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经导管主动脉瓣置换术后使用 Evolut PRO 治疗升主动脉假体瓣感染性心内膜炎导致的升主动脉巨大假性动脉瘤患者的升主动脉置换和主动脉瓣置换 1 例

A Case of Ascending Aortic Replacement and Aortic Valve Replacement in a Patient with Giant Pseudoaneurysm of the Ascending Aorta due to Prosthetic Valve Endocarditis after Transcatheter Aortic Valve Replacement Using Evolut PRO.

机构信息

Department of Cardiovascular Surgery, Osaka University Hospital, Suita, Osaka, Japan.

出版信息

Ann Thorac Cardiovasc Surg. 2024 Jan 26;30(1). doi: 10.5761/atcs.cr.22-00089. Epub 2022 Aug 24.

DOI:10.5761/atcs.cr.22-00089
PMID:36002292
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10902662/
Abstract

An 82-year-old man who underwent transcatheter aortic valve replacement (TAVR) using a 34-mm Evolut PRO (Medtronic, Minneapolis, MN, USA) for severe aortic stenosis 21 months previously presented with fever. Transesophageal echocardiography showed thickening of the valve leaflets of the transcatheter heart valve and movable structures such as verrucae on the upper edge of the Evolut PRO stent. Contrast-enhanced cardiac computed tomography showed a 72-mm saccular pseudoaneurysm on the dorsal aspect of the ascending aorta at the superior border of the Evolut PRO stent. Because of a suspected infected aortic aneurysm caused by prosthetic valve endocarditis (PVE), we performed aortic valve replacement using 23 mm Avalus (Medtronic, Minneapolis, MN, USA) and ascending aortic replacement using 26 mm Gelweave (Vascutek Terumo Inc, Scotland, UK). The postoperative course was uneventful. This report highlights that patients with PVE after TAVR may develop pseudoaneurysms of the ascending aorta.

摘要

一位 82 岁男性，21 个月前因严重主动脉瓣狭窄接受了 34 毫米 Evolut PRO（美敦力，明尼苏达州明尼阿波利斯，美国）经导管主动脉瓣置换术（TAVR），现出现发热症状。经食管超声心动图显示经导管心脏瓣膜的瓣叶增厚，以及 Evolut PRO 支架上缘的可移动结构，如疣状突起。增强心脏计算机断层扫描显示 Evolut PRO 支架上缘的升主动脉背侧有一个 72 毫米的囊状假性动脉瘤。由于疑似由人工瓣膜心内膜炎（PVE）引起的感染性主动脉瘤，我们使用 23 毫米 Avalus（美敦力，明尼苏达州明尼阿波利斯，美国）进行主动脉瓣置换和 26 毫米 Gelweave（Vascutek Terumo Inc，苏格兰，英国）进行升主动脉置换。术后过程顺利。本报告强调，TAVR 后发生 PVE 的患者可能会发展为升主动脉假性动脉瘤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a53c/10902662/7f20a87309a1/atcs-30-1-22-00089-figure03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a53c/10902662/50e46a1e569a/atcs-30-1-22-00089-figure01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a53c/10902662/5a29ad0abb37/atcs-30-1-22-00089-figure02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a53c/10902662/7f20a87309a1/atcs-30-1-22-00089-figure03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a53c/10902662/50e46a1e569a/atcs-30-1-22-00089-figure01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a53c/10902662/5a29ad0abb37/atcs-30-1-22-00089-figure02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a53c/10902662/7f20a87309a1/atcs-30-1-22-00089-figure03.jpg

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Redo surgery after transcatheter aortic valve replacement with a balloon-expandable valve.经导管主动脉瓣置换术后使用球囊扩张瓣膜的再次手术。
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Surgical Explantation of Transcatheter Aortic Bioprostheses: Balloon vs Self-Expandable Devices.
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J Cardiothorac Surg. 2024 Nov 6;19(1):623. doi: 10.1186/s13019-024-03122-x.
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