心室中隔欠損症に重症大動脈弁狭窄症を合併した患者への経カテーテル的大動脈弁置換術の周術期管理

Perioperative Management of Transcatheter Aortic Valve Replacement in a Patient with Severe Aortic Stenosis and Ventricular Septal Defect

要旨

　心室中隔欠損症に重症大動脈弁狭窄症を合併した患者に対する経カテーテル的大動脈弁置換術の周術期管理を経験した。このような患者に対しては，大動脈弁狭窄症の過小評価および心室中隔欠損症の過大評価に注意して，手術適用の決定や周術期管理を行うことが重要である。

　Abstract：The patient was a woman in her 80s. She was admitted to the hospital due to heart failure and was diagnosed with VSD and AS. Echocardiography revealed severe aortic stenosis with Peak velocity 4.7 m・sec⁻¹ and VSD with Qp/Qs 1.45. We decided to perform TAVR for this patient. Anesthesia was administered under general anesthesia, and the procedure was completed without problems. Postoperative right heart catheterization revealed a decrease, Qp/Qs to 1.31.

　In patients with VSD combined with AS, it is important to manage them with caution to avoid underestimation of AS and overestimation of VSD.