经导管主动脉瓣置入术（TAV-in-TAV）后使用尺寸小一号的SAPIEN瓣膜进行索引经导管主动脉瓣扩张术
Index Transcatheter Aortic Valve Expansion After TAV-in-TAV Using a One-Size-Smaller SAPIEN Valve.
作者信息
Mitsui Kentaro, Okada Atsushi, Kawamoto Naonori, Takagi Kensuke
机构信息
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
出版信息
JACC Case Rep. 2025 Aug 6;30(22):104499. doi: 10.1016/j.jaccas.2025.104499.
BACKGROUND
Index transcatheter aortic valve (TAV) expansion during TAV-in-TAV is crucial as it changes the valve-to-aorta distances and may increase the intraprocedural risk.
CASE SUMMARY
A TAV-in-TAV procedure was planned for a 90-year-old woman with prior TAV replacement (23-mm SAPIEN XT) who presented with prosthetic valve stenosis. Second TAV sizing was assessed by averaging the stent areas of the index TAV and by drawing a virtual circle on preprocedural computed tomography (CT). CT imaging also revealed significant calcification of the index TAV leaflets. The team opted for a one-size-smaller 20-mm SAPIEN3 valve. During the procedure, the index TAV expanded by creating a gap between the 2 valve stents. Postprocedural CT confirmed index TAV expansion and the calcified leaflets in the gap, which likely facilitated the expansion.
DISCUSSION
Our case highlights the importance of considering leaflet calcification of the index TAV when planning TAV-in-TAV, which includes second TAV sizing and predicting index TAV expansion.
背景
在经导管主动脉瓣植入术（TAV-in-TAV）中，初次经导管主动脉瓣（TAV）的扩张至关重要，因为它会改变瓣膜与主动脉的距离，并可能增加术中风险。
病例摘要
计划为一名90岁女性进行TAV-in-TAV手术，该女性曾接受过TAV置换术（23毫米SAPIEN XT），现出现人工瓣膜狭窄。通过平均初次TAV的支架面积并在术前计算机断层扫描（CT）上绘制虚拟圆来评估第二次TAV的尺寸。CT成像还显示初次TAV瓣叶有明显钙化。团队选择了尺寸小一号的20毫米SAPIEN3瓣膜。在手术过程中，初次TAV通过在两个瓣膜支架之间形成间隙而扩张。术后CT证实了初次TAV的扩张以及间隙中的钙化瓣叶，这可能促进了扩张。
讨论
我们的病例强调了在计划TAV-in-TAV时考虑初次TAV瓣叶钙化的重要性，这包括第二次TAV尺寸的确定和预测初次TAV的扩张。
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