功能性二叶式主动脉瓣经导管主动脉瓣置换术并发症一例

Complications in a case of functional bicuspid aortic valve treated with transcatheter aortic valve replacement

该文报告1例功能性二叶式主动脉瓣重度狭窄钙化患者行经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)治疗,术前经心脏彩色多普勒超声(彩超)、多排螺旋CT评估升主动脉及冠状动脉情况、髂血管解剖、瓣膜形态及钙化程度;术中缝合器缝合穿刺处后出现股动脉穿孔,予以外周球囊压迫止血处理;术后患者出现神经精神症状,颅脑MRI提示多发急性脑梗死,予以抗凝、抗血小板、营养神经药物治疗。随访1年,复查心脏彩超提示人工主动脉瓣周少许反流信号,患者生活自理,神经系统检查未见明显异常。TAVR适应证随着评估、器械、技术的创新在未来将不断拓展。而手术数据总结可以推动手术效果进步、减少手术并发症发生。

This paper reports a case of severe stenosis and calcification of functional bicuspid aortic valve treated with transcatheter aortic valve replacement(TAVR). Before the operation, echocardiography and multidetector computed tomography were used to evaluate the ascending aorta, coronary artery, iliac artery anatomy, valve morphology, and valve calcification. During the operation, femoral artery perforation occurred after suturing the puncture site. The treatment of compression and hemostasis with peripheral balloon was performed. After the operation, neuropsychiatric symptoms appeared. The result of brain MRI indicated multiple acute cerebral infarction.Anticoagulant, antiplatelet, and neurotrophic drugs were used. After 1-year follow-up, echocardiography showed a little reflux signal around the artificial aortic valve, and the patient’s nervous system examination showed no obvious abnormality. TAVR indications will continue to expand in the near future with the innovation of evaluation, devices,and technology. The summary of operation data can promote progress of TAVR and reduce the occurrence of complications.