经导管主动脉瓣置换术治疗无支架生物瓣膜结构性衰败1例  

Transcatheter aortic valve replacement for the treatment of structural failure of stentless biological valves:a case report

作　　者：李易航 夏智渊 万俊义 徐亮 房芳 潘湘斌[1] 张戈军[1] LI Yi-hang;XIA Zhi-yuan;WAN Jun-yi;XU Liang;FANG Fang;PAN Xiang-bin;ZHANG Ge-jun(Center for Structural Heart Disease,National Center for Cardiovascular Diseases,Fuwai Hospitial,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100032,China)

机构地区：[1]国家心血管病中心、北京协和医学院中国医学科学院阜外医院结构性心脏病中心,北京100032

出　　处：《中国介入心脏病学杂志》2023年第6期467-470,共4页Chinese Journal of Interventional Cardiology

摘　　要：由于生物瓣膜不需要长期抗凝的特点,外科应用生物瓣膜治疗主动脉瓣功能障碍的患者比例不断增加。然而,由于瓣膜衰败等因素影响,生物瓣膜寿命较短,二次外科手术的风险高,尤其是在老年患者中。瓣中瓣经导管主动脉瓣置换术(ViV-TAVR)是外科生物瓣膜衰败后、患者二次外科手术可行的替代方案。目前世界上大多数ViV-TAVR手术多是TAVR失败的一种补救措施,而无支架外科生物瓣膜X线标记物,对介入治疗可能更具挑战性。本文报道1例无支架生物瓣膜衰败后于X线引导下行经导管主动脉瓣置换术。因此术前全面CT检查对整体手术过程具有重要参考价值,该病例对临床上的类似情况提供新的思路。Bioprosthetic valves are increasingly implanted for surgical treatment of patients with aortic valve dysfunction,with the advantage of no need for long-term anticoagulation.However,due to factors such as valve failure,the lifespan of biological valves is relatively short,and the risk of secondary surgery is high,especially in elderly patients.Valve-in-valve transcatheter aortic valve replacement(ViVTAVR)is a optional remedial measures to open heart surgery in select patients with bioprosthetic valve dysfunction.Most ViV-TAVR procedures worldwide have been performed in failing transcatheter aortic valve implantation;stentless bioprostheses lack fl uoroscopic markers and could be more challenging for transcatheter therapy.This article reports a patient who underwent percutaneous aortic valve replacement after the failure of a stent free biological valve and completed the operation under the guidance of radiation.The application of complete preoperative CT examination runs through the entire surgical process,providing assurance for the success of the operation.It is hoped to provide reference for similar clinical cases.

关 键 词：经导管主动脉瓣置换术 无支架生物瓣膜 瓣中瓣 

分 类 号：R542.5[医药卫生—心血管疾病]