在门节约根置换后,用于主动脉排泄的跨导管主动脉置换:一个案例系列
Harish Sharma1,2, Anthony Mechery2, Ewa Lawton2
1Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK.
European heart journal. Case reports
|January 13, 2025
概括
过导管大动脉置换 (TAVR) 提供了一种可行的解决方案,用于在节省大动脉根置换 (VSARR) 后重复严重的大动脉吐 (AR). 这种方法,使用气球可扩展的门,适度过大,在两个具有挑战性的情况下证明了安全性和有效性.
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
- 医疗成像医学成像
背景情况:
- 门节约大动脉根替换 (VSARR) 是一种治疗大动脉根扩张和大动脉吐 (AR) 的手术,可保护本源大动脉.
- 在VSARR之后AR的复发可能需要重新手术,这往往会带来重大风险.
- 现有有限的文献指导过导管大动脉置换 (TAVR) 在以前有VSARR的患者.
研究的目的:
- 在VSARR之后,为复发性严重AR呈现两个成功TAVR的病例.
- 评估TAVR在患者之前VSARR的可行性和安全性.
- 为TAVR后VSARR的程序规划提供见解.
主要方法:
- 计算机断层扫描 (CT) 扫描用于术前规划,评估大动脉尺寸和门适用性.
- 透气管大动脉置换 (TAVR) 使用气球可扩展进行.
- 门尺寸包括基于CT和尺寸气球评估的适度过大尺寸 (10% -11%) 的目标,以获得最佳的固定.
主要成果:
- 这两位患有复发性严重VSARR后AR的患者都成功地接受了TAVR治疗.
- 术后的评估显示没有显著的跨膜或膜吐.
- 随访CT扫描证实没有门迁移,并保留了冠状动脉通道,这表明如果需要的话,适合未来的干预.
结论:
- 在VSARR之后,TAVR是复发性严重AR的可行和安全的治疗选择,特别是在重复手术风险高的患者中.
- 在这种情况下,中度的透导心脏 (THV) 过大 (10% -11%) 似乎是安全有效的.
- 仔细的程序前评估,包括CT和尺寸气球评估,对于VSARR后的成功TAVR至关重要.
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