Sanford Corry B, Urbanczyk Jonathan P, Mixon Timothy A
Department of Internal Medicine, Baylor Scott and White Medical Center - Temple , Temple , Texas.
Division of Cardiology, Baylor Scott and White Medical Center - Temple , Temple , Texas.
Proc (Bayl Univ Med Cent). 2022 Dec 22;36(2):216-218. doi: 10.1080/08998280.2022.2158770. eCollection 2023.
Transcatheter aortic valve replacement (TAVR) in the setting of an anomalous left circumflex coronary artery (LCX) has had a variety of outcomes. Most commonly an anomalous LCX originates as a separate ostium arising from the right coronary sinus or is found branching off of the proximal right coronary artery. The artery courses around the aortic annulus before taking the course seen in typical anatomy. Given this deviation from typical anatomy and increased aortic annulus pressure by the replacement valve, there is an increased risk of a complication such as acute coronary artery occlusion. Special consideration and preparation are needed to prevent adverse outcomes, including death. We report a case in which intraprocedural anomalous LCX rescue stenting proved to be effective for treatment of acute coronary occlusion. Follow-up angiography provided an opportunity to demonstrate long-term patency in rescue stenting during TAVR.
在左旋冠状动脉（LCX）异常的情况下进行经导管主动脉瓣置换术（TAVR）会产生多种结果。最常见的是，异常的左旋冠状动脉起源于右冠状动脉窦的一个单独开口，或者从右冠状动脉近端分支出来。该动脉在走行于典型解剖结构所见路径之前，先环绕主动脉瓣环。鉴于这种与典型解剖结构的偏差以及置换瓣膜导致的主动脉瓣环压力增加，急性冠状动脉闭塞等并发症的风险会增加。需要特别考虑和准备以防止包括死亡在内的不良后果。我们报告了一例术中对异常左旋冠状动脉进行抢救性支架置入术被证明对治疗急性冠状动脉闭塞有效的病例。随访血管造影为证明经导管主动脉瓣置换术期间抢救性支架置入术的长期通畅提供了机会。
