Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan.
J Card Surg. 2022 Nov;37(11):3928-3931. doi: 10.1111/jocs.16858. Epub 2022 Aug 30.
Modern multi-slice computed tomography (CT) has increased the detection of hypo-attenuated leaflet thickening (HALT). Furthermore, HALT's impact on transcatheter or surgical biological aortic valve (AV) prostheses has attracted attention. However, few reports on HALT in sutureless bioprostheses exist. Herein, we report a case of early structural valve deterioration due to HALT after AV replacement (AVR) with a Perceval bioprosthesis, which improved after anticoagulation therapy. A 79-year-old man admitted to our hospital with paroxysmal atrial fibrillation (PAF) during hemodialysis was also diagnosed with AV stenosis and, coronary artery disease, and PAF. He underwent AVR, coronary artery bypass grafting, and left atrial appendage resection. Although the postoperative course was uneventful with dual antiplatelet therapy, postoperative enhanced CT revealed HALT with reduced leaflet motion, and echocardiography showed an increased transvalvular pressure gradient. After using warfarin with target prothrombin time-international normalized ratio of 2-2.5 and/or heparin with target activated partial thromboplastin time of 45-60 s, the HALT disappeared with an improved transvalvular pressure gradient without any thromboembolic events.
现代多层计算机断层扫描（CT）提高了对低衰减瓣叶增厚（HALT）的检测能力。此外，HALT 对经导管或外科生物主动脉瓣（AV）假体的影响引起了关注。然而，关于无缝线生物假体中 HALT 的报道很少。在此，我们报告了一例使用 Perceval 生物假体置换 AV 后因 HALT 导致早期结构性瓣膜恶化的病例，经抗凝治疗后得到改善。一名 79 岁男性在血液透析时发生阵发性心房颤动（PAF），被诊断为 AV 狭窄、冠状动脉疾病和 PAF。他接受了 AV 置换、冠状动脉旁路移植术和左心耳切除术。尽管术后使用双联抗血小板治疗过程顺利，但术后增强 CT 显示 HALT 伴瓣叶活动减少，超声心动图显示跨瓣压力梯度增加。使用华法林（目标凝血酶原时间-国际标准化比值为 2-2.5）和/或肝素（目标活化部分凝血活酶时间为 45-60 秒）后，HALT 消失，跨瓣压力梯度改善，无血栓栓塞事件发生。
