経カテーテル的大動脈弁置換術中に破裂したバルーンを合併症なく回収できた1例

Retrieval of the Ruptured Balloon during Transcatheter Aortic Valve Replacement without Complications：Report of a Case

はじめに　経カテーテル的大動脈弁置換術（TAVR）は，さまざまなリスクの併存により外科的大動脈弁置換術（SAVR）が困難な重症大動脈弁狭窄症（AS）が適応となる．SAVRよりも低侵襲とされているが，TAVR特有の合併症が存在する．われわれは，バルーン拡張型デバイスを用いたTAVRにおいてバルーン破裂をきたした例を経験したので報告する．

A 77-year-old man with a history of coronary artery bypass grafting underwent transcatheter aortic valve replacement （TAVR） via femoral artery for severe aortic stenosis （AS）. Preoperative computed tomography （CT） showed there was mild calcification at the sino-tubular junction （STJ）. Sapien 3 was implanted successfully, but at the end of full inflation, the balloon ruptured. The ruptured balloon was retrieved without any remnants or vascular injury. A transesophageal echocardiogram showed adequate valve deployment.

TAVR with its less invasiveness has become an alternative treatment for high risk patients who cannot endure surgical aortic valve replacement （SAVR）. Although there are several complications related to TAVR, they can be predicted in many cases by analysis of preoperative imaging. In this case, the rupture of the balloon was not predicted because there was no significant calcification at the STJ. Caution should be taken even though there seems to be low risk of complications by preoperative imaging modalities.