急诊经导管主动脉瓣置换术术后即刻的瓣膜血栓一例

A case report of acute prothesis thrombosis after emergent transcatheter aortic valve replacement

该文报道了一例诊断为重度主动脉瓣狭窄患者。入院后,因患者血流动力学指标不稳定,心脏瓣膜多学科团队讨论以后,急诊行经导管主动脉瓣置换术。手术顺利,瓣膜植入后术中超声心动图提示跨瓣压差、瓣膜前向血流速度极大改善。但术后第2天床旁超声心动图提示跨瓣压差增高、人工瓣膜前向血流加速。综合考虑急性瓣膜血栓可能性大。采用华法林、肝素等综合抗凝治疗后,跨瓣压差、人工瓣膜前向血流速度均大幅改善。

This article reports a patient diagnosed with severe aortic stenosis. After admission, the cardiac multidisciplinary team performed transcatheter aortic valve replacement(TAVR) emergently due to its unstable hemodynamics. The procedure was successful, and the initial cardiogram during the operation after TAVR suggested that the stenosis was greatly improved. But gradually the next day bedside echocardiography suggested that the transvalvular pressure difference increased and the prosthetic valve forward blood flow accelerated. Acute valve thrombosis after TAVR was taken into consideration. Warfarin and heparin were administrated for anticoagulation, after which the pressure difference across the valve and the forward blood flow rate of the artificial valve were evenly improved.