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经导管主动脉瓣置入术患者合并右冠状动脉夹层、术后高度房室传导阻滞及急性神经损伤

TAVI PATIENT WITH RCA DISSECTION, POST-TAVR HIGH DEGREE AV BLOCK AND ACUTE NEUROLOGICAL INJURY.

作者信息

Jelić Alan, Predrijevac Mladen, Rotkvić Luka, Slivnjak Valentina, Šesto Igor, Szavits Nossan Janko, Škopljanac Mačina Andrija, Štambuk Krešimir

机构信息

Magdalena Clinic for Cardiovascular Disease at School of Medicine of JJ Strossmayer University in Osijek, Ljudevita Gaja 2, 49217 Krapinske Toplice, Croatia.

Faculty of Dental Medicine and Health, J.J. Strossmayer University in Osijek, Osijek, Croatia.

出版信息

Acta Clin Croat. 2024 Mar;63(Suppl1):111-115. doi: 10.20471/acc.2024.63.s1.21.

DOI:10.20471/acc.2024.63.s1.21
PMID:40599467
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12207890/
Abstract

TAVI (Transcatheter Aortic Valve Implantation) is a minimally invasive procedure for the treatment of severe aortic stenosis (AS) in elderly and comorbid patients. Following the guidelines of eminent cardiac societies, a decision on the treatment modality is made by the so-called "heart team". Despite being less invasive, the procedure is related to some complications, among which the most common ones are stroke, life-threatening bleeding, vascular injury, kidney injury, conduction disturbances demanding permanent pacemaker (PPM) implantation, and perivalvular leak (PVL). Here we present a case report of multiple periprocedural complications in the same patient, related to TAVI, such as right coronary artery (RCA) dissection on preoperative coronary angiography (CA), postprocedural acute neurologic injury and high grade atrioventricular (AV) block followed by PPM implantation.

摘要

经导管主动脉瓣植入术（TAVI）是一种用于治疗老年及合并症患者严重主动脉瓣狭窄（AS）的微创手术。遵循著名心脏学会的指南，由所谓的“心脏团队”做出治疗方式的决策。尽管该手术侵入性较小，但仍会引发一些并发症，其中最常见的有中风、危及生命的出血、血管损伤、肾损伤、需要植入永久起搏器（PPM）的传导障碍以及瓣周漏（PVL）。在此，我们呈现一例同一患者在TAVI围手术期出现多种并发症的病例报告，这些并发症包括术前冠状动脉造影（CA）时右冠状动脉（RCA）夹层、术后急性神经损伤以及随后需要植入PPM的高度房室（AV）阻滞。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/285e3ee28a62/acc-63_supp1-111-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/a0adff305ba5/acc-63_supp1-111-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/278ad715b6a4/acc-63_supp1-111-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/72c7ad5b0150/acc-63_supp1-111-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/336f069cfcad/acc-63_supp1-111-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/285e3ee28a62/acc-63_supp1-111-f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/a0adff305ba5/acc-63_supp1-111-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/278ad715b6a4/acc-63_supp1-111-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/72c7ad5b0150/acc-63_supp1-111-f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/336f069cfcad/acc-63_supp1-111-f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/08bc/12207890/285e3ee28a62/acc-63_supp1-111-f5.jpg

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本文引用的文献

1
Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement.经导管主动脉瓣置换术中的脑栓塞保护。
N Engl J Med. 2022 Oct 6;387(14):1253-1263. doi: 10.1056/NEJMoa2204961. Epub 2022 Sep 17.
2
Transcatheter Aortic Valve Implantation With or Without Predilation: A Meta-Analysis.经导管主动脉瓣植入术（预扩张与否）：一项荟萃分析
J Invasive Cardiol. 2022 Feb;34(2):E104-E113. doi: 10.25270/jic/21.00023. Epub 2022 Jan 6.
3
ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter aortic VAlve implantaTION): A Randomized Clinical Trial.
经皮冠状动脉介入治疗在前瞻性经导管主动脉瓣植入术之前的作用：一项随机临床试验。
JACC Cardiovasc Interv. 2021 Sep 27;14(18):1965-1974. doi: 10.1016/j.jcin.2021.06.041.
4
Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: a consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease.经导管主动脉瓣植入术患者抗血栓治疗的管理：ESC 血栓形成工作组和欧洲经皮心血管介入协会（EAPCI）与 ESC 瓣膜性心脏病理事会合作的共识文件。
Eur Heart J. 2021 Jun 14;42(23):2265-2269. doi: 10.1093/eurheartj/ehab196.
5
The incidence and impact of cardiac conduction disturbances after transcatheter aortic valve replacement.经导管主动脉瓣置换术后心脏传导障碍的发生率及影响
Ann Cardiothorac Surg. 2020 Nov;9(6):452-467. doi: 10.21037/acs-2020-av-23.
6
Cerebral Embolic Protection in TAVI: Friend or Foe.经导管主动脉瓣植入术中的脑栓塞保护：是友还是敌？
Interv Cardiol. 2019 Feb;14(1):22-25. doi: 10.15420/icr.2018.32.2.
7
To revascularize or not before transcatheter aortic valve implantation?在经导管主动脉瓣植入术前是否进行血管重建？
J Thorac Dis. 2018 Nov;10(Suppl 30):S3578-S3587. doi: 10.21037/jtd.2018.09.85.
8
Independent impact of extent of coronary artery disease and percutaneous revascularisation on 30-day and one-year mortality after TAVI: a meta-analysis of adjusted observational results.经皮血运重建对 TAVI 术后 30 天和 1 年死亡率的独立影响：调整后的观察结果的荟萃分析。
EuroIntervention. 2018 Dec 7;14(11):e1169-e1177. doi: 10.4244/EIJ-D-18-00098.
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Transcatheter aortic valve replacement with the 34 mm Medtronic Evolut valve : Early results of single institution experience.采用34毫米美敦力Evolut瓣膜进行经导管主动脉瓣置换术：单机构经验的早期结果。
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Interv Cardiol. 2018 May;13(2):69-76. doi: 10.15420/icr.2018:2:2.