Unique haemodynamics in a patient with apicoaortic conduit dysfunction who underwent transcatheter aortic valve replacement
Unique haemodynamics in a patient with apicoaortic conduit dysfunction who underwent transcatheter aortic valve replacement
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接受经导管主动脉瓣置换术的心尖主动脉导管功能障碍患者的独特血流动力学
DOI：
10.1093/ehjci/jez323
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Niinami Hiroshi
中科院分区：
文献类型：
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作者：
Domoto Satoru;Nagao Michinobu;Isomura Shogo;Yamaguchi Junichi;Niinami Hiroshi
超声心动图显示峰值流速为4.2 m/s，平均梯度为41 mmHg， AAC内无反流。四维流动磁共振成像（MRI）显示系统循环主要从AAC喷射（图B和在线补充数据，视频S1）。经诊断为AAC功能障碍，我们决定行经导管主动脉瓣置换术（TAVR）治疗原生主动脉瓣（NAV）。使用标准技术从股路植入26mm美敦力CoreValve Evolut R（图C）。四维血流MRI显示系统循环从NAV和AAC喷射（图D和在线补充数据，视频S2）。我们使用MRI相对比评估血流动力学。AAC和NAV的脑卒中容积（SVs）分别为58mL和9mL。TAVR前弓部血流从降主动脉逆行（图E，箭头表示血流方向，数字表示血流体积，单位为毫升）。NAV和AAC的SV分别增加到41 mL和45 mL。TAVR后总SV增加，弓血流量顺行（图F）。AAC功能障碍TAVR后的血流动力学尚不清楚。本病例突出了TAVR合并AAC功能障碍患者独特的血流动力学。
Echocardiography revealed a peak velocity of 4.2 m/s, a mean gradient of 41 mmHg, and no regurgitation within the AAC. Four-dimensional flow magnetic resonance imaging (MRI) revealed that the systematic circulation was mostly ejected from the AAC (Panel B and Supplementary data online, Video S1). AAC dysfunction was diagnosed, and we decided to perform transcatheter aortic valve replacement (TAVR) for the native aortic valve (NAV).A 26-mm Medtronic CoreValve Evolut R was implanted from the femoral route using the standard technique (Panel C). Four-dimensional flow MRI revealed that the systematic circulation was ejected from both the NAV and the AAC (Panel D and Supplementary data online, Video S2). We evaluated the haemodynamics using phase contrast MRI. The stroke volumes (SVs) from the AAC and NAV were 58mL and 9mL, respectively. The arch blood flow was retrograde from the descending aorta before TAVR (Panel E, the arrows indicate the flow direction and the numbers indicate the flow volume in millilitres). The SV from the NAV and AAC increased to 41 mL and 45 mL, respectively. The total SV increased, and the arch blood flow became antegrade after TAVR (Panel F). The haemodynamics after TAVR for AAC dysfunction remain unknown. This case highlights the unique haemodynamics in a patient who underwent TAVR with AAC dysfunction.