老年重症主动脉瓣狭窄患者冠状动脉高度过低的预防冠状动脉闭塞1例报告

Kumar Viveka
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摘要

背景:经导管主动脉瓣置换术(TAVR)是治疗严重症状性主动脉瓣狭窄(AS)的常用方法。然而,低冠状动脉高度的存在在TAVR期间或之后具有较高的冠状动脉阻塞风险。病例:在本病例报告中,我们介绍了我们对一位老年、高风险(STS评分- 12.08%)女性严重AS患者的经股- tavr治疗经验,该患者冠状动脉高度低(右:7.4 mm,左:8.7 mm)。她有较低的环面积(287 mm2)和中度低的瓣膜面积(0.7 cm2)。她的平均和峰值压力梯度(pg)分别为38 mmHg和61 mmHg。根据心脏小组的评估,建议采用TAVR,并选择20毫米球囊可膨胀(BE) Myval经导管心脏瓣膜(THV)。无术中或术后并发症报道,术后血流动力学,即平均和峰值PGs分别改善至16 mmHg和30 mmHg。患者住院4天后出院,情况稳定。结论:我们报道了一例冠状动脉高度较低的患者成功植入小型BE Myval THV (20mm)。危及生命的并发症,包括瓣旁漏,冠状动脉阻塞,或环破裂被很好地避免;因此,我们确定Myval THV是治疗解剖学困难的严重AS的合适设备。然而,这种新型瓣膜的可行性需要在更大规模的研究中得到确认。
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Preventing Coronary Occlusion in an Elderly Severe Aortic Stenosis Patient with Critically Low Coronary Heights – A Case Report
Background: Transcatheter Aortic Valve Replacement (TAVR) is an established treatment for severe, symptomatic Aortic Stenosis (AS). However, the presence of low coronary heights confers a high risk for coronary obstruction during or after TAVR. Case: In this case report, we present our experience with transfemoral-TAVR in an elderly, high-risk (STS score – 12.08%) female severe AS patient with low coronary heights (right: 7.4 mm, left: 8.7 mm). She had lower annulus area (287 mm2) and moderately low valve area (0.7 cm2) as well. Her mean and peak pressure gradients (PGs) were 38 mmHg and 61 mmHg, respectively. Upon the Heart Team’s evaluation, TAVR was recommended and a 20 mm Balloon Expandable (BE) Myval Transcatheter Heart Valve (THV) was selected. No peri-procedural or post-procedural complications were reported and the post-procedural hemodynamics, namely the mean and peak PGs improved to 16 mmHg and 30 mmHg after TAVR, respectively. The patient was discharged in a stable condition after four days of hospital stay. Conclusion: We report the successful implantation of a small-sized BE Myval THV (20 mm) in a patient with low coronary heights. Life-threatening complications including paravalvular leak, coronary obstruction, or annular rupture were well averted; hence, we ascertain that the Myval THV is a suitable device for treating severe AS in difficult anatomies. However, the viability of the novel valve needs to be reaffirmed in larger studies.
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