经导管主动脉瓣置换术治疗四叶式主动脉瓣一例

Transcatheter aortic valve replacement for quadricuspid aortic valve:a case report

四叶式主动脉瓣(quadricuspid aortic valve,QAV)作为一种罕见的先天性心脏病,其远期病变类型多以反流为主。经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)在这类患者中的应用极为少见。该文报道了一例QAV合并严重反流且存在瓣下小隔膜的高龄患者,通过术前评估及心脏团队的讨论指导,选择较高过膨胀率(oversize率)的可回收瓣膜,顺利完成了TAVR手术,并通过调整瓣膜植入深度一站式覆盖了瓣下隔膜,术后患者心悸等症状明显改善,未见明显瓣周漏以及反流,为该类患者的TAVR手术方案提供了参考。

Quadricuspid aortic valve(QAV)is a rare congenital heart disease,and its long-term lesion type is mainly reflux.The application of transcatheter aortic valve replacement(TAVR)in such patients is extremely rare.This article reports a case of an elderly patient with QAV complicated with severe regurgitation and small subvalvular membrane.Through preoperative evaluation and guidance from the cardiac team discussion,a relatively high oversize rate retrievable valve was selected and the TAVR surgery was successfully completed.At the same time,the valve implantation depth was adjusted to cover the subvalvular membrane.After surgery,the patient’s symptoms such as palpitations were significantly improved.No obvious perivalvular leakage or regurgitation was observed.It provides a reference for TAVR surgical plans for such patients.