经心尖途径经导管主动脉瓣置换术救治单纯性主动脉瓣重度反流1例

目的 探讨经心尖途径经导管主动脉瓣置换术治疗单纯性主动脉瓣关闭不全的可行性.方法 回顾性分析2016年9月8日浙江大学医学院附属第二医院心脏中心开展的浙江省首例经心尖途径经导管主动脉瓣置换术的术前评估、术中操作以及患者术后情况.结果 患者严格进行术前评估,术中行全身麻醉、气管插管,透视下定位后第五肋间小切口进胸,打开心包,选择心尖裸区预置荷包,穿刺后导入超滑泥鳅导丝跨过主动脉瓣到达降主动脉,导入J-Valve输送系统逐步释放,经食道超声心动图评估主动脉瓣反流从术前的大量到瓣膜释放后无反流,撤出瓣膜输送系统,手术成功结束.术后患者症状明显缓解,出现Ⅰ度房室传导阻滞,未发生死亡、心肌梗死、心包填塞、动脉夹层等并发症.结论 经心尖途径经导管主动脉瓣置换术是安全可行的,患者的远期预后还有待进一步观察.

Trans-apical transcatheter aortic valve replacement for patient with severe pure aortic regurgitation

Objective To explore the feasibility of transapical transcatheter aortic valve replacement (TF-TAVR) for patient with severe pure aortic regurgitation (AR).Methods A patientwith severe pure AR underwent TF-TAVR at the Second Affiliated Hospital of Zhejiang University School of Medicine on September 8,2016,was retrospectively analyzedfor the preoperative assessment,procedural process and the postoperative recovery.Results A patient with pure AR was assessed before TF-TAVR carefully according to the inclusion criteria.General anesthesia and intubation were performed during the procedure.Apex was exposed in the fifth intercostal space under the guidance of X-ray,followed by purse-string suture.Terumo wire crossed aortic valve and went to descending aorta after puncture of apex.J-Valve system was inserted and released step by step.In comparison with severe AR before procedure,no AR was found from transesophageal echocardiography (TEE) monitoring after TF-TAVR.Before discharge,symptom of the patient was relieved and no severe complications such as death,myocardial infarction,pericardial tamponade and aorta dissection,except first degree atrioventricular block was found.Conclusions It is feasible and safe using TF-TAVR for severe pure AR,while follow-up is necessary for the evaluation of long-term prognosis.