Ballout Edouard, Combaret Nicolas, Riocreux Clément, Souteyrand Géraud
Puy de Dome, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand 63000, France.
Cardiology, Clermont-Ferrand University Hospital, 58 rue Montalembert, Clermont-Ferrand 63000, France.
Eur Heart J Case Rep. 2022 Aug 3;6(8):ytac313. doi: 10.1093/ehjcr/ytac313. eCollection 2022 Aug.
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as an alternative for the treatment of degenerated bioprosthetic valves (BPVs) for high surgical risk patients. However, this procedure often results in patient-prosthesis mismatch. BPV fracture is a novel technique to address this problem. From now, complications following BPV fracture are few.
We present the case of a 84-year-old female with history of first surgical aortic BPV replacement with a Mitroflow Sorin 23 mm due to severe aotic stenosis in 2009. In 2017, a second intervention due to bioprosthetic aortic valve stenosis valve was performed with valve-in-valve TAVI with CoreValve Evolut R 23 mm. In 2021, she was admitted with severe heart failure due to TAVI degeneration with severe stenosis in the bioprothesis. After heart team discussions, the patient was deemed inoperable for new heart surgery and considered as a candidate for BPV fracture as last possible alternative. After BPV fracture was performed, the patient suffered acute hypotension. Urgent transoesophageal echocardiography and angiogram demonstrated severe acute intra-TAVI aortic insufficiency because of probable disruption of the CoreValve leaflets. The patient was successfully treated with a ViV 23 mm SAPIEN three Edwards valve with a resolution of the aortic insufficiency and improvement of her haemodynamics. The patient remains asymptomatic after 6 months, with improvement in clinical status.
This case demonstrates a disruption of the transcatheter heart valve leaflets causing severe aortic regurgitation as one of the complication of BPV fracture. To our knowledge, this is the first report of a TAVI in a patient who was already operated with ViV-TAVI. Although case series described few complications with improvement in clinical status, the procedure should be established with appropriate planning and careful technique.
瓣中瓣经导管主动脉瓣植入术（TAVI）已成为治疗生物瓣退化且手术风险高的患者的一种替代方法。然而，该手术常导致患者与人工瓣膜不匹配。生物瓣破裂是解决这一问题的新技术。目前，生物瓣破裂后的并发症较少。
我们报告一例84岁女性患者，2009年因严重主动脉瓣狭窄首次接受外科主动脉生物瓣置换术，植入Mitroflow Sorin 23毫米生物瓣。2017年，因生物瓣主动脉瓣狭窄，行经导管主动脉瓣置换术（TAVI），植入CoreValve Evolut R 23毫米瓣膜。2021年，她因TAVI退化及生物瓣严重狭窄导致严重心力衰竭入院。经心脏团队讨论，患者被认为无法进行新的心脏手术，考虑作为生物瓣破裂的候选者，这是最后的可能选择。生物瓣破裂术后，患者出现急性低血压。紧急经食管超声心动图和血管造影显示，由于CoreValve瓣叶可能破裂，导致严重的急性TAVI内主动脉瓣关闭不全。患者成功接受了23毫米SAPIEN 3爱德华兹瓣膜瓣中瓣治疗，主动脉瓣关闭不全得到解决，血流动力学得到改善。6个月后患者仍无症状，临床状况有所改善。
本病例显示经导管心脏瓣膜瓣叶破裂导致严重主动脉瓣反流是生物瓣破裂的并发症之一。据我们所知，这是首例在已接受瓣中瓣TAVI手术的患者中进行TAVI的报告。尽管病例系列报道的并发症较少，临床状况有所改善，但该手术仍应进行适当规划并采用谨慎的技术。
Zotero 插件
