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一名患有二叶式主动脉瓣的年轻患者在主动脉瓣成形术期间左回旋支动脉闭塞：病例报告

Left circumflex artery occlusion during aortic valvuloplasty in a young patient with bicuspid aortic valve: a case report.

作者信息

Otsuka Yutaro, Tsubokawa Tsunehisa

机构信息

Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan.

出版信息

JA Clin Rep. 2025 Jul 24;11(1):41. doi: 10.1186/s40981-025-00806-8.

DOI:10.1186/s40981-025-00806-8
PMID:40705179
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12290129/
Abstract

BACKGROUND

Aortic valvuloplasty serves as a valve-preserving alternative to aortic valve replacement and offers advantages in younger patients. However, intraoperative complications associated with this technique have rarely been reported.

CASE PRESENTATION

A 15-year-old male with severe aortic regurgitation due to a congenital bicuspid aortic valve underwent aortic valvuloplasty. During separation from cardiopulmonary bypass, ST-segment elevation was noted on electrocardiography, and transesophageal echocardiography (TEE) revealed regional wall motion abnormalities. Color Doppler imaging revealed absent flow in the left circumflex artery (LCx). The anesthesiology team promptly alerted the surgeons, and LCx occlusion due to suture annuloplasty was suspected. Removal of the implicated suture restored flow and stabilized hemodynamics.

CONCLUSIONS

Systematic intraoperative assessment and documentation of coronary flow via TEE are instrumental in diagnosing coronary artery occlusion. Moreover, mutual trust and clear, timely communication between anesthesiologists and surgeons are essential to maintaining surgical safety.

摘要

背景

主动脉瓣成形术是一种保留瓣膜的主动脉瓣置换替代方法，对年轻患者具有优势。然而，与该技术相关的术中并发症鲜有报道。

病例报告

一名15岁男性因先天性二叶式主动脉瓣导致严重主动脉瓣反流，接受了主动脉瓣成形术。在脱离体外循环时，心电图显示ST段抬高，经食管超声心动图（TEE）显示局部室壁运动异常。彩色多普勒成像显示左旋支动脉（LCx）血流中断。麻醉团队迅速提醒外科医生，怀疑是缝合瓣环成形术导致LCx闭塞。移除相关缝线后血流恢复，血流动力学稳定。

结论

通过TEE进行系统的术中冠状动脉血流评估和记录有助于诊断冠状动脉闭塞。此外，麻醉医生和外科医生之间相互信任以及清晰、及时的沟通对于维持手术安全至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/fd5afd96bcd8/40981_2025_806_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/2a73c93e6a42/40981_2025_806_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/c09358b0a339/40981_2025_806_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/cdcd1983e081/40981_2025_806_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/eb163022cc03/40981_2025_806_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/fd5afd96bcd8/40981_2025_806_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/2a73c93e6a42/40981_2025_806_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/c09358b0a339/40981_2025_806_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/cdcd1983e081/40981_2025_806_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/eb163022cc03/40981_2025_806_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7be2/12290129/fd5afd96bcd8/40981_2025_806_Fig5_HTML.jpg

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Aortic Valve Repair: The Evolving Frontiers of Aortic Annuloplasty.主动脉瓣修复：主动脉瓣环成形术的前沿进展
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