主动脉瓣置换术后并发经导管主动脉瓣置换术的血栓性血小板减少性紫癜（TTP）：病例报告及文献复习。
Thrombotic Thrombocytopenia Purpura (TTP) following emergent aortic valve replacement after a complicated TAVR procedure: a case report and review of the literature.
机构信息
Intensive care unit in Cardiovascular Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Cardiovascular Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
出版信息
J Cardiothorac Surg. 2024 Sep 23;19(1):545. doi: 10.1186/s13019-024-03055-5.
BACKGROUND
Thrombotic thrombocytopenic purpura (TTP) is a rare hematological disorder. The occurrence of TTP subsequent to an emergent aortic valve replacement after a TAVR procedure is exceedingly uncommon with only a few reported cases worldwide.
CASE PRESENTATION
We report the case of a 70-year-old female patient diagnosed with aortic insufficiency. Following a transcatheter aortic valve replacement, she underwent emergency aortic valve replacement under cardiopulmonary bypass on the subsequent day due to heart valve displacement. The postoperative diagnosis revealed TTP and symptomatic treatment involving plasma exchange was administered. After demonstrating steady improvement, the patient was eventually discharged.
CONCLUSION
Aortic valve replacement after TAVR is a high-risk procedure and increases susceptibility for developing secondary TTP. The diagnosis and treatment of secondary TPP is considerably challenging, and early diagnosis with symptomatic treatment including plasma exchange can increase patient survival.
背景
血栓性血小板减少性紫癜（TTP）是一种罕见的血液系统疾病。TAVR 手术后发生 TTP 并需要紧急进行主动脉瓣置换术的情况极为罕见，全球仅有少数几例报告。
病例介绍
我们报告了一例 70 岁女性患者，被诊断为主动脉瓣关闭不全。在进行经导管主动脉瓣置换术后，她在第二天因心脏瓣膜移位而接受了体外循环下的紧急主动脉瓣置换术。术后诊断为 TTP，并进行了症状性血浆置换治疗。患者病情稳定后好转，最终出院。
结论
TAVR 后行主动脉瓣置换术是一种高风险的手术，会增加发生继发性 TTP 的风险。继发性 TPP 的诊断和治疗极具挑战性，早期诊断并进行包括血浆置换在内的症状性治疗可提高患者生存率。
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