严重脊柱侧弯的重度主动脉瓣狭窄患者行经导管主动脉瓣置换术一例

Transcatheter aortic valve replacement for severe aortic stenosis complicated by severe scoliosis:a case report

重度主动脉瓣狭窄患者会逐渐出现心力衰竭症状,主动脉瓣置换是目前有效的治疗方法,而经导管主动脉瓣置换术适用于高风险的老年患者。现报道一例严重脊柱侧弯的重度主动脉瓣狭窄患者行经导管主动脉瓣置换术,术前详细的评估及避免外周血管损伤是该病例的特点。该患者为老年男性,合并严重的脊柱侧弯,充分评估手术风险及获益后,制定手术策略,患者呈仰卧位完善术前CT,之后术中先使用超长鞘管通过胸腹主动脉折角处,造影辅助调整并确定最佳释放角度后,精确释放瓣膜,手术过程顺利,无严重外周血管损伤。

Patients with severe aortic stenosis will gradually develop symptoms of heart failure. Aortic valve replacement is an effective treatment at present, while transcatheter aortic valve replacement is suitable for high-risk elderly patients. This article reports a patient with severe aortic valve stenosis and severe scoliosis who underwent transcatheter aortic valve replacement. Detailed preoperative evaluation and avoidance of peripheral vascular injury were the characteristics of this case. The patient was an elderly male with severe scoliosis. After fully evaluating the risks and benefits of surgery, a surgical strategy was formulated. The patient was in the supine position to complete the preoperative CT, and then the long sheath was used to pass through the thoracoabdominal aortic angle during the operation. After angiography-assisted adjustment and determination of the optimal release angle, the valve was accurately released, and the operation went smoothly without serious peripheral vascular damage.