉狭窄。胸部X线显示肺水肿。实验室检查显示其血清钠为135 mmol/L。患者接受利尿剂治疗以缓解症状，但效果不佳。症状加重，血压下降。随后，她在体外膜肺氧合（ECMO）支持下接受了急诊TAVR。术后，她的尿量明显增加，血清钠从140 mmol/L急剧升至172 mmol/L。磁共振成像（MRI）扫描显示脑桥有多个病灶，提示ODS。
迄今为止，这是首例报道的接受TAVR后发生ODS的患者。在当前临床实践中，由于肺水肿，利尿剂常用于主动脉狭窄患者。患者接受TAVR后，肾脏灌注压力迅速恢复正常，加上高剂量利尿剂的残留作用，此阶段的液体量和电解质水平平衡相当脆弱，必须谨慎管理。如果患者在此阶段出现神经症状/体征，应考虑ODS，可能需要进行MRI检查。
