Intraoperative paravalvular leakage after sutureless aortic valve replacement corrected with secondary balloon dilatation -A case report-
Anesthesia and Pain Medicine 2016³â 11±Ç 2È£ p.186 ~ p.189
À̺¸¶ó(Lee Bo-Ra) - Yonsei University College of Medicine Department of Anesthesiology and Pain Medicine
ÀåÁØÈì(Jang Jun-Heum) - CHA University CHA Bundang Medical Center Department of Anesthesiology and Pain Medicine
À̽ſµ(Lee Shin-Young) - Yonsei University College of Medicine Department of Thoracic and Cardiovascular Surgery
¼ÛÁ¾¿í(Song Jong-Wook) - Yonsei University College of Medicine Department of Anesthesiology and Pain Medicine
Abstract
Sutureless aortic valve replacement was performed in a 72-year-old female patient with severe aortic stenosis who had undergone coronary revascularization and pacemaker implantation. After valve excision, decalcification was deliberately incompletely performed at the commissure of the left- and non-coronary cusp to obtain a regular and circular annular margin. After implantation of the stented valve, no paravalvular leakage was noted on water irrigation testing. Upon weaning from cardiopulmonary bypass, a moderate degree of paravalvular leakage was observed by transesophageal echocardiography at the junction of the left- and non-coronary cusp. Instead of removing the valve and performing more complete decalcification to implant a larger valve, secondary balloon dilatation and warm sterile water irrigation were performed to allow further expansion and fixing of the metal alloy stent around the aortic wall to minimize the duration of aortic cross-clamp. No paravalvular leakage was observed thereafter and the patient was discharged without any complications.
Å°¿öµå
Paravalvular leakage, Sutureless aortic valve replacement, Transesophageal echocardiography
KMID :
1155520160110020186
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À¯È¿¼º°á°ú(Recomendation)
In cases of paravalvular leakage despite the use of a correct sized valve at a regular margin of annulus obtained by incomplete decalcification, secondary ballooning and warm water irrigation may be attempted to induce further expansion of the stented valve to prevent paravalvular leakage while minimizing the aortic cross clamp time and medical costs.