経カテーテル的大動脈弁置換術後遠隔期における人工弁離開

Midterm Structural Valve Failure of the Transcatheter Aortic Valve due to Leaflet Dehiscence

われわれはEdwards Sapien XT（Edwards Lifesciences社，Irvine）による経カテーテル的大動脈弁置換術（TAVI）の6年6ヵ月後に外科的大動脈弁置換術（SAVR）を施行した症例を経験したので報告する．

We experienced a rare case of acute heart failure due to prosthetic valve regurgitation seven years after the transcatheter aortic valve implantation （TAVI）. We performed an emergent surgical aortic valve replacement. Intraoperative findings revealed the dehiscence of both sides of the anatomical noncoronary cusp without evident signs of degenerations such as thickening, calcification, or infection. Postoperative course was uneventful, and the patient discharged home 20 days after surgery. Although cause of valve failure was unclear, we are seriously concerned about the increase of similar cases in the future. Application of TAVI especially to younger patients should be avoided until long-term safety is demonstrated.