トランスキャセータ後大動脈弁置換 急性重度のミトラル吐:症例報告
AlMothana Manasrah1, Farid Khan2, Priyanka Singh1
1Department of Internal Medicine, United Health Services Wilson Medical Center, Johnson City, New York, USA.
まとめ
トランスキャテーターによる大動脈弁置換 (TAVR) は,急性ミトラルリグルジテーション (MR) を引き起こす可能性があります. 低血圧による一時的なパピラ筋機能障害は,TAVR後の可逆的なMRの潜在的な原因です.
科学分野:
- 心臓病学 心臓病学
- 介入性心臓病学 介入性心臓病学
- 心臓外科手術について
背景:
- トランスキャテータ大動脈弁置換 (TAVR) は,高リスク患者における重度の大動脈狭窄症 (AS) の標準治療である.
- 急性ミトラル反発 (MR) は,TAVR後の珍しい合併症です.
- 迅速な認識と介入は,TAVRの合併症の管理に不可欠です.
研究 の 目的:
- TAVR後に重症MRが新たに発症した症例を報告する.
- この患者の急性MRのメカニズムを調査するために.
- リバーシブルMRの潜在的な原因として,一時的なパピラ筋機能障害を強調する.
主な方法:
- 重度のASを持つ94歳の女性がTAVRを受けていたケースプレゼンテーション.
- MRおよび構造的異常に対する処置前および処置後のイメージングの評価.
- 血液動力学的状態とTAVR後の臨床経過のモニタリング.
主要な成果:
- TAVRの直後に重症で新規発症したMRを発症し,血液動力学的に妥協した.
- 術後のイメージングでは,構造的なミトラ弁 (MV) 損傷は認められなかったが,小葉片コアプテーションの障害は認められた.
- MRの重症度は数日で有意に改善し,1年間のフォローアップではほんのわずかなMRしか認められなかった.
結論:
- 新発症した重度のTAVR後のMRは,迅速な管理を必要とする重大な合併症です.
- 低血圧による一時的なパピラ筋機能障害は,TAVR後の可逆的なMRを引き起こす可能性があります.
- 構造的なMV異常やイシュケミアのない可逆的なMR症例では,パピラリ筋機能障害を考慮してください.
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