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我们能成功吗？四叶式主动脉瓣的双“大教堂”经导管主动脉瓣置换术

Can We Six It? Double BASILICA Transcatheter Aortic Valve Replacement in Quadricuspid Aortic Valve.

作者信息

Shekiladze Nikoloz, Murphy Andrew, Babaliaros Vasilis, Ueyama Hiroki, Greenbaum Adam, Gleason Patrick, Xie Joe

机构信息

Division of Interventional Cardiology, Structural Heart & Valve Center, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

出版信息

J Soc Cardiovasc Angiogr Interv. 2024 Feb 29;3(5):101352. doi: 10.1016/j.jscai.2024.101352. eCollection 2024 May.

DOI:10.1016/j.jscai.2024.101352
PMID:39132463
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11308060/
Abstract

Coronary artery obstruction is an uncommon yet devastating complication of transcatheter aortic valve replacement (TAVR) and may necessitate leaflet modification. A 38-year-old man presented to our center with quadricuspid aortic valve with severe aortic regurgitation. Double leaflet modification was performed with the Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) technique prior to TAVR, creating 6 leaflets from 4. The patient tolerated the procedure well with symptomatic improvement. Follow-up transthoracic echocardiogram showed normal bioprosthetic aortic valve function. This case demonstrates feasibility of this procedure with comprehensive preprocedural analysis and intraprocedural imaging guidance.

摘要

冠状动脉阻塞是经导管主动脉瓣置换术（TAVR）一种罕见但具有破坏性的并发症，可能需要对瓣叶进行调整。一名38岁男性因四叶式主动脉瓣伴严重主动脉瓣反流就诊于我们中心。在TAVR术前，采用生物人工瓣膜或天然主动脉瓣叶有意撕裂以预防医源性冠状动脉阻塞（BASILICA）技术进行双瓣叶调整，将4个瓣叶变为6个瓣叶。患者对该手术耐受性良好，症状得到改善。随访经胸超声心动图显示生物人工主动脉瓣功能正常。本病例证明了在全面的术前分析和术中影像引导下该手术的可行性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/4e68a316e5b5/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/4ec4775233f5/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/79be11179bd7/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/42235c494a21/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/fa69139a43d1/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/4e68a316e5b5/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/4ec4775233f5/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/79be11179bd7/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/42235c494a21/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/fa69139a43d1/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9fe3/11308060/4e68a316e5b5/gr5.jpg

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本文引用的文献

1
Coronary Obstruction After Transcatheter Aortic Valve Replacement: Insights From the Spanish TAVI Registry.经导管主动脉瓣置换术后的冠状动脉阻塞：来自西班牙 TAVI 注册研究的见解。
JACC Cardiovasc Interv. 2023 May 22;16(10):1208-1217. doi: 10.1016/j.jcin.2023.03.024.
2
Transcatheter aortic valve replacement in patients with quadricuspid aortic valve in a single center.单中心四叶式主动脉瓣患者的经导管主动脉瓣置换术
Front Cardiovasc Med. 2022 Sep 28;9:1011466. doi: 10.3389/fcvm.2022.1011466. eCollection 2022.
3
Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: Results From the Multicenter International BASILICA Registry.
经导管主动脉瓣置换术中预防冠状动脉阻塞：多中心国际 BASILICA 注册研究结果。
JACC Cardiovasc Interv. 2021 May 10;14(9):941-948. doi: 10.1016/j.jcin.2021.02.035. Epub 2021 Mar 6.
4
TAVR in a Patient With Quadricuspid Aortic Stenosis: The Role of Patient-Specific Computer Simulation in Treatment Planning and Outcome Prediction.四叶式主动脉瓣狭窄患者的经导管主动脉瓣置换术：个体化计算机模拟在治疗规划和结果预测中的作用。
JACC Cardiovasc Interv. 2021 May 10;14(9):e93-e95. doi: 10.1016/j.jcin.2021.01.014. Epub 2021 Apr 14.
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Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: From Computed Tomography to BASILICA.经导管主动脉瓣置换术中预防冠状动脉阻塞：从计算机断层扫描到 BASILICA。
JACC Cardiovasc Interv. 2019 Jul 8;12(13):1197-1216. doi: 10.1016/j.jcin.2019.04.052.
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Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry.经导管主动脉瓣置换术后退行性生物瓣外科瓣的冠状动脉阻塞发生率、预测因素及临床结局：来自 VIVID 登记研究的结果。
Eur Heart J. 2018 Feb 21;39(8):687-695. doi: 10.1093/eurheartj/ehx455.
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