TAVR的晚期并发症:内心炎和剖析通过战略手术来管理
Yuika Kameda1, Mayu Nishida1, Mio Kasai1
1Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan.
JACC. Case reports
|October 31, 2025
概括
本案例研究提出了一种成功的策略,用于管理假体内心炎 (PVE) 和经过透气管大动脉置换 (TAVR) 后的大动脉剖析. 像冷水探索和无动脉置换等技术为高风险患者提供了实际的优势.
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
- 假肢管管理 假肢管管理
背景情况:
- 假肢内心炎 (PVE) 和大动脉剖析是通过导管大动脉置换 (TAVR) 后的罕见但严重的并发症.
- 目前,没有标准化手术方法来管理这些综合并发症.
- 这些事件在高风险患者群体中带来了重大挑战.
研究的目的:
- 提出一个可重复的手术策略来管理TAVR后的PVE和大动脉剖析组合.
- 突出特定技术在减轻与复杂的TAVR并发症相关的风险方面的实用性.
- 强调在高风险患者中量身定制的外科计划的重要性.
主要方法:
- 一名74岁的女性患者在TAVR后6个月使用Evolut PRO+门开发了PVE和上升性大动脉剖析.
- 诊断成像包括心声回声 (植被,周泄漏) 和计算机断层扫描 (大动脉剖析).
- 紧急手术涉及假体门的扩张,上升大动脉置换和无大动脉门置换.
主要成果:
- 该患者因TAVR相关的PVE和大动脉剖析而接受了成功的紧急手术.
- 假体门用冷水扩张和陷技术小心翼翼地切除.
- 进行了无动脉置换,成功缩短了手术时间.
结论:
- 成功管理TAVR相关的PVE与大动脉剖析需要了解假体门的特征和个性化手术规划.
- 冷水探索和无动脉置换是减少复杂病例手术风险的宝贵技术.
- 这一案例证明了在高风险患者中管理严重TAVR并发症的可重复策略.
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