经导管主动脉瓣置换术期间因脱垂性主动脉瓣乳头肌纤维弹性瘤导致的冠状动脉闭塞
Coronary Occlusion During Transcatheter Aortic Valve Replacement Due to Prolapsing Aortic Valve Papillary Fibroelastoma.
作者信息
Gilliland Thomas, Chukwudi Chijioke, Jassar Arminder, Osho Asishana, Inglessis-Azuaje Ignacio
机构信息
Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Division of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
出版信息
JACC Case Rep. 2025 Jun 4;30(13):103541. doi: 10.1016/j.jaccas.2025.103541.
BACKGROUND
Transcatheter aortic valve replacement (TAVR) is rarely attempted in cases of aortic stenosis with concomitant papillary fibroelastoma because of concerns for intraprocedural systemic embolization. Coronary obstruction caused by prolapse of the mass into the coronary ostia has not yet been reported, to our knowledge.
CASE SUMMARY
An 85-year-old woman with severe symptomatic aortic stenosis and high surgical risk was referred for TAVR. The result of preoperative imaging was notable for an 8-mm left coronary cusp papillary fibroelastoma. When a transcatheter heart valve was deployed, the mass prolapsed into and obstructed the left coronary artery. Emergent left main coronary artery stenting restored coronary flow.
DISCUSSION
Whereas embolization is an important concern, coronary obstruction due to leaflet mass prolapse can occur. Careful preprocedural planning and up-front coronary protection may mitigate this risk.
TAKE-HOME MESSAGE: TAVR in patients with aortic valve papillary fibroelastoma carries theoretical risks of both distal embolization and coronary obstruction.
背景
由于担心术中发生全身性栓塞，经导管主动脉瓣置换术（TAVR）很少用于伴有乳头肌纤维弹性瘤的主动脉瓣狭窄病例。据我们所知，尚未有因肿块脱垂至冠状动脉开口而导致冠状动脉阻塞的报道。
病例摘要
一名85岁有严重症状性主动脉瓣狭窄且手术风险高的女性被转诊接受TAVR。术前影像学检查结果显示左冠状动脉瓣叶有一个8毫米的乳头肌纤维弹性瘤。当植入经导管心脏瓣膜时，肿块脱垂并阻塞了左冠状动脉。紧急进行左主干冠状动脉支架置入术恢复了冠状动脉血流。
讨论
虽然栓塞是一个重要问题，但瓣叶肿块脱垂可导致冠状动脉阻塞。仔细的术前规划和预先的冠状动脉保护可能会降低这种风险。
要点
主动脉瓣乳头肌纤维弹性瘤患者进行TAVR理论上存在远端栓塞和冠状动脉阻塞的风险。
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