PDF(Pubmed)
Abstract：
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgery. However, there is a risk of surgical manipulation causing detachment of a lesion of the aortic valve, which can result in various embolisms.
METHODS: An 87-year-old woman with symptomatic severe aortic valve stenosis was scheduled for transfemoral TAVI under monitored anesthesia. Preoperative examination revealed severe calcification of the aortic valve, but there was no calcification in the ascending aorta. After a delivery catheter system passed the aortic valve, left radial arterial pressure dropped significantly, and complete atrioventricular block (CAVB) occurred. Catecholamine administration and ventricular pacing improved hemodynamics, and a self-expandable valve was implanted. CAVB resolved after surgery, but her state of consciousness was poor, and her left hand became ischemic. Imaging studies revealed multiple embolic infarcts in her bilateral cerebrum and cerebellum.
CONCLUSIONS: It should be noted that there is a risk of detachment of a calcified lesion of the aortic valve during TAVI, which can cause embolisms not only in the brain but also in the extremities and coronary arteries.
METHODS: An 87-year-old woman with symptomatic severe aortic valve stenosis was scheduled for transfemoral TAVI under monitored anesthesia. Preoperative examination revealed severe calcification of the aortic valve, but there was no calcification in the ascending aorta. After a delivery catheter system passed the aortic valve, left radial arterial pressure dropped significantly, and complete atrioventricular block (CAVB) occurred. Catecholamine administration and ventricular pacing improved hemodynamics, and a self-expandable valve was implanted. CAVB resolved after surgery, but her state of consciousness was poor, and her left hand became ischemic. Imaging studies revealed multiple embolic infarcts in her bilateral cerebrum and cerebellum.
CONCLUSIONS: It should be noted that there is a risk of detachment of a calcified lesion of the aortic valve during TAVI, which can cause embolisms not only in the brain but also in the extremities and coronary arteries.
摘要：
背景：经导管主动脉瓣植入术（TAVI）是一种微创手术。然而,有手术操作导致主动脉瓣病变脱离的风险，会导致各种栓塞。
方法：一名87岁有症状的重度主动脉瓣狭窄的女性患者在麻醉监测下进行经股动脉TAVI。术前检查显示主动脉瓣严重钙化，但是升主动脉没有钙化.输送导管系统通过主动脉瓣后,左桡动脉压显著下降,完全性房室传导阻滞（CAVB）。儿茶酚胺给药和心室起搏改善了血流动力学，并植入了可自行扩张的瓣膜.CAVB在手术后解决，但是她的意识状态很差，她的左手缺血了.影像学检查显示她的双侧大脑和小脑有多处栓塞性梗塞。
结论：应注意，TAVI期间主动脉瓣钙化病变有脱离的风险，不仅会在大脑中，还会在四肢和冠状动脉中引起栓塞。
方法：一名87岁有症状的重度主动脉瓣狭窄的女性患者在麻醉监测下进行经股动脉TAVI。术前检查显示主动脉瓣严重钙化，但是升主动脉没有钙化.输送导管系统通过主动脉瓣后,左桡动脉压显著下降,完全性房室传导阻滞（CAVB）。儿茶酚胺给药和心室起搏改善了血流动力学，并植入了可自行扩张的瓣膜.CAVB在手术后解决，但是她的意识状态很差，她的左手缺血了.影像学检查显示她的双侧大脑和小脑有多处栓塞性梗塞。
结论：应注意，TAVI期间主动脉瓣钙化病变有脱离的风险，不仅会在大脑中，还会在四肢和冠状动脉中引起栓塞。
