左腋通道经导管主动脉瓣置入术治疗双侧乳腺内动脉和左侧永久性起搏器植入术患者。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Christos Papageorgiou, Konstantinos Tampakis, Anastasios Chronopoulos, Vaios Tzifos
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引用次数: 0

摘要

经股骨入路已被确立为大多数经导管主动脉瓣植入术(TAVI)患者的金标准入路。然而,在解剖困难或严重弥漫性外周动脉疾病的情况下,可考虑其他血管通路,如经腋窝入路。我们报告一位92岁的男士,由于严重的症状性主动脉瓣狭窄,有外周股-股搭桥手术、冠状动脉搭桥手术和永久性双腔左侧植入起搏器的病史。由于手术风险高,解剖难度大,我们选择了经左腋窝入路行TAVI。在手术切开和透视引导下插入14-F血管鞘,同时小剂量注射造影剂确认左乳内动脉(LIMA)移植物的非闭塞位置和通畅。使用硬导丝穿过严重钙化的主动脉瓣,随后将其置入左心室。球囊主动脉瓣成形术后进行了成功的TAVI,没有明显的主动脉反流或瓣旁泄漏。患者恢复平稳,72小时后出院。对于扩展外周动脉病变的高危患者,腋窝入路TAVI是一种可行的选择。据我们所知,这是第一例描述在一名患有严重合并症的90多岁患者中植入新型环内自膨胀瓣膜平台的病例报告,并且在选定的通路部位有多次干预的显著历史。在混合手术中,细致的前期策略规划和专业之间的有效合作对于获得良好的临床结果至关重要,特别是在具有挑战性解剖结构的病例中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Left Axillary Access for Transcatheter Aortic Valve Implantation in a Patient With Two Dependent Internal Mammary Artery Grafts and a Permanent Left-Sided Implanted Pacemaker.

Left Axillary Access for Transcatheter Aortic Valve Implantation in a Patient With Two Dependent Internal Mammary Artery Grafts and a Permanent Left-Sided Implanted Pacemaker.

Left Axillary Access for Transcatheter Aortic Valve Implantation in a Patient With Two Dependent Internal Mammary Artery Grafts and a Permanent Left-Sided Implanted Pacemaker.

Left Axillary Access for Transcatheter Aortic Valve Implantation in a Patient With Two Dependent Internal Mammary Artery Grafts and a Permanent Left-Sided Implanted Pacemaker.

Transfemoral access has been established as the gold standard approach for the majority of patients undergoing transcatheter aortic valve implantation (TAVI). However, in cases with anatomical difficulties or severely diffused peripheral arterial disease, alternative vascular access may be considered such as the transaxillary approach. We present the case of a 92-year-old gentleman with exertional dyspnea due to severe symptomatic aortic stenosis and a history of peripheral femoro-femoral bypass surgery, coronary arterial bypass surgery and a permanent dual-chamber left-side implanted pacemaker. Due to the high surgical risk and the severe anatomical difficulties, the method of TAVI using the left axillary approach was opted. A 14-F vascular sheath was inserted with surgical cutdown and with fluoroscopic guidance while small injections of contrast confirmed the non-occlusive position and the patency of the left internal mammary artery (LIMA) graft. A stiff guidewire was used to cross the heavily calcified aortic valve and subsequently was placed into the left ventricle. Balloon aortic valvuloplasty was performed followed by a successful TAVI with no significant aortic regurgitation or paravalvular leak. The patient recuperated uneventfully and was discharged after 72 h. Axillary access for TAVI is a feasible option for high-risk patients with extended peripheral arteriopathy. To our knowledge this is the first case report describing the implantation of a newer type of intra-annular self-expanding valve platform in a nonagenarian patient with severe comorbidities and such a remarkable history of multiple previous interventions in the selected access site. Meticulous upfront strategy planning and efficient collaboration between specialties is of outmost importance in hybrid procedures for favorable clinical outcomes, especially in cases with challenging anatomies.

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来源期刊
Cardiology Research
Cardiology Research CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.50
自引率
0.00%
发文量
42
期刊介绍: Cardiology Research is an open access, peer-reviewed, international journal. All submissions relating to basic research and clinical practice of cardiology and cardiovascular medicine are in this journal''s scope. This journal focuses on publishing original research and observations in all cardiovascular medicine aspects. Manuscript types include original article, review, case report, short communication, book review, letter to the editor.
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