主动脉瓣重度狭窄患者经导管主动脉瓣置换术后左主干不完全阻塞一例  

Incomplete left main coronary obstruction after transcatheter aortic valve replacement for severe aortic stenosis:a case report

作　　者：邵一兵[1] 夏伟[1] 牛兆倬[2] 姜静[3] 李捷[4] SHAO Yibing;XIA Wei;NIU Zhaozhuo;JIANG Jing;LI Jie(Department of Cardiology,Qingdao Municipal Hospital,Qingdao,Shandong266000,P.R.China;Department of Cardiac Surgery,Qingdao Municipal Hospital Qingdao,Shandong 266000,P.R.China;Department of Echocardiology,Qingdao Municipal Hospital,Qingdao,Shandong 266000,P.R.China;Department of Cardiology,Guangdong General Hospital Guangzhou,Guangdong 510000,P.R.China)

机构地区：[1]青岛市市立医院东院区心内一科,山东青岛266000 [2]青岛市市立医院东院区心外科,山东青岛266000 [3]青岛市市立医院东院区心脏超声科,山东青岛266000 [4]广东省人民医院心内科,广州510000

出　　处：《华西医学》2020年第9期1140-1143,共4页West China Medical Journal

基　　金：青岛市市立医院临床诊疗技术创新基金(CXJJ-017)。

摘　　要：该文报道1例因慢性心力衰竭急性加重入院的84岁重度主动脉瓣狭窄患者,拟行经导管主动脉瓣置换术。术前及术中评估显示左冠状动脉(冠脉)开口堵塞高风险,术中用预埋冠脉导丝及支架保护,置入23 mm自膨胀主动脉瓣瓣膜后出现瓣叶部分阻塞左冠脉开口,但冠脉血流未受影响,术中未行冠脉血运重建。术后第3日出现急性心肌梗死伴低血压,造影示左冠脉开口堵塞加重,行补救性状动脉支架植入术,术后病情好转。该病例提示对预判经导管主动脉瓣置换术中冠脉阻塞高风险,尤其是术中出现冠脉开口部分阻塞时,应积极予冠脉血运重建术。An 84-year-old severe aortic stenosis patient admitted with acute heart failure was reported.Transcatheter aortic valve replacement(TAVR)was proposed.The patient was at high risk of the left coronary artery occlusion in preoperative and intraoperative evaluation.Coronary artery protection was performed by pre-embedded coronary artery guide wire and stent during the TAVR.The left coronary artery was partially blocked by valve leaflet after23 mm self-expanding aortic valve was released.Coronary revascularization was not performed as the coronary blood flow was not affected.However,the patient suffered acute myocardial infarction with hypotension on the third day after TAVR.Emergency angiography showed that left coronary artery was more blocked than before and the condition improved after left main coronary stent implantation.This case suggested that aggressive coronary revascularization should be considered for high risk of coronary artery obstruction during TAVR,especially for partial obstruction of coronary artery.

关 键 词：经导管主动脉瓣置换术 冠状动脉堵塞 心肌梗死 

分 类 号：R654.2[医药卫生—外科学]