Xu Rongfeng, Ding Jiandong, Chen Lijuan, Feng Yi, Ma Genshan
Department of Cardiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, 210009 Jiangsu, China.
Case Rep Cardiol. 2022 Jul 8;2022:6257367. doi: 10.1155/2022/6257367. eCollection 2022.
Acute coronary artery occlusion (CAO) during transcatheter aortic valve replacement (TAVR) is a rare but life-threatening complication during the procedure; there were a few case reports about an anomalous LCX during perioperative period. We report a case of successful coronary protection using the chimney stenting technique in a patient with a severely calcified aortic valve and an anomalous LCX. . A 75-year-old man was found an anomalous left circumflex coronary artery (LCX) originating from the right coronary cusp with severely calcified aortic valve stenosis requiring TAVR. When a self-expanding aortic valve was deployed, we found flow compromise in the right coronary system and circumflex to TIMI-0 flow. By using the chimney stenting technique, we rapidly planted 2 stents from the proximal CX branch to the sinotubular junction and the coronary flow was maintained.
Chimney stenting protection as a bailout technique is safe and feasible and should be considered in patients deemed to be at high risk of coronary flow compromise, especially with an anomalous LCX.
经导管主动脉瓣置换术（TAVR）期间急性冠状动脉闭塞（CAO）是该手术中一种罕见但危及生命的并发症；围手术期关于异常左旋支冠状动脉（LCX）的病例报告较少。我们报告一例在严重钙化主动脉瓣且LCX异常的患者中使用烟囱式支架置入技术成功实现冠状动脉保护的病例。一名75岁男性被发现左回旋支冠状动脉（LCX）起源于右冠状动脉瓣叶且伴有严重钙化主动脉瓣狭窄，需要进行TAVR。当置入自膨胀主动脉瓣时，我们发现右冠状动脉系统血流受损，回旋支血流降至TIMI-0级。通过使用烟囱式支架置入技术，我们迅速从近端CX分支至窦管交界处植入2枚支架，冠状动脉血流得以维持。
烟囱式支架置入保护作为一种补救技术是安全可行的，对于被认为有冠状动脉血流受损高风险的患者，尤其是伴有异常LCX的患者，应予以考虑。
