Matsuura Makoto, Kuroyanagi Satoshi, Furuya Onichi, Hiramatsu Norihiko, Takemoto Tetsushi, Kobayashi Masaaki, Okuda Shintaro, Hashimoto Kazuya
Department of Cardiovascular Surgery, Kishiwada Tokusyukai Hospital, Osaka, Japan.
Kyobu Geka. 2024 Mar;77(3):191-195.
We experienced a case of surgical aortic valve re-replacement due to structural valve deterioration caused by pannus formation 4 years after transcatheter aortic valve replacement( TAVR). The patient underwent surgery because the mean transvalvular pressure gradient increased to 48 mmHg on echocardiography. Contrast-enhanced computed tomography (CT) was useful for predicting the site of adhesion to surrounding tissue preoperatively and exploring the presence of the pannus. Intraoperative findings showed the TAVR valve was covered with neointima except around the origins of the left and right coronary arteries and was firmly adhered to the surrounding tissues. As residual pannus was present in the subvalvular tissues, it was carefully removed. The explanted TAVR valve functioned well with good opening and closure. The postoperative course was uneventful. Pannus formation can result from mechanical stress. TAVR valves put significantly greater stress on the left ventricular outflow tract than surgical valves and may be more likely to cause pannus formation.
我们遇到一例经导管主动脉瓣置换术（TAVR）4年后因瓣周组织形成导致人工瓣膜结构退化而进行再次主动脉瓣置换手术的病例。患者接受手术是因为超声心动图显示平均跨瓣压差增加至48 mmHg。对比增强计算机断层扫描（CT）有助于术前预测与周围组织的粘连部位并探查瓣周组织的存在情况。术中发现TAVR瓣膜除左右冠状动脉起源处周围外均被新生内膜覆盖，并与周围组织紧密粘连。由于瓣下组织存在残留瓣周组织，故小心予以清除。取出的TAVR瓣膜开闭良好，功能正常。术后病程平稳。瓣周组织形成可能由机械应力导致。TAVR瓣膜对左心室流出道施加的应力明显大于外科手术瓣膜，可能更易导致瓣周组织形成。
