一名有症状的严重主动脉瓣狭窄的89岁男子由于年老和有冠状动脉旁路移植术史而接受了经导管主动脉瓣植入术。计算机断层扫描显示三尖瓣主动脉瓣和主动脉瓣环严重钙化,周长为88.7毫米。34毫米EvolutPRO+(美敦力公司,明尼阿波利斯,MN,美国)被选中。球囊主动脉瓣成形术后,尝试部署EvolutPRO+,但观察到明显的扩张失败。将EvolutPRO+从身体中取出后,观察到框架变形。一个新的EvolutPRO+再次尝试,但在经食道超声心动图中发现了类似的magatama样内折。幸运的是,患者的血流动力学相对稳定。使用25mmZ-MEDII(NuMED,Inc.,蒙特利尔,加拿大)进行重塑。
■在自膨式经导管主动脉瓣(TAV)中,TAV帧的弯曲是众所周知的关键问题之一。然而,这是罕见的,很少遇到。在这种情况下,反复发生TAV帧内折,并在体外和体内评估了折叠的形态。此外,我们报告说,一些TAV可以通过后扩张来重塑。
An 89-year-old man with symptomatic severe aortic stenosis underwent transcatheter aortic valve implantation due to old age and a history of coronary artery bypass grafting. Computed tomography showed a tricuspid aortic valve and severe calcification at the aortic valve annulus, with a perimeter of 88.7 mm. The 34-mm Evolut PRO+ (Medtronic Inc., Minneapolis, MN, USA) was selected. After balloon aortic valvuloplasty, deployment of the Evolut PRO+ was attempted, but significant expansion failure was observed. Upon retraction and removal of the Evolut PRO+ from the body, frame deformation was observed. A new Evolut PRO+ was tried again, but a similar finding was noted as a magatama-like infolding on transesophageal echocardiography. Fortunately, the patient\'s hemodynamics were relatively stable. Post-dilation was performed using a 25 mm Z-MED II (NuMED, Inc., Montreal, Canada) for reshaping.
UNASSIGNED: In self-expanding transcatheter aortic valves (TAVs), bending of the TAV frame is widely known as one of the key problems. However, this is rare and infrequently encountered. In this
case, TAV frame infolding occurred repeatedly, and the morphology of the infolding was evaluated in vitro and in vivo. Furthermore, we report that some TAVs can be reshaped by post-dilation.