Diagnosis and Management of Rare Case of Mesenteric Hematoma Rupture after Transcatheter Aortic Valve Replacement (TAVR): A Case Report and Review of the Literature.

Case Reports in Vascular Medicine Pub Date : 2018-11-21 eCollection Date: 2018-01-01 DOI:10.1155/2018/6273538
Danish Abbasi, Jeffrey E Vanhook, Khashayar Salartash, Howard Levite
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Abstract

We present a case of a 78-year-old female with history of diastolic heart failure and paroxysmal atrial fibrillation on apixaban presenting with worsening shortness of breath. She underwent transesophageal echocardiogram showing severe aortic stenosis with a valve area of 0.8 cm2. Coronary angiography did not reveal significant coronary artery disease. CT of chest, abdomen, and pelvis did not show any evidence of hematoma or dissection. Patient was scheduled for transfemoral TAVR. Patient's apixaban was discontinued prior to the procedure. She received heparin during the procedure. She successfully underwent left transfemoral aortic valve replacement. Shortly after the procedure, she complained of abdominal pain and became hypotensive. Blood pressure was 76/44 mm of Hg (MAP 58). Hemoglobin dropped to 8.1 g/dl (baseline 13). Stat CT abdomen and pelvis showed a large volume of hemorrhage in the peritoneal cavity. CTA of abdomen showed no evidence of aortic aneurysm or dissection but active extravasation below the inferior aspect of the spleen. Catheterization of the superior mesenteric artery (SMA) identified ileal branch of SMA as the source of bleeding. Embolization using gel foam slurry followed by a coil insertion was performed. Repeat angiogram demonstrated continued extravasation through arcade collaterals. A rapid exploration of the abdominal cavity revealed ruptured mesenteric hematoma. Evacuation of hematoma was performed. Portion of small ileum and bleeding mesenteric branch vessel was resected. Her condition stabilized with no postoperative bleeding and she was discharged on warfarin postoperatively. Use of antithrombotic therapy increases risk of bleeding in TAVR patients. Mesenteric hematoma rupture if not identified can be life-threatening. We believe that this is the first reported case of mesenteric hematoma rupture after a TAVR procedure.

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经导管主动脉瓣置换术(TAVR)后肠系膜血肿破裂罕见病例的诊断和处理:病例报告和文献综述。
我们报告了一例 78 岁女性患者的病例,她有舒张性心力衰竭和阵发性心房颤动病史,服用阿哌沙班后出现气短加重。她接受了经食道超声心动图检查,结果显示主动脉瓣严重狭窄,瓣膜面积为 0.8 平方厘米。冠状动脉造影未发现明显的冠状动脉疾病。胸部、腹部和骨盆 CT 未显示任何血肿或夹层迹象。患者被安排接受经口 TAVR。患者在术前停用了阿哌沙班。她在手术期间接受了肝素治疗。她成功接受了左侧经胸主动脉瓣置换术。术后不久,她抱怨腹痛并出现低血压。血压为 76/44 mmHg(MAP 58)。血红蛋白降至 8.1 g/dl(基线 13)。腹部和盆腔 CT 显示腹腔大量出血。腹部CTA显示没有主动脉瘤或夹层的迹象,但脾脏下部有活动性外渗。肠系膜上动脉(SMA)导管检查确定 SMA 回肠分支为出血源。使用凝胶泡沫浆进行栓塞,然后插入线圈。复查血管造影显示,出血继续通过弧形袢外流。对腹腔进行快速探查后发现肠系膜血肿破裂。对血肿进行了抽吸。切除了部分小回肠和出血的肠系膜分支血管。她的病情趋于稳定,术后没有出血,术后服用华法林即可出院。使用抗血栓治疗会增加 TAVR 患者出血的风险。肠系膜血肿破裂如不及时发现,可能危及生命。我们认为这是首例报道的 TAVR 术后肠系膜血肿破裂病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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