Rekhtman David, Iyengar Amit, Han Jason, Shad Rohan, Cevasco Marisa, Szeto Wilson, Brown Chase
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC Case Rep. 2024 Nov 20;29(22):102732. doi: 10.1016/j.jaccas.2024.102732.
Porcelain aorta describes circumferential calcification in the ascending aorta that may extend through the aortic arch. This is commonly observed in patients with a history of mediastinal radiation, end-stage renal disease, or chronic vascular inflammation. Mediastinal radiation has been shown to cause intimal and medial calcification of the aorta, as well as diastolic myocardial dysfunction, valvular disease, and coronary artery disease. In recent years, patients with aortic stenosis and concomitant porcelain aorta have been increasingly managed with transcatheter aortic valve replacements rather than surgical replacement to reduce periprocedural risks. We describe the surgical management of a patient with severe mitral valve stenosis, porcelain aorta, and patient prosthesis mismatch from a previously deployed transcatheter aortic valve replacement using right axillary arterial canulation and hypothermic circulatory arrest. To our knowledge, this is the first published case where a porcelain aorta was replaced surgically after failed transcatheter management of severe aortic stenosis.
瓷化主动脉是指升主动脉的环形钙化，可延伸至主动脉弓。这在有纵隔放疗史、终末期肾病或慢性血管炎症的患者中很常见。纵隔放疗已被证明可导致主动脉内膜和中膜钙化，以及舒张期心肌功能障碍、瓣膜疾病和冠状动脉疾病。近年来，对于合并瓷化主动脉的主动脉瓣狭窄患者，越来越多地采用经导管主动脉瓣置换术而非外科置换术来降低围手术期风险。我们描述了一例严重二尖瓣狭窄、瓷化主动脉且存在先前植入的经导管主动脉瓣置换术后人工瓣膜与患者不匹配的患者的手术治疗，采用右腋动脉插管和低温循环停止。据我们所知，这是首例在严重主动脉瓣狭窄经导管治疗失败后进行瓷化主动脉手术置换的病例报道。
