经导管主动脉瓣置换术治疗二尖瓣主动脉瓣一例。

Mymensingh medical journal : MMJ Pub Date : 2023-07-01
P K Karmakar, F Ahmed, A Momen, M Monwar, P R Das, M H Ameen, S Jannat, A Roy, M J Uddin, K K Karmoker, B Dutta, M S Rahman, S C Mandal, M Mohiuddin
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引用次数: 0

摘要

在其他瓣膜性心脏病中,主动脉瓣狭窄(AS)在发达国家最为常见。经导管主动脉瓣置换术(TAVR)是重度钙化主动脉瓣狭窄高、中危患者最可接受的治疗方法。在诸多挑战中,主要挑战之一是处理双尖瓣主动脉瓣(BAV)。非圆形静脉环、大体积小叶导致瓣周渗漏、破裂风险和经常非常严重的钙化可能导致术中卒中,导致不良临床结果。该病例为68岁女性,既往有2型糖尿病(DM)、甲状腺功能减退、二尖瓣主动脉瓣及严重主动脉瓣狭窄、支气管哮喘病史,多次拒绝任何心脏直视手术建议,是我们TAVR的志愿者候选人。TAVR成功后,峰值压力梯度从100mmHg降至17mmHg。因此,TAVR对于具有良好解剖结构的严重主动脉狭窄和二尖瓣主动脉瓣的高选择性患者可能是一种可行的选择。
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Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve: A Case Report.

Among other valvular heart disease Aortic stenosis (AS) is the most common in the developed world. Transcatheter Aortic Valve Replacement (TAVR) is most acceptable treatment option for patient with severely calcified aortic stenosis with high and intermediate risk group. Among several challenges, one of the main challenges is to deal with bicuspid aortic valve (BAV). Non-circular annulus, bulky leaflets leading to perivalvular leaks and risk for rupture and often very severe calcification may contribute to periprocedural strokes leading to poor clinical outcome. This case, a 68-year-old woman with a history of type 2 diabetes mellitus (DM), hypothyroidism, bicuspid aortic valve and severe aortic stenosis, bronchial asthma, who had repeatedly refused any suggestion for open heart surgery, was our volunteer candidate for TAVR. After successful TAVR the peak pressure gradient decreased from 100mmHg to 17mmHg. So, TAVR could be a viable option for highly selected patients with severe aortic stenosis and bicuspid aortic valve who have favourable anatomy.

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