Fujita Hiroshi, Ito Tsuyoshi, Kikuchi Shohei, Seo Yoshihiro
Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Eur Heart J Case Rep. 2022 Dec 27;7(1):ytac486. doi: 10.1093/ehjcr/ytac486. eCollection 2023 Jan.
Transcatheter aortic valve implantation (TAVI) has been established as an effective and safe treatment for patients with severe aortic stenosis (AS). It is reported that vascular complications, especially aortic dissection, are rare. However, aortic dissection may be a serious consequence if it occurs. We experienced a case of delayed onset of ascending aortic dissection after TAVI.
An 82-year-old woman presented with dyspnoea and general fatigue. Echocardiography revealed severe AS and she was diagnosed with heart failure associated with AS. She had difficulty controlling heart failure and required the intervention of the aortic valve. We evaluated the aortic valve and access routes with contrast-enhanced computed tomography (CT), which showed marked dilatation of the ascending aorta. Transcatheter aortic valve implantation was performed and the procedure was completed without major complications. Transoesophageal echocardiography during the procedure did not detect any obvious arterial injury. However, on the second postoperative day, the patient suddenly became unconscious and a CT indicated an ascending aortic dissection. Unfortunately, she passed away. An autopsy revealed the fragility of the ascending aorta.
Patients with AS and aortic root dilatation may develop delayed onset of ascending aortic dissection after TAVI.
经导管主动脉瓣植入术（TAVI）已被确立为重度主动脉瓣狭窄（AS）患者的一种有效且安全的治疗方法。据报道，血管并发症，尤其是主动脉夹层，较为罕见。然而，一旦发生，主动脉夹层可能会导致严重后果。我们遇到了一例TAVI术后升主动脉夹层延迟发生的病例。
一名82岁女性因呼吸困难和全身乏力就诊。超声心动图显示重度AS，她被诊断为与AS相关的心力衰竭。她在控制心力衰竭方面存在困难，需要进行主动脉瓣干预。我们通过增强计算机断层扫描（CT）评估了主动脉瓣和入路途径，结果显示升主动脉明显扩张。进行了经导管主动脉瓣植入术，手术过程顺利，未出现重大并发症。术中经食管超声心动图未发现任何明显的动脉损伤。然而，术后第二天，患者突然昏迷，CT显示升主动脉夹层。不幸的是，她去世了。尸检显示升主动脉脆弱。
患有AS且主动脉根部扩张的患者在TAVI术后可能会发生升主动脉夹层延迟发作。
