Khadija Haitham Abu, Alnees Mohammad, Gandelman Gera, George Jacob, Blatt Alex
Heart Center, Kaplan Medical Center, Rehovot, affiliated with the Hebrew University, Jerusalem, Israel.
Heart Center, Kaplan Medical Center, Rehovot, affiliated with the Hebrew University, Jerusalem, Israel; Harvard Medical School, Postgraduate Medical Education, Global Clinical Scholars Research Training Program, Boston, USA.
Int J Surg Case Rep. 2024 Nov;124:110441. doi: 10.1016/j.ijscr.2024.110441. Epub 2024 Oct 10.
Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat severe aortic stenosis. While TAVI is generally safe and effective, it can be complicated by rare adverse events such as prosthetic leaflet dislodgment leading to acute free aortic regurgitation.
We report the case of a female patient who experienced acute free aortic regurgitation following elective TAVI. This complication arose due to prosthetic leaflet dislodgment after post-dilatation of the implanted valve. The timely identification and management of this rare complication are essential to prevent potentially fatal outcomes.
The moderate paravalvular regurgitation (PVR) observed in this case was likely caused by the unsealing of heavily calcified aortic valve leaflets. While post-dilatation is a routine practice to optimize valve function, it poses the risk of serious complications, including leaflet dislodgment. Transoesophageal echocardiography (TEE) confirmed the loss of function of the prosthetic leaflet, which was likely exacerbated by aggressive post-dilatation techniques. The use of intravascular lithotripsy could be considered to mitigate the risk of significant PVR by effectively modifying the calcified valve structure.
Acute prosthetic leaflet dislodgment leading to free aortic regurgitation is a very rare but serious complication of TAVI. Early recognition and immediate intervention are crucial to manage this life-threatening event and optimize patient outcomes.
经导管主动脉瓣植入术（TAVI）是一种用于治疗严重主动脉瓣狭窄的微创手术。虽然TAVI总体上安全有效，但可能会出现罕见的不良事件，如人工瓣膜叶移位导致急性主动脉瓣反流。
我们报告一例女性患者，在择期TAVI后发生急性主动脉瓣反流。这种并发症是由于植入瓣膜后扩张导致人工瓣膜叶移位引起的。及时识别和处理这种罕见并发症对于预防潜在的致命后果至关重要。
本病例中观察到的中度瓣周反流（PVR）可能是由于严重钙化的主动脉瓣叶未完全密封所致。虽然后扩张是优化瓣膜功能的常规操作，但它存在严重并发症的风险，包括瓣膜叶移位。经食管超声心动图（TEE）证实了人工瓣膜叶功能丧失，这可能因激进的后扩张技术而加剧。可考虑使用血管内碎石术通过有效改变钙化瓣膜结构来降低显著PVR的风险。
急性人工瓣膜叶移位导致主动脉瓣反流是TAVI一种非常罕见但严重的并发症。早期识别和立即干预对于处理这一危及生命的事件并优化患者预后至关重要。
