超声引导下无造影剂经导管主动脉瓣置换术一例  

Contrast-zero ultrasound-guided transcatheter aortic valve replacement:A case report

作　　者：董捷 欧阳文斌 李泽夫 张凤文 徐东辉 王建德 谢涌泉 胡晓鹏 潘湘斌 DONG Jie;OUYANG Wenbin;LI Zefu;ZHANG Fengwen;XU Donghui;WANG Jiande;XIE Yongquan;HU Xiaopeng;PAN Xiangbin(Department of Structural Heart Disease,National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100037,P.R.China;National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine,Key Laboratory of Innovative Cardiovascular Devices,Chinese Academy of Medical Sciences,National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing,100037,P.R.China;Department of Echocardiography Imaging,National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院结构性心脏病中心,北京100037 [2]国家卫生健康委心血管疾病再生医学研究重点实验室、中国医学科学院心血管创新器械重点实验室、国家心血管疾病临床医学研究中心,北京100037 [3]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院超声影像中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2023年第2期320-324,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81970444);中央级公益性科研院所基本科研业务费(2019PT350005);北京市科技计划(Z201100005420030);国家高层次人才特殊支持计划(2020-RSW02);中国医学科学院医学与健康科技创新工程(2021-I2M-1-065)。

摘　　要：传统经导管主动脉瓣置换术一般推荐在全身麻醉、经胸超声心动图和造影剂透视下完成,以更好引导瓣膜植入。然而,术中透视常用到的含碘造影剂会给肾脏带来一定损害,甚至造成急性肾损伤。我们报道了1例75岁诊断为主动脉重度狭窄并中度关闭不全、慢性肾功能不全的患者。由于患者存在肾功能不全且对造影剂过敏,我们进行了无造影剂、单纯透视、经食管超声引导下经导管主动脉瓣置换术。患者术后狭窄解除,主动脉瓣瓣架固定,术后7 d顺利出院。Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography,and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve.However,iodine-containing contrast agent possibly damages the patient’s kidney,and even induces the acute kidney injury.We reported a 75-year-old patient diagnosed with severe aortic valve stenosis,moderate regurgitation,and chronic renal failure.We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent.Seven days after surgery,the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.

关 键 词：经导管主动脉瓣置换术 主动脉瓣狭窄 超声心动图 造影剂过敏 病例报告 

分 类 号：R654.2[医药卫生—外科学]