経皮的大動脈弁留置術における自己大動脈弁前拡張時に生じたstuck valveにより急性心原性肺水腫を生じた1症例

A Case of Acute Cardiogenic Pulmonary Edema due to a Stuck Valve Caused by Pre-dilation during Transcatheter Aortic Valve Implantation

要旨

　91歳，女性に対する局所麻酔下経カテーテル大動脈弁留置術において，自己大動脈弁に対する前拡張時に自己大動脈弁の左冠尖が開放位で固定され，重症心原性肺水腫を来した症例を経験した。経カテーテル大動脈弁留置術で生じうる重篤な合併症の予防と迅速な対応のため，ハイリスク症例を術前に把握し，麻酔方法や循環管理を正しく選択すべきであると考えられた。

　We report a 91-year-old woman who developed severe cardiogenic pulmonary edema due to the immobilization of the left coronary apex in the open position caused by pre-dilation during transcatheter aortic valve implantation（TAVI）, and a large amount of blood phlegm was blown out via the oral endotracheal tube.

　Although TAVI is less invasive than open heart surgery, serious complications sometimes occur. To prevent and deal with serious complications, it is important to identify high-risk cases preoperatively and to select anesthesia and circulatory management correctly.