Case Report: Emergency High-Risk Percutaneous Coronary Intervention Following Transcatheter Aortic Valve Implantation in Bicuspid Anatomy.
Case Report: Emergency High-Risk Percutaneous Coronary Intervention Following Transcatheter Aortic Valve Implantation in Bicuspid Anatomy.
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DOI：
10.3389/fcvm.2020.620272
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发表时间：
2020
影响因子：
3.6
通讯作者：
Dorman S
中科院分区：
文献类型：
--
作者：
El-Medany A;Doolub G;Dastidar A;Joshi N;Johnson T;Dorman S
背景：在越来越多的严重症状性主动脉瓣狭窄（as）患者中，经导管主动脉瓣植入术（TAVR）作为外科主动脉瓣置换术（SAVR）的一种有价值的替代方法继续发展。AS经常与冠状动脉疾病共存，随着TAVR使用的增加，TAVR术后进行技术上具有挑战性的经皮冠状动脉介入治疗（PCI）的频率将会增加。病例总结：我们在此报告一例53岁的男性患者，他有复杂的病史，包括1型糖尿病和透析依赖性肾衰竭，并曾因严重的二尖瓣主动脉瓣狭窄而接受Evolut-R TAVR，他在出现急性冠状动脉综合征（ACS）继发的心室颤动（VF）后，接受血管内超声研究（IVUS）引导的左主干（LMS）远端和左前降段（LAD）病变的PCI。讨论：通过TAVR假体的侧边细胞选择性地接合冠状动脉口是具有挑战性的，特别是在紧急情况下。本文描述了与本病例相关的特殊挑战，并对在这种情况下可以提供帮助的策略和设备进行了最新的文献检索。
Background: Transcatheter aortic valve implantation (TAVR) continues to develop as a valuable alternative to surgical aortic valve replacement (SAVR) in an increasingly wide spectrum of patients with severe symptomatic aortic stenosis (AS). AS frequently coexists with coronary artery disease, and performing technically challenging percutaneous coronary intervention (PCI) following TAVR will become more frequent with increased use of TAVR. Case Summary: We herein report the case of a 53-years-old man with complex medical history including type 1 diabetes and dialysis-dependent renal failure and prior Evolut-R TAVR for critical bicuspid aortic valve stenosis who underwent intravascular ultrasound study (IVUS)-guided PCI to a critical distal left main stem (LMS) and proximal left anterior descending (LAD) lesion after presenting with ventricular fibrillation (VF) secondary to an acute coronary syndrome (ACS). Discussion: Selective engagement of coronary ostia through the side cells of TAVR prosthesis can be challenging, especially in an emergency setting. The particular challenges associated with this case are described, as well as an up-to-date literature search on strategies and equipment that can help in this situation.
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