自己拡張型経カテーテル的大動脈弁留置術後に心不全を繰り返した1例

Repeated Heart Failure after Transcatheter Aortic Valve Implantation Using Self-expandable Bioprosthetic Valve：Report of a Case

はじめに　重症大動脈弁狭窄症（AS）に伴う僧帽弁閉鎖不全症（MR）は，外科的大動脈弁置換術（SAVR）後に改善する症例もあり，軽度のMRであれば介入しないことも多い．経カテーテル的大動脈弁留置術（TAVI）後のMRも改善する症例が多いとされるが1），機械的損傷や収縮期前方運動，幾何学的変化などが原因で悪化する報告もある2）．われわれは，術前軽度であったMRがTAVI後に悪化し，急性心不全を繰り返した症例を経験したため報告する．

The patient was an 81-year-old man. Transcatheter aortic valve implantation （TAVI） was performed for severe aortic stenosis using Evolut R. The patient moved to intensive care unit without an adverse event after the operation. But repeated acute heart failure occurred several times during hospital stay. Mitral regurgitation （MR） was worsened from mild at baseline to moderate or more by transthoracic echocardiography. Various factors that worsened MR after TAVI have been reported, and treatment strategy for severe aortic stenosis patients with MR should be carefully developed.