“烟囱”支架技术处理经导管主动脉瓣置换术中左冠状动脉开口堵塞一例

A case of“chimney”stent technique for left coronary ostia obstruction during transcatheter aortic valve replacement

该文报道了1例以劳力性呼吸困难为主要症状的78岁重度主动脉瓣狭窄患者,术前评估显示其外科手术风险极高,拟行经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)。但该患者属于冠状动脉堵塞的高危人群,心脏团队权衡利弊后,最终决定在采用导丝及球囊保护的情况下进行TAVR。手术过程中,自膨瓣释放后出现左冠状动脉开口堵塞,遂紧急行"烟囱"支架植入术,最终成功完成了瓣膜植入和冠状动脉血运重建,患者术后病情好转,随访情况良好。该文借此探讨TAVR术中冠状动脉堵塞的危险因素,以及"烟囱"支架技术的有效性及安全性。

This case was a 78-year-old woman characterized exertional dyspnea and diagnosed with severe aortic stenosis.Preoperative evaluation revealed that the patient had a very high surgical risk,so transcatheter aortic valve replacement(TAVR)was proposed.But this patient was at high risk of coronary obstruction.After weighing advantages and disadvantages,the heart team decided to choose TAVR under the protection of guide wire and balloon at last.Left coronary ostia obstruction happened after self-expanding valve released during TAVR.Then,emergency"chimney"stent implantation was performed.Finally,TAVR and coronary revascularization was successfully completed.The patient’s condition was improved after TAVR and being good in follow-up.Based on this case,risk factors of coronary obstruction during TAVR and effectiveness and safety of"chimney"stent technique was discussed.