经导管主动脉瓣瓣中瓣置换术后多发性瓣周漏介入封堵治疗1例  

A case of multiple paravalvular leaks treated by catheter intervention after transcatheter aortic valve replacement valve-in-valve surgery

作　　者：刘伟丽 李大成[2] 刘松[3] 屈占军 李燕超 唐国璋[5] 江磊[4] LIU Wei-li;LI Da-cheng;LIU Song;QU Zhan-jun;LI Yan-chao;TANG Guo-zhang;JIANG Lei(Interventional operating room,Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院介入手术室,山东青岛266003 [2]青岛大学附属医院PET-CT中心,山东青岛266003 [3]青岛大学附属医院心血管内科,山东青岛266003 [4]青岛大学附属医院心血管外科,山东青岛266003 [5]青岛大学附属医院心脏超声科,山东青岛266003

出　　处：《中国介入心脏病学杂志》2023年第10期796-800,共5页Chinese Journal of Interventional Cardiology

摘　　要：患者2年前行经导管主动脉瓣瓣中瓣置换术治疗重度主动脉瓣狭窄,术后并发中度瓣周漏(PVL),后进展为重度PVL、纽约心脏病协会(NYHA)心功能分级Ⅳ级、慢性心力衰竭。进行经导管介入封堵术成功封堵多漏口,PVL改善为轻-中度。半年后复查,NYHA心功能分级Ⅱ级、PVL改善为轻度,治疗效果满意。本例提示经导管主动脉瓣置换术(TAVR)术前影像评估应对PVL进行可能性分析,预计发生概率较大时,可针对性选择瓣膜以预防或改善PVL,并做好同期PVL封堵术准备;充分利用CT 3D重建、计算机辅助3D打印技术对多隧道PVL直观、立体和精准显示,对于合理选择封堵器和导丝,指导封堵策略,提高手术成功率具有重要价值。The patient underwent Transcatheter aortic valve replacement(TAVR)valve-in-valve surgery for severe aortic stenosis two years ago.Later,he developed into severe multiple paravalvular leaks(PVLs),with New York Heart Association(NYHA)classⅣheart failure.The PVLs were successfully blocked by transcatheter interventional closure and improved to mild-moderate level.The follow-up check after six months showed the PVLs improved to mild.The therapeutic effect is satisfied.This case suggests us that the possibility of PVL should be evaluated in the preoperative imaging evaluation of TAVR.When the probability is expected to be high,we should select specifical valve to prevent or improve PVLs,and the transcatheter interventional closure surgery should be prepared at the same time.3D CT reconstruction and computer-aided 3D printing technology should be fully utilized for the visualized,stereoscopic and precise display of multiple PVLs,which is of great value for selection of appropriate occluder and guide wire,guiding interventional closure strategies,and improving the surgery success rate.

关 键 词：多发性瓣周漏 介入封堵治疗 经导管主动脉瓣瓣中瓣置换术 计算机辅助3D打印 

分 类 号：R54[医药卫生—心血管疾病]