极低射血分数的重度主动脉瓣狭窄患者行经导管主动脉瓣置换术一例

A case of transcatheter aortic valve replacement of severe aortic stenosis with extremely low left ventricular ejection fraction

患者为82岁老年男性,主诉"反复气促1年,加重2周"入院,既往曾多次在外院诊治,经利尿等处置后症状可缓解。患者入院后明确诊断为重度主动脉瓣狭窄,合并严重左心功能不全。心脏彩色多普勒超声提示左心室射血分数仅为16.1%,且主动脉瓣区峰值压差22 mm Hg(1 mm Hg=0.133 kPa),主动脉瓣区平均压差14 mm Hg,是典型的"低压差、低流速"型主动脉瓣狭窄病例。在遵循诊疗规范为患者完善多巴酚丁胺负荷超声心动图后,测得左心室射血分数也仅为26%,主动脉瓣跨瓣流速2.59 m/s,跨瓣压差27/16 mm Hg。提示患者左心储备功能极差,行换瓣手术的潜在获益有限。考虑到患者气促等症状进行性加重,治疗团队为患者在体外膜肺氧合辅助下经股动脉实施了经导管主动脉瓣置换术。术后患者症状迅速改善,各项临床指标明显好转,获得了较佳的预后。

An 82-year-old male was hospitalized complaining of dyspnea for 1 year and aggravating for2 weeks. He had been treated in other hospitals for several times due to such situation and his symptom could be relieved by diuretics. After admission, he was diagnosed as severe aortic stenosis with extremely low left ventricular contractile function;transthoracic echocardiography showed a left ventricular ejection fraction of only 16.1%. He was classified as a typical case of severe aortic stenosis with "low transaortic velocity and low transaortic gradient" since the transaortic velocity being 2.36 m/s and transaortic gradient being 22/14 mm Hg(1 mm Hg=0.133 kPa). Dobutaminestress echocardiography suggested that the patient’s left ventricular reserve function was extremely poor and the potential benefits of valvular surgery were finite as the former data being 2.59 m/s and 27/16 mm Hg respectively. In consideration of progressive exacerbation of the patient’s symptoms, we eventually conducted transcatheter aortic valve replacement surgery with the support of extracorporeal membrane oxygenation. His symptoms such as dyspnea disappeared after the surgery and clinical parameters had also got a significant improvement.