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Modified Transcatheter Hufnagel Procedure as a Bridge to Surgical Aortic Valve Replacement.
改良经导管Hufnagel手术作为外科主动脉瓣置换术的桥梁。
- 影响因子:1.80
- DOI:10.1016/j.athoracsur.2019.09.084
- 作者列表:"Fukuhara S","Hobbs R","Chetcuti SJ","Patel HJ
- 发表时间:2020-06-01
Abstract
:The history of aortic valve surgery began with the Hufnagel procedure. In 1953, Hufnagel reported the first successful treatment of aortic insufficiency by the implantation of a ball-valve prosthesis into the descending aorta. We present a 33-year-old male patient with a complicated surgical history needing a sixth-time redo aortic valve replacement for severe prosthetic paravalvular leak in the presence of fresh intracranial hemorrhage. His deteriorating clinical picture was successfully temporized by a transcatheter valve placement in the descending aorta (modified Hufnagel procedure). This report illustrates a potential role of a modified Hufnagel procedure as a bridge to definitive surgery.
摘要
: 主动脉瓣手术的历史始于Hufnagel手术。在1953,Hufnagel报道了第一例通过将球形瓣膜假体植入降主动脉成功治疗主动脉瓣关闭不全。我们介绍了一名33岁的男性患者,其具有复杂的手术史,在存在新鲜颅内出血的情况下,因严重的人工瓣周漏需要第六次重做主动脉瓣置换术。他恶化的临床表现通过降主动脉经导管瓣膜置入术 (改良Hufnagel术) 成功地暂时缓解。本报告说明了改良Hufnagel手术作为最终手术的桥梁的潜在作用。
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METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
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心脏结构和心脏血流的可视化,用于诊断评估或通过内窥镜、放射性核素成像等技术来指导心脏手术。