Çoklu komorbiditesi olan bir hastada perkütan aortik kapak ve korumasız sol ana koroner stent implantasyonu;Basamaklı yaklaşım

Year 2021, Volume: 11 Issue: 1, 201 - 206, 22.03.2021

Cenk Sarı , Serdal Baştuğ , Mustafa Duran Engin Bozkurt

https://doi.org/10.31832/smj.746025

Abstract

Yaşam beklentisi arttıkça, aort darlığı (AS) prevalansı da artar. Cerrahi aort kapak replasmanı (s-AVR), ciddi ko-morbid durumların yokluğunda düşük operatif mortalite ile gerçekleştirilir ve hem semptomlarda düzelme hem de survey katkısı sağlamaktadır. Bununla birlikte, hastaların% 30'unda sol ventrikül disfonksiyonu, ileri yaş ve eşlik eden hastalıklar nedeniyle AVR uygulanamaz. Ayrıca, bu hastalarda koroner arter hastalığı yüksek prevalansa sahiptir ve aynı nedensel faktörlerin çoğunu paylaşmaktadır. Bu vaka sunumumuzda basamaklı yaklaşımla sol ana arter stentleme ve transkateter aort kapak replasmanı yapılması sonrası dramatik iyileşme görülen bir hastayı sunuyoruz.

Keywords

transkatater aortik kapak implantasyonu, koroner arter hastalığı, aort darlığı

Combined Percutaneous Aortic Valve Replacement and Unprotected Left Main Stenting in a Patients with Multiple Comorbidities;Stepwise Approach

Abstract

Yaşam beklentisi arttıkça, aort darlığı (AS) prevalansı da artar. Cerrahi aort kapak replasmanı (s-AVR), ciddi ko-morbid durumların yokluğunda düşük operatif mortalite ile gerçekleştirilir ve hem semptomlarda düzelme hem de survey katkısı sağlamaktadır. Bununla birlikte, hastaların% 30'unda sol ventrikül disfonksiyonu, ileri yaş ve eşlik eden hastalıklar nedeniyle AVR uygulanamaz. Ayrıca, bu hastalarda koroner arter hastalığı yüksek prevalansa sahiptir ve aynı nedensel faktörlerin çoğunu paylaşmaktadır. Bu vaka sunumumuzda basamaklı yaklaşımla sol ana arter stentleme ve transkateter aort kapak replasmanı yapılması sonrası dramatik iyileşme görülen bir hastayı sunuyoruz.

Keywords

Aort darlığı, transkateter aort kapak implantasyonu, koroner arter hastalığı

References

• 1. Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J. 2005;26:2714–2720.
• 2. Bach DS, Siao D, Girard SE, et al. Evaluation of patients with severe symptomatic aortic stenosis who do not undergo aortic valve replacement: the potential role of subjectively overestimated operative risk. Circ Cardiovasc Qual Outcomes.2009;2:533-539.
• 3. Cribier A, Eltchaninoff H, Bash A,et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002, 106:3006-3008.
• 4. Ortlepp JR, Schmitz F, Bozoglu T, Hanrath P, Hoffmann R. Cardiovascular risk factors in patients with aortic stenosis predict prevalence of coronary artery disease but not of aortic stenosis: an angiographic pair matched case–control study. Heart 2003, 89:1019-1022.
• 5. Dworakowski R, MacCarthy PA, Monaghan M,et al. Transcatheter aortic valve implantation for severe aortic stenosis-a new paradigm for multidisciplinary intervention: a prospective cohort study. Am Heart J 2010, 160:237-243.
• 6. Masson J-B, Lee M, Boone RH, Ali Al A, et al. Impact of coronary artery disease on outcomes after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2010, 76:165-173.
• 7. Dewey TM, Brown DL, Herbert MA,et al. Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation. Ann Thorac Surg 2010, 89:758-767.
• 8. Mohler ER, Sheridan MJ, Nichols R, Harvey WP, Waller BF. Development and progression of aortic valve stenosis: atherosclerosis risk factors–a causal relationship? a clinical morphologic study. Clin Cardiol 1991, 14:995-999.
• 9. Doshi SN, Sherman W. Balloon valvuloplasty and rotational atherectomy stenting in a 92-year-old patient with severe aortic stenosis and unprotected critical left main disease. Int J Cardiol. 2005;99:477-8.
• 10. Takagi T, Stankovic G, Finci L, et al. Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery. Circulation. 2002;106:698–702.
• 11. Ayhan H, Kasapkara HA, Durmaz T, et al. Impact of transcatheter aortic valve implantation in patients with reduced ejection fraction. Cardiol J. 2015;22(1):108-14)
• 12. Monin J-L, Quéré J-P, Monchi M, et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation 2003, 108:319-324.
• 13. Quere J-P, Monin J-L, Levy F, et al. Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic stenosis. Circulation 2006, 113:1738-1744.
• 14. Davies JE, Whinnett ZI, Francis DP, et al. Evidence of a dominant backward-propagating “suction”wave responsible for diastolic coronary filling in humans, attenuated in left ventricular hypertrophy. Circulation 2006, 113:1768-1778.
• 15. Davies JE, Sen S, Broyd C, et al. Arterial pulse wave dynamics after Percutaneous Aortic valve replacement: fall in coronary diastolic suction with increasing heart rate as a basis for angina symptoms in Aortic Stenosis. Circulation 2011, 124:1565-1572.
• 16. Barbash IM, Ben-Dor I, Dvir D, et al. Incidence and predictors of acute kidney injury after transcatheter aortic valve replacement. Am Heart J. 2012;163:1031–1036.
• 17. Keleş T, Ayhan H ,Durmaz T, et al. Improvement in renal functions with transcatheter aortic valve implantation. J Geriatr Cardiol. 2013 Dec; 10(4): 317–322.