Shinoda Daigo, Miyagawa Atsushi, Yokoyama Nobu, Yuri Koichi
Department of Cardiovascular Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Kyobu Geka. 2024 Jun;77(6):433-437.
Some cases of coronary artery occlusion by prosthetic valves after surgical aortic valve replacement (SAVR) may be diagnosed and treated during operation if it is difficult to be separated from cardiopulmonary bypass. We present a case of a 74-year-old woman with symptomatic aortic stenosis due to bicuspid valve and a narrow aortic valve annulus. SAVR was considered to be feasible over transcatheter aortic valve implantation given her anatomy and frailty. A few hours after successful SAVR using a 19 mm bioprosthetic valve, she became hemodynamically unstable in the intensive care unit, and coronary angiography revealed severe stenosis at the right coronary artery orifice. Percutaneous coronary intervention was deemed technically demanding, and she subsequently underwent coronary artery bypass grafting. On the 35th postoperative day, the patient was transferred to another facility for rehabilitation. Two years after surgery, she has no chest symptoms and constantly visits the outpatient clinic by herself.
在外科主动脉瓣置换术(SAVR)后,一些人工瓣膜导致冠状动脉阻塞的病例,如果难以脱离体外循环,可在手术中进行诊断和治疗。我们报告一例74岁女性病例,因二尖瓣病变和主动脉瓣环狭窄出现有症状的主动脉瓣狭窄。考虑到她的解剖结构和身体虚弱状况,与经导管主动脉瓣植入术相比,SAVR被认为是可行的。在成功使用19毫米生物瓣进行SAVR几小时后,她在重症监护病房出现血流动力学不稳定,冠状动脉造影显示右冠状动脉口严重狭窄。经皮冠状动脉介入治疗在技术上要求较高,随后她接受了冠状动脉旁路移植术。术后第35天,患者转至另一机构进行康复治疗。手术两年后,她没有胸部症状,且能自行定期到门诊就诊。