Aortic stenosis complicated by cardiogenic shock treated by transcatheter aortic valve replacement with extracorporeal membrane oxygenation: A case report.
Aortic stenosis complicated by cardiogenic shock treated by transcatheter aortic valve replacement with extracorporeal membrane oxygenation: A case report.
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DOI：
10.1097/md.0000000000011900
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发表时间：
2018-08
期刊：
影响因子：
1.6
通讯作者：
Fang Z
中科院分区：
文献类型：
--
作者：
Huang J;Chen P;Hu X;Tang J;Fang Z
主动脉瓣狭窄（AS）继发的心源性休克是一个具有挑战性的问题，因为与治疗相关的死亡率很高，并且此类患者的成功治疗很少。一名 77 岁男性出现运动不耐受、进行性劳力性呼吸困难和胸痛。患者经皮冠状动脉介入治疗后出现心源性休克。他通过经胸超声心动图（TTE）和冠状动脉造影确诊。他的主要诊断是AS和冠状动脉疾病。患者接受了静脉动脉体外膜肺氧合（VA-ECMO）和经导管主动脉瓣置换术（TAVR）。截至5个月随访，患者身体状况良好，能够基本独立生活。 TTE提示左心室舒张末期容积从66 mm减少至45 mm，左心室射血分数从20%上升至50%。继发于 AS 的心源性休克患者的治疗非常困难。 ECMO 联合 TAVR 可能是一个合理的策略。
Cardiogenic shock secondary to aortic stenosis (AS) is a challenging problem owing to the high mortality associated with treatment, and successful treatment of such patients has been rare. A 77-year-old man presented with exercise intolerance and progressive exertional dyspnea and chest pain. The patient was suffered from cardiogenic shock after percutaneous coronary intervention. He was diagnosed by transthoracic echocardiography (TTE) and coronary angiogram. His main diagnose was AS and coronary artery disease. The patient received venoarterial extracorporeal membrane oxygenation (VA-ECMO) and transcatheter aortic valve replacement (TAVR). As of the 5-month follow-up, the patient was well, and capable of basic independent living. The TTE suggested that the left ventricular end-diastolic volume had decreased from 66 to 45 mm and the left ventricular ejection fraction had risen from 20% to 50%. Patients with cardiogenic shock secondary to AS are very difficult to treat medically. ECMO with TAVR may be a reasonable strategy.