Hüseyin AYHAN, Tahir DURMAZ, Hacı Ahmet KASAPKARA, Hakan SÜYGÜN, Engin BOZKURT

Transkateter aort kapak implantasyonu sırasında sol ana koroner arter tıkanıklığını önlemede kılavuz tel-balon tekniği:Olgu sunumu

Ciddi aort darlığı olan, cerrahi açıdan yüksek riskli veya uygun olmayan hastaların tedavisinde transkateter aort kapak implantasyonu (TAKİ) etkili ve güvenilir bir yöntemdir. Buna rağmen, işleme ait çeşitli komplikasyonlar gelişebilmektedir. Bu komplikasyonlardan biri, sol ana koroner arter (SAKA) ostiyumunun kalsifikasyon, natif kapak küspü veya biyoprotez kapak tarafından tıkanmasıdır. Sol ana koroner arter tıkanması zor tedavi edilir ve olasılıkla katastrofik şekilde sonuçlanır. Dolayısıyla, amaç SAKA'nın tıkanmasını önlemek olmalıdır. Bu yazıda TAKİ sırasında natif kapak kalsifikasyonunun SAKA'yı tıkayacağı fark edilerek akut SAKA tıkanmasının önlendiği 85 yaşında bir kadın hasta sunuldu. Bildiğimiz kadarıyla, SAKA tıkanıklığını önlemek için kullandığımız etkili yöntem literatürde bildirilmemiştir.

Guide wire-balloon technique to prevent occlusion of the left main coronary artery during transcatheter aortic valve implantation: Case report

Transcatheter aortic valve implantation (TAVI) is an effective and reliable method in the treatment of patients with serious aortic stenosis who are at high risk or inconvenient for surgery. Nevertheless, various procedurerelated complications may develop. One of these complications is the obstruction of the ostial left main coronary artery (LMCA) due to calcification, native valve cusp, or bioprosthesis valve. It is difficult to treat LMCA obstruction and potentially it ends up catastrophically. Therefore, the aim must be to prevent LMCA obstruction. This article presents an 85-year-old female patient in whom acute LMCA obstruction was prevented by noticing that native valve calcification would obstruct LMCA during TAVI. To our knowledge, the effective method we used to prevent LMCA obstruction has not been reported in the literature.

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1. Lefèvre T, Kappetein AP, Wolner E, Nataf P, Thomas M, Schächinger V, et al. One year follow-up of the multi-centre European PARTNER transcatheter heart valve study. Eur Heart J 2011;32:148-57.
2. Stabile E, Sorropago G, Cioppa A, Cota L, Agrusta M, Lucchetti V, et al. Acute left main obstructions following TAVI. EuroIntervention 2010;6:100-5.
3. Webb JG, Chandavimol M, Thompson CR, Ricci DR, Carere RG, Munt BI, et al. Percutaneous aortic valve implantation retrogra de from the femoral artery. Circulation 2006;113:842-50.
4. Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 2010;122:62-9.
5. Bartorelli AL, Andreini D, Sisillo E, Tamborini G, Fusari M, Biglioli P. Left main coronary artery occlusion after percutaneous aortic valve implantation. Ann Thorac Surg 2010;89:953-5.
6. Ribeiro HB, Nombela-Franco L, Urena M, Mok M, Pasian S, Doyle D, et al. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv 2013;6:452-61.
7. Kapadia SR, Svensson L, Tuzcu EM. Successful percutaneous management of left main trunk occlusion during percutaneous aortic valve replace ment. Catheter Cardiovasc Interv 2009;73:966-72.
8. Spiro J, Nadeem A, Doshi SN. Delayed left main stem obstruction following successful TAVI with an Edwards SAPIEN XT valve: successful resuscitation and percutaneous coronary intervention using a non-invasive automated chest compression device (AutoPulse). J Invasive Cardiol 2012;24:224-8.
9. Gogas BD, Zacharoulis AA, Antoniadis AG. Acute coronary occlusion following TAVI. Catheter Cardiovasc Interv 2011;77:435-8.
10. Uyar IS, Gül I, Okur FF. Which one is the best access when the transfemoral way is not a suitable access for TAVI patients? Turk Gogus Kalp Dama 2014;22:897-8.