经导管主动脉瓣置换术治疗以瓣叶增厚为主的二叶式主动脉瓣狭窄一例

Transcatheter aortic valve replacement for a patient with bicuspid aortic valve stenosis characterized by leaflet thickening: a case report

以瓣叶增厚为主的主动脉瓣狭窄因为其缺乏钙化的主动脉瓣难以为人工瓣膜的固定提供有效支撑,存在术后瓣周漏和二次瓣膜植入的风险,而被广泛地视为经导管主动脉瓣置换术的相对禁忌证,但主动脉瓣成形术和自膨式经导管心脏瓣膜表现出良好的安全性和有效性。该文报告了一例经导管主动脉瓣置换术治疗以瓣叶增厚为主的二叶式主动脉瓣狭窄患者,患者经治疗后心累、气紧症状较前明显好转,纽约心脏病学会分级恢复为Ⅱ级,术后人工瓣膜未见瓣周漏,心脏超声提示平均跨瓣压差和主动脉瓣最大流速较术前明显下降。

Due to the lack of calcification of the aortic valve, it is difficult to provide effective support for the fixation of artificial valve in aortic stenosis characterized by leaflet thickening. There is a risk of postoperative perivalvular leakage and secondary valve implantation, which is widely regarded as a relative contraindication for transcatheter aortic valve replacement(TAVR). But aortic valvuloplasty and self-expanding transcatheter aortic valve has showed its safety and efficacy. This paper reports a patient with bicuspid aortic valve characterized by leaflet thickening treated with TAVR. After the operation, the patient’s symptom of exertional dyspnea was significantly improved, New York Heart Association class increased to Ⅱ, no perivalvular leakage was found, and the mean transaortic pressure gradient and the maximum aortic valve velocity decreased significantly.