基层医院急诊经导管主动脉瓣置换术治疗主动脉瓣狭窄合并急性心力衰竭休克患者1例

A case of emergency transcatheter aortic valve replacement treatment for aortic stenosis complicated with acute heart failure shock in primary hospital

主动脉瓣狭窄作为常见的心脏瓣膜病病情进展快、临床预后差。在合并急性心力衰竭的情况下,心脏泵血功能严重受损,可能导致心脏输出量显著减少,从而引起休克。经导管主动脉瓣置换术(TAVR)自2002年首例成功以来,已成为老年主动脉瓣狭窄患者的一线治疗手段。在国内,随着技术的进步和医师培训的加强,基层医院在TAVR治疗方面的能力正在增强。本病例报道1例伴有急性心力衰竭休克的重度主动脉瓣狭窄患者在基层医院接受急诊TAVR治疗。因条件限制,在不备体外循环及体外膜肺氧合支持下紧急实施了TAVR。患者术中扩张瓣膜后血压即升至105/65 mmHg,术后症状明显缓解,复查心脏彩色多普勒超声示狭窄解除,心功能明显改善。本例手术的成功为基层医院重度主动脉瓣狭窄合并心力衰竭患者行急诊TAVR治疗提供了一定的借鉴。

Aortic valve stenosis,as a common heart valve disease,progresses rapidly and has a poor clinical prognosis.In the case of combined acute heart failure,the pumping function of the heart is severely impaired,which may lead to a significant decrease in cardiac output,resulting in a state of shock.Transcatheter aortic valve replacement(TAVR)has become afirst-line treatment for elderly patients with aortic valve stenosis since itsfirst successful case in 2002.In China,with the advancement of technology and the strengthening of physician training,the capacity of grassroots hospitals in TAVR treatment is increasing.This case reports a patient with severe aortic valve stenosis accompanied by acute heart failure and shock status who received emergency TAVR treatment at a grassroots hospital.Due to limitations in conditions,TAVR was urgently implemented without extracorporeal circulation and extracorporeal membrane oxygenation support.The patient's blood pressure immediately rose to 105/65 mmHg after valve dilation during surgery,and the postoperative symptoms were significantly relieved.Follow up color Doppler ultrasound showed that the stenosis was relieved and the heart function was significantly improved.The success of this surgery provides a reference for emergency TAVR treatment in patients with severe aortic valve stenosis and heart failure in grassroots hospitals.