Naar Jan, Vondrakova Dagmar, Kruger Andreas, Janotka Marek, Zemanova Iva, Syrucek Martin, Neuzil Petr, Ostadal Petr
Department of Cardiology, Na Homolce Hospital, 150 30 Prague, Czech Republic.
Department of Pathology, Na Homolce Hospital, 150 30 Prague, Czech Republic.
J Clin Med. 2023 Aug 16;12(16):5318. doi: 10.3390/jcm12165318.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive therapeutic procedure with a consistent, linear increase in the number of implantations worldwide. Recently, TAVR has been rapidly expanding into lower-risk populations. Sporadic cases of late prosthesis-related Stanford type A dissection have been documented in self-expanding, as well as balloon-expandable TAVR valves, manifested primarily as acute aortic syndrome. We present the case of a 76-year-old male, who experienced refractory in-hospital cardiac arrest with non-shockable rhythm due to the obstruction of coronary flow caused by aortic dissection type A, with entry directly adjacent to the aortic prosthesis according to autopsy. The patient died despite the engagement of extracorporeal cardiopulmonary resuscitation. Aortic dissection developed one year after a transfemoral TAVR procedure using an Edwards SAPIEN 3 29 mm self-expanding valve. TAVR-associated late aortic dissection type A represents a rare, life-threatening condition with various clinical manifestations. The risk factors have not been well described and the differential diagnosis may be challenging. As the number of TAVR recipients and their life expectancy is increasing, we may face this complication more often in future.
经导管主动脉瓣置换术（TAVR）是一种微创治疗方法，全球范围内植入数量持续呈线性增长。最近，TAVR已迅速扩展至低风险人群。在自膨胀式以及球囊扩张式TAVR瓣膜中，均有散发性晚期人工瓣膜相关的斯坦福A型主动脉夹层病例的记录，主要表现为急性主动脉综合征。我们报告一例76岁男性病例，该患者因A型主动脉夹层导致冠状动脉血流受阻，在医院发生难治性心脏骤停且心律不可电击复律，尸检显示夹层入口紧邻主动脉人工瓣膜。尽管进行了体外心肺复苏，患者仍死亡。该患者在经股动脉行TAVR手术并使用爱德华SAPIEN 3 29mm自膨胀瓣膜一年后发生主动脉夹层。TAVR相关的晚期A型主动脉夹层是一种罕见的、危及生命的疾病，有多种临床表现。其危险因素尚未得到充分描述，鉴别诊断可能具有挑战性。随着TAVR接受者数量及其预期寿命的增加，未来我们可能会更频繁地面临这种并发症。
