经导管主动脉瓣延迟移入左心室流出道。
Delayed Migration of a Transcatheter Aortic Valve Into the Left Ventricular Outflow Tract.
作者信息
Issany Arsh, Debs Dany F, Abusubaih Lana, Abdel-Ahmed Mohamed, Iyer Vijay
机构信息
Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
Roger Williams Medical Center, Providence, Rhode Island, USA.
出版信息
JACC Case Rep. 2025 Jul 30;30(21):104437. doi: 10.1016/j.jaccas.2025.104437.
BACKGROUND
Late device migration is a rare complication of the transcatheter aortic valve replacement procedure.
CASE SUMMARY
This is a 60-year-old man with a medical history of surgical aortic valve replacement with subsequent transcatheter aortic valve replacement who presented to the emergency department for chest discomfort and dyspnea. The transthoracic echocardiogram showed moderate prosthetic aortic regurgitation and severe prosthetic aortic valve stenosis, with evidence of valve migration. The patient underwent a successful transcatheter aortic valve-in-valve replacement.
DISCUSSION
Transcatheter heart valve migration, typically occurring shortly after deployment, is uncommon in late presentations, with few cases reported. Migration occurs when retrograde forces overcome the strength of the valve's endothelial attachment. Previous surgical aortic valve replacement, worsening heart failure, and endothelial dysfunction may have played a role in migration.
TAKE-HOME MESSAGES: Transcatheter heart valve migration is a potentially lethal complication. Patients presenting with acute heart failure and known bioprosthesis require prompt evaluation with echocardiography.
背景
人工瓣膜晚期移位是经导管主动脉瓣置换术的一种罕见并发症。
病例摘要
这是一名60岁男性，有外科主动脉瓣置换病史，随后接受了经导管主动脉瓣置换术，因胸部不适和呼吸困难就诊于急诊科。经胸超声心动图显示人工主动脉瓣中度反流和重度人工主动脉瓣狭窄，并有瓣膜移位的证据。该患者成功接受了经导管主动脉瓣中置瓣膜置换术。
讨论
经导管心脏瓣膜移位通常发生在植入后不久，晚期出现这种情况并不常见，报道的病例很少。当逆向力超过瓣膜内皮附着的强度时就会发生移位。既往外科主动脉瓣置换术、心力衰竭加重和内皮功能障碍可能在移位中起了作用。
要点
经导管心脏瓣膜移位是一种潜在的致命并发症。出现急性心力衰竭且已知有人工生物瓣膜的患者需要迅速进行超声心动图评估。
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