降主动脉重度扭曲经导管主动脉瓣置换术一例

A case report of transcatheter aortic valve replacement with descending aorta severe distortion

一例89岁男性患者,因胸闷、气短、双下肢浮肿半个月入中国人民解放军总医院第一医学中心。诊断为主动脉瓣重度狭窄。术前CT评估见降主动脉重度扭曲,术前美国胸外科医师协会评分为11.2%,拟行经导管主动脉瓣置换术。术前建立完善的手术预案,术中应用双导丝及14F左心耳封堵长鞘辅助下逐步球囊扩张的方法,成功完成瓣膜植入。对于主动脉重度迂曲的患者,如何顺利完成经导管主动脉瓣置换术,该病例可提供一些借鉴。

An 89 years old male patient was admitted to the First Medical Center of Chinese PLA General Hospital due to chest tightness and shortness of breath for half a month. Severe aortic valve stenosis was found in post admission assessment. We proposed to perform transcatheter aortic valve replacement surgery. Preoperative evaluation showed severe distortion of the descending aorta. We used the double guide wire technique and a 14 F long sheath to assist the stepwise balloon expansion, and successfully completed the valve implantation. For patients with severe tortuous aorta,how to successfully complete transcatheter aortic valve replacement, this case may provide some reference.