Mohammed Fawaz, Gubitosa James C, Huffman Travis R, Abdul-Waheed Mohammad, Rafeedheen Rahil
Internal Medicine, University of Kentucky College of Medicine, Bowling Green, USA.
Cardiology, University of Kentucky College of Medicine, Bowling Green, USA.
Cureus. 2023 Aug 21;15(8):e43847. doi: 10.7759/cureus.43847. eCollection 2023 Aug.
Prosthetic valvular infolding during transcatheter aortic valve implantation (TAVI) is an under-recognized yet significant complication that can occur. Here, we describe the case of a 61-year-old male with a history of heart failure with reduced ejection fraction (HFrEF) and low-flow, low-gradient severe aortic valve stenosis of a bicuspid aortic valve who presented to undergo TAVI. During the procedure, repositioning of the valve resulted in prosthetic valvular infolding and resultant severe aortic regurgitation (AR), culminating in cardiac arrest. Swift balloon valvuloplasty corrected the valve geometry and eliminated any AR, allowing hemodynamic recovery and completion of the procedure. Our case and review highlight methods, both angiographic and echocardiographic, to recognize prosthetic valvular infolding the moment it presents, as well as strategies to correct the infolding with minimal detriment to the patient.
经导管主动脉瓣植入术（TAVI）期间的人工瓣膜折叠是一种未被充分认识但很重要的并发症。在此，我们描述了一名61岁男性患者的病例，该患者有射血分数降低的心力衰竭（HFrEF）病史，患有二叶式主动脉瓣的低流量、低梯度严重主动脉瓣狭窄，前来接受TAVI。在手术过程中，瓣膜重新定位导致人工瓣膜折叠并进而引发严重主动脉瓣反流（AR），最终导致心脏骤停。迅速进行球囊瓣膜成形术纠正了瓣膜形态并消除了所有AR，实现了血流动力学恢复并完成了手术。我们的病例及综述强调了通过血管造影和超声心动图等方法在人工瓣膜折叠出现时予以识别，以及以对患者损害最小的方式纠正折叠的策略。
