经导管主动脉瓣置换术并发冠状动脉堵塞及腹膜后血肿一例  

Transcatheter aortic valve replacement complicated with coronary obstruction and retroperitoneal hematoma:a case report

作　　者：孙英皓 李捷 郑胜能 付明 李光 范瑞新 罗建方 SUN Yinghao;LI Jie;ZHENG Shengneng;FU Ming;LI Guang;FAN Ruixin;LUO Jianfang(Department of Cardiology/Guangdong Provincial Peopled Hospital/Guangdong Academy of Medical Sciences/Guangdong Cardiovascular Institute,Guangzhou,Guangdong 510080,P.R.China;Department of Cardiovascular Surgery,Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences/Guangdong Cardiovascular Institute,Guangzhou,Guangdong 510080,P.R.China)

机构地区：[1]广东省人民医院/广东省医学科学院/广东省心血管病研究所心血管内科,广州510080 [2]广东省人民医院/广东省医学科学院/广东省心血管病研究所心血管外科,广州510080

出　　处：《华西医学》2020年第9期1131-1134,共4页West China Medical Journal

基　　金：广东省人民医院高水平医院建设项目(DFJH201807)。

摘　　要：该文介绍了1例主动脉瓣重度反流并中度狭窄的患者在经导管主动脉瓣置换术中发生冠状动脉堵塞及术后出现腹膜后血肿的临床诊疗过程。患者术中出现循环崩溃,予体外膜肺氧合支持及冠状动脉保护下行经导管主动脉瓣置换术,冠状动脉造影未见明显异常,撤回导丝,复查造影发现左冠状动脉开口堵塞,遂经瓣架网眼置入冠状动脉支架至左冠状动脉开口。经导管主动脉瓣置换术后2周患者腹部CT提示腹膜后巨大血肿,紧急造影提示左髂外动脉造影剂外渗,遂予球囊压迫后植入覆膜支架。该文对冠状动脉堵塞及血管并发症的临床特点、危险因素及处理策略进行讨论,具有一定临床参考价值。This article presented the clinical diagnosis and management of a patient with severe aortic regurgitation and moderate aortic stenosis who underwent transcatheter aortic valve replacement complicated with coronary obstruction and retroperitoneal hematoma.The hemodynamics collapsed during the procedure,and transcatheter aortic valve replacement was performed under support of extracorporeal membrane oxygenation and coronary protection.After a negative coronary angiography,the wire was extracted,but a repeated angiography showed left coronary obstruction,so a coronary stent was implanted to the ostium of left coronary artery through the grid of the valve stent.Abdominal CT showed a giant retroperitoneal hematoma 2 weeks after transcatheter aortic valve replacement,and the emergent angiography indicated contrast leakage from left external iliac artery,so a balloon compression was performed followed by a covered stent implantation.This article also provided the clinical characteristics,risk factors and management of coronary obstruction and vascular complication for clinical reference.

关 键 词：经导管主动脉瓣置换术 冠状动脉堵塞 血管并发症 

分 类 号：R654.2[医药卫生—外科学]