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经导管主动脉瓣置换术(TAVR)后行胸主动脉腔内修复术(TEVAR)治疗急性A型主动脉夹层。

Thoracic endovascular aortic repair (TEVAR) for an acute type A aortic dissection following transcatheter aortic valve replacement (TAVR).

作者信息

Dang Vy C, Haddad Paul, McFall Ross G, Klopfenstein Jennifer, Reardon Michael J, Rahimi Maham

机构信息

Texas A&M University College of Medicine, Bryan, TX.

Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX.

出版信息

J Vasc Surg Cases Innov Tech. 2024 Oct 24;11(1):101653. doi: 10.1016/j.jvscit.2024.101653. eCollection 2025 Feb.

Abstract

An 86-year-old male with multiple medical comorbidities was referred for an elective transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis with an ejection fraction of 35%. A self-expanding valve was deployed successfully, but intraoperative transesophageal echocardiography (TEE) confirmed an acute type A aortic dissection (ATAAD), necessitating immediate intervention. Multiple intraoperative imaging modalities were utilized for deployment of a conformable GORE TAG (cTAG) stent graft for thoracic endovascular aortic repair (TEVAR). This case demonstrates TEVAR as an effective, minimally invasive option for immediate repair of ATAAD as a complication of TAVR in a high-risk surgical patient.

摘要

一名患有多种内科合并症的86岁男性因严重症状性主动脉瓣狭窄且射血分数为35%,被转诊接受择期经导管主动脉瓣置换术(TAVR)。成功植入了一个自膨胀瓣膜,但术中经食管超声心动图(TEE)证实为急性A型主动脉夹层(ATAAD),需要立即干预。术中使用了多种成像方式来部署用于胸主动脉腔内修复(TEVAR)的顺应性GORE TAG(cTAG)支架移植物。本病例表明,对于高危手术患者,TEVAR作为TAVR并发症ATAAD即刻修复的一种有效、微创选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b40f/11617754/402b4131aeab/gr1.jpg

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