左主干分叉病变经皮冠状动脉介入和经导管主动脉瓣置换一站式手术一例

One-stop operation of percutaneous coronary intervention for left main bifurcation disease and transcatheter aortic valve replacement:a case report

经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)已成为重度主动脉瓣狭窄的主要治疗方式之一,然而,高龄患者常同时合并冠状动脉疾病,需给予经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗。该文报道了为一例左主干分叉病变合并重度主动脉瓣狭窄的71岁男性患者完成的TAVR+PCI一站式手术,术中首先对冠状动脉病变进行造影评估,在直头导丝跨瓣成功后,将猪尾导管置入左心室,然后对病变冠状动脉行PCI术,最后对狭窄的主动脉瓣行TAVR治疗,术后患者血流动力学稳定,症状改善显著,表现出TAVR+PCI一站式手术的良好临床效果。

Transcatheter aortic valve replacement(TAVR) has become one of the main treatments for severe aortic stenosis. However, percutaneous coronary intervention(PCI) is often required in elderly patients who combine with coronary artery disease. This paper reports a case of one-stop TAVR+PCI operation for a 71-year-old male patient with left main bifurcation lesions and severe aortic stenosis. During the procedure, first of all, the coronary arteries were assessed by angiography, and the pigtail catheter was implanted in the left ventricle after the straight guidewire transvalved successfully;then PCI was performed on the diseased coronary arteries;finally, the stenosis of aortic valve was treated with TAVR. After operation, the hemodynamics of the patient was stable and symptoms were significantly improved, showing a good clinical effect of one-stop operation of TAVR+PCI.