Liu Weili, Li Dacheng, Qu Zhanjun, Tang Guozhang, Liu Song, Li Yanchao, Jiang Lei
Interventional Operation Room Affiliated Hospital of Qingdao University Qingdao China.
Department of Nuclear Medicine Affiliated Hospital of Qingdao University Qingdao China.
Clin Case Rep. 2024 Aug 7;12(8):e9315. doi: 10.1002/ccr3.9315. eCollection 2024 Aug.
In recent years, it is necessary to Redo-TAVR for the patients with bioprosthetic valve degeneration. This case report described a unique instance to successfully Redo-TAVR a patient with bioprosthetic valve degeneration, in addition, with left cerebral infarction and renal insufficiency.
Over time, more and more patients have bioprosthetic valve degeneration either used in SAVR or TAVR. In order to solve the produced problems due to the degenerated bioprosthetic valve, Redo-TAVR was increasingly popular due to its safe and efficiency especially for the high risk and complicated symptoms patients. In this case, the patient with left cerebral infarction and renal insufficiency has exhibited severe regurgitation and obvious neoplasm around the previous replaced aortic valve. For the patient with complicated symptoms, we did not image for this patient and only used CT to determine the position and angle for the Redo-TAVR on the base of metal stent for the previous replaced aortic valve. During the Redo-TAVR process, for fear of the obvious neoplasm slipping from the previous replaced aortic valve to embolism of important organs, before carrying out the Redo-TAVR, cerebral protection device, temporary pacemaker, and coronary artery protection device were utilized in order to avoid the damage for the important organs from the obvious neoplasm slipping from the previous replaced aortic valve. The surgery was successful and the patient recovered well. The patient's symptoms of chest tightness and suffocation have been greatly reduced.
近年来，对于生物瓣退化的患者，再次经导管主动脉瓣置换术（Redo-TAVR）很有必要。本病例报告描述了一例成功为生物瓣退化患者进行再次经导管主动脉瓣置换术的独特案例，此外，该患者还伴有左脑梗死和肾功能不全。
随着时间的推移，越来越多接受外科主动脉瓣置换术（SAVR）或经导管主动脉瓣置换术（TAVR）的患者出现生物瓣退化。为了解决生物瓣退化所产生的问题，再次经导管主动脉瓣置换术因其安全性和有效性，在高危和症状复杂的患者中越来越受欢迎。在本病例中，患有左脑梗死和肾功能不全的患者，其先前置换的主动脉瓣周围出现了严重反流和明显赘生物。对于症状复杂的该患者，我们未对其进行造影成像，仅根据先前置换主动脉瓣的金属支架，使用计算机断层扫描（CT）来确定再次经导管主动脉瓣置换术的位置和角度。在再次经导管主动脉瓣置换术过程中，由于担心明显赘生物从先前置换的主动脉瓣上脱落导致重要器官栓塞，在进行再次经导管主动脉瓣置换术前，使用了脑保护装置、临时起搏器和冠状动脉保护装置，以避免明显赘生物从先前置换的主动脉瓣上脱落对重要器官造成损害。手术成功，患者恢复良好。患者胸闷、气促症状明显减轻。
