经导管主动脉瓣置入术治疗妊娠合并生物瓣主动脉瓣疾病中的瓣中瓣置换
Valve-in-Valve Transcatheter Aortic Valve Replacement for Bioprosthetic Aortic Valve Disease in Pregnancy.
作者信息
Driggin Elissa, Bloom Jason, Kodali Susheel, Purisch Stephanie E, Haythe Jennifer
机构信息
Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA.
出版信息
JACC Case Rep. 2025 Mar 19;30(6 Pt 2):103386. doi: 10.1016/j.jaccas.2025.103386.
BACKGROUND
Management of valvular disease in pregnancy is complex. Hemodynamic changes associated with pregnancy may exacerbate underlying disease.
CASE SUMMARY
A 32-year-old woman with a history of remote bioprosthetic aortic valve replacement (AVR) presented to care in early pregnancy with progressive dyspnea on exertion. Examination and an echocardiogram revealed moderate to severe bioprosthetic aortic stenosis and severe aortic insufficiency. The patient underwent valve-in-valve transcatheter AVR in the second trimester as a bridge to an uncomplicated term vaginal delivery. She was discharged on postpartum day 2.
DISCUSSION
Structural valve degeneration may be accelerated in pregnancy. Although regurgitant lesions are generally well tolerated, mixed aortic valve lesions may represent a higher-risk phenotype exacerbated by hemodynamic changes of pregnancy and may require intervention.
TAKE HOME MESSAGE
A multidisciplinary cardio-obstetrics team is essential to manage patients with severe, symptomatic valvular heart disease effectively during pregnancy.
背景
妊娠期瓣膜病的管理较为复杂。与妊娠相关的血流动力学变化可能会加重潜在疾病。
病例摘要
一名有生物瓣主动脉瓣置换术（AVR）史的32岁女性在妊娠早期因进行性劳力性呼吸困难前来就诊。检查及超声心动图显示中度至重度生物瓣主动脉瓣狭窄及重度主动脉瓣关闭不全。患者在孕中期接受了经导管瓣膜内瓣膜AVR，作为通向无并发症足月阴道分娩的桥梁。她在产后第2天出院。
讨论
妊娠期结构性瓣膜退变可能会加速。虽然反流性病变通常耐受性良好，但混合性主动脉瓣病变可能代表一种更高风险的表型，会因妊娠的血流动力学变化而加剧，可能需要干预。
要点
多学科心脏产科团队对于在妊娠期有效管理重度、有症状的瓣膜性心脏病患者至关重要。
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