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通过导管更换大动脉门后的大动脉环断裂:成功管理危险并发症
Andrew Jones1, Hossein Amirjamshidi2, Peter Knight2
1University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Journal of cardiothoracic surgery
|November 14, 2023
概括
在TAVR过程中大动脉环断裂是一种罕见但致命的并发症. 这一案例系列成功地使用心周切割,排水和必要时进行手术干预来管理三次破裂,提供了潜在的管理策略.
科学领域:
- 心血管外科心血管外科
- 干预心脏病学 干预心脏病学
- 医疗并发症 医疗并发症
背景情况:
- 大动脉环断裂是跨导管大动脉置换 (TAVR) 的严重并发症.
- 关于预测和管理这种罕见事件的现有数据不足,缺乏基于证据的指导方针.
- 在TAVR之后,大动脉环断裂的成功管理策略需要进一步阐明.
研究的目的:
- 描述了TAVR后发生的三起大动脉环断裂病例的成功管理.
- 基于这些案例,提出TAVR期间大动脉环断裂的潜在管理算法.
- 突出及时诊断和干预在管理这一关键并发症的重要性.
主要方法:
- 一系列病例描述了三名患者在TAVR期间或之后经历了大动脉环断裂.
- 干预措施包括心脏膜切换,心脏膜排水放置,血液静止剂的使用,以及新出现的手术置换.
- 心声和动脉图用于诊断和监测并发症.
主要成果:
- 这三个患有大动脉环断裂的患者都获得了成功的出院.
- 管理涉及一个分阶段的方法,包括血液动力学评估,心声学,心周切口和心周排水.
- 一名患者因持续出血而需要过渡到急需的开放性外科动脉置换.
结论:
- 建议的管理策略包括识别血液动力学不稳定性,通过心声图确认心周溢出,进行心周切割,放置心周排水,并使用静血剂.
- 重复动脉图非常重要,以排除正在进行的外流.
- 如果血液静止不能实现或血液动力学不稳定性持续存在,就必须立即过渡到新出现的外科治疗.
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