经导管主动脉瓣植入术治疗严重二尖瓣主动脉狭窄合并巨细胞动脉炎

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105312

Issam Altnji MBBS, MD, James P. Curtain MB, BS, PhD, Stephen O'Connor MB, BCh, MD

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引用次数: 0

摘要

背景：经导管主动脉瓣植入术（TAVI）治疗双尖瓣主动脉狭窄（AS）和主动脉炎的临床应用尚未见报道。由于复杂的解剖结构，双尖牙AS给TAVI带来了巨大的挑战。此外，主动脉炎将使病例更具挑战性。我们报告了一例71岁的女性，她有巨细胞动脉炎和严重的双尖AS，低血流，低梯度，并成功接受了TAVI。患者表现为急性心力衰竭伴射血分数降低。经过全面的评估，一个多学科的团队选择了TAVI，因为患者的手术风险高，并有多种合并症。大剂量口服类固醇治疗2周，并皮下注射tocilizumab。TAVI手术成功，短期疗效良好。结论本病例证明了TAVI治疗重度双尖瓣AS合并主动脉炎患者的可行性，并强调了谨慎选择患者的必要性。

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Transcatheter Aortic Valve Implantation for Severe Bicuspid Aortic Stenosis With Concomitant Giant Cell Arteritis Aortitis

Background

The use of transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic stenosis (AS) and aortitis has not been previously reported. Bicuspid AS creates significant challenges for TAVI due to complex anatomy. Furthermore, aortitis would make the case more challenging.

Case Summary

We report a case of a 71-year-old woman with a history of giant cell arteritis aortitis and severe bicuspid AS with low-flow, low-gradient who successfully underwent TAVI. The patient presented with acute heart failure with reduced ejection fraction. Following a thorough evaluation, a multidisciplinary team chose TAVI owing to the patient's high surgical risk and multiple comorbidities. Aortitis was managed with high-dose oral steroids for 2 weeks and subcutaneous tocilizumab. TAVI was performed successfully with a favorable short-term outcome.