“一站式”经导管主动脉瓣置换联合经皮腔内室间隔心肌消融手术1例

 经导管主动脉瓣置换术（transcatheter aortic valve replacement，TAVR）是治疗主动脉瓣狭窄（aortic valve stenosis，AS）的一种成熟手段。AS患者几乎均合并心肌肥厚，目前对于合并梗阻性肥厚型心肌病（hypertrophic obstructive cardiomyopathy，HOCM）的AS患者首先考虑外科手术而非TAVR。但高龄、高危患者常不能耐受外科手术，介入手段能否安全有效治疗此类患者尚存疑问。本文报道1例77岁女性患者，重度AS合并HOCM，经评估后行“一站式”TAVR联合经皮腔内室间隔心肌消融术（percutaneous transluminal septal myocardial ablation，PTSMA），术后患者恢复良好。本病例为国内开展的首例“一站式”TAVR+PTSMA，为TAVR术中紧急处理并发症和拓宽适应证提供新的依据。

One-stop transcatheter aortic valve replacement combined with percutaneous transluminal septal myocardial ablation: a case report

Transcatheter aortic valve replacement (TAVR) is a mature method to treat aortic valve stenosis (AS).Almost all patients with AS have cardiac hypertrophy.At present,AS patients with hypertrophic obstructive cardiomyopathy (HOCM) are recommended for surgery firstly,not TAVR.However,the elderly and high-risk patients often cannot tolerate surgery,and whether intervention can treat such patients safely and effectively is still questionable.This paper reports that a 77-year-old female patient with severe AS and HOCM underwent one-stop TAVR+percutaneous transluminal septal myocardial ablation (percutaneous transluminal septal myocardial ablation,PTSMA) on the basis of careful evaluation.The patient is recovering well.This case is the first one-stop TAVR+PTSMA developed in China,providing a new basis for the treatment of emergency complications during TAVR and the expansion of indications.