Mendoza Juan Cristobal, Morales Álvaro, Monjarrez Vega Mario, Romero Christopher, Castrillo Borge Gery, Baltodano Dangla Cesar
Cardiology, Hospital Militar Escuela "Dr. Alejandro Dávila Bolaños", Managua, NIC.
School of Medicine, Hospital Militar Escuela "Dr. Alejandro Dávila Bolaños", Managua, NIC.
Cureus. 2024 Dec 22;16(12):e76195. doi: 10.7759/cureus.76195. eCollection 2024 Dec.
Severe aortic valve stenosis poses a significant risk for the aging population, often escalating from mild symptoms to life-threatening heart failure and sudden death. Without timely intervention, this condition can lead to disastrous outcomes. The advent of transcatheter aortic valve implantation (TAVI) has gained popularity, emerging as an effective alternative for managing severe aortic stenosis (AS) in high-risk patients experiencing deterioration of previously implanted bioprosthetic surgical aortic valves (SAV), which introduces complex challenges such as device compatibility and anatomical considerations. We report the case of a 76-year-old male with a history of stage III hypertension, compensated type 2 diabetes, and aortic valve disease who underwent bioprosthetic valve replacement in 2013. His medications included metoprolol, metformin/glibenclamide, and levothyroxine. He presented with moderate exertional dyspnea (NYHA II) over four months, relieved by rest. Physical examination revealed a crescendo-decrescendo systolic murmur at the aortic focus. The aortic prosthesis stenosis was confirmed by a transthoracic echocardiogram. A CT angiogram showed bioprosthetic degeneration and significant calcification, allowing for transcatheter aortic valve implantation in the surgical aortic valve. The procedure was successfully performed via the transfemoral route using a 21.5 mm MyVal balloon-expandable valve. The intervention improved the patient's quality of life, resolving NYHA class III dyspnea and enabling greater independence in daily activities. Echocardiographic findings demonstrated a significant reduction in the transvalvular gradient, enhancing cardiac function and eliminating the immediate risk of valvular dysfunction progression, contributing to increased life expectancy and emotional well-being. This case highlights the feasibility and clinical benefits of transcatheter aortic valve implantation in surgical aortic valves for managing valve degeneration in a resource-limited setting, thereby representing a significant advancement in the treatment of aortic valve disease. The successful outcome demonstrates the importance of adopting innovative, minimally invasive techniques, particularly in regions with limited advanced interventions, by alleviating dyspnea, enhancing cardiac function, and significantly improving the patient's quality of life, emotional well-being, and prognosis.
严重主动脉瓣狭窄对老年人群构成重大风险，通常会从轻微症状逐渐发展为危及生命的心力衰竭和猝死。若不及时干预，这种情况可能导致灾难性后果。经导管主动脉瓣植入术（TAVI）的出现越来越受欢迎，成为治疗高危患者严重主动脉瓣狭窄（AS）的有效替代方法，这些患者之前植入的生物人工心脏瓣膜（SAV）出现退化，这带来了诸如器械兼容性和解剖学考虑等复杂挑战。我们报告一例76岁男性病例，该患者有III期高血压、代偿性2型糖尿病和主动脉瓣疾病史，于2013年接受了生物人工瓣膜置换术。他的药物包括美托洛尔、二甲双胍/格列本脲和左甲状腺素。他在四个月内出现中度劳力性呼吸困难（纽约心脏协会II级），休息后缓解。体格检查发现主动脉听诊区有递增递减型收缩期杂音。经胸超声心动图证实主动脉人工瓣膜狭窄。CT血管造影显示生物人工瓣膜退化和显著钙化，适合在外科主动脉瓣中进行经导管主动脉瓣植入。该手术通过经股动脉途径成功进行，使用了一个21.5毫米的MyVal球囊扩张瓣膜。该干预改善了患者的生活质量，解决了纽约心脏协会III级呼吸困难，使患者在日常活动中能够更加独立。超声心动图结果显示跨瓣压差显著降低，增强了心脏功能，消除了瓣膜功能障碍进展的直接风险，有助于延长预期寿命和改善情绪健康。该病例突出了在资源有限的情况下，经导管主动脉瓣植入术在外科主动脉瓣中治疗瓣膜退化的可行性和临床益处，从而代表了主动脉瓣疾病治疗的重大进展。成功的结果表明，采用创新的微创技术非常重要，特别是在先进干预手段有限的地区，通过缓解呼吸困难、增强心脏功能以及显著改善患者的生活质量、情绪健康和预后。
