在心室辅助装置支持下,经导管瓣膜置换术治疗主动脉不全逆转固定肺动脉高压

F. Ahmad, M. Ricciardi, L. Davidson, A. Anderson, K. Ghafourian, I. Okwuosa, E. Vorovich, J. Wilcox, D. Holloway, D. Pham, J. Rich
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引用次数: 0

摘要

我们报告了一位43岁的女性非缺血性心肌病患者,由于严重的“固定”肺动脉高压(PH),植入了心室辅助装置(VAD)作为移植的桥梁。在植入VAD的三个月内,她的“固定”PH完全消失了。近两年后,由于严重的HLA异敏化,她仍然使用VAD,根据标准标准,她出现呼吸困难和“中度”主动脉不全(AI)。侵入性血流动力学显示在左侧充盈压力升高的情况下,严重的PH复发。我们得出结论,AI确实是严重的,是导致她的症状和复发性PH的原因。尽管她的主动脉瓣未钙化,身体习惯小,经过彻底的评估,包括细致的环形测量和适当的瓣膜尺寸,她接受了经导管主动脉瓣置换术(TAVR),她的AI和复发性严重的PH都得到了完全的解决。本病例强调,在单个患者中,“固定”的PH逆转,左心室卸载充足。根据标准标准,“中度”AI通常是“严重”的,必须在伴有复发性PH的VAD患者中考虑,并且需要对VAD患者的TAVR进行细致的术前规划,包括精确测量主动脉环以确保瓣膜足够大。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reversal of fixed pulmonary hypertension with transcatheter valve replacement for aortic insufficiency on ventricular assist device support
We present a 43-year-old woman with a nonischemic cardiomyopathy implanted with a ventricular assist device (VAD) as bridge to transplant due to severe, “fixed” pulmonary hypertension (PH). Within three months of VAD implant, her “fixed” PH had resolved entirely. Nearly two years later, still supported with a VAD because of severe HLA allosensitization, she developed dyspnea and “moderate” aortic insufficiency (AI) by standard criteria. Invasive hemodynamics revealed recurrence of severe PH in the setting of elevated left-sided filling pressures. We concluded the AI was indeed severe and the cause of her symptoms and recurrent PH. Despite her noncalcified aortic valve and small body habitus, after a thorough assessment, including meticulous annular measurements and appropriate valve sizing, she underwent a transcatheter aortic valve replacement (TAVR) with complete resolution of both her AI and recurrent, severe PH. This case highlights, in a single patient, reversal of “fixed” PH with adequate left ventricular unloading, that “moderate” AI by standard criteria is often “severe” and must be considered in a VAD patient with recurrent PH, and the need for meticulous pre-procedural planning for TAVR in patients with VADs, including accurate measurements of the aortic annulus to ensure adequate oversizing of the valve.
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