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NEJM:经导管主动脉瓣置换术后致胆固醇结晶栓塞 -案例报道

2016-09-15 MedSci MedSci原创

患者男性,88岁,既往有心肌梗死病史。

患者男性,88岁,既往有心肌梗死病史曾做过冠状动脉旁路移植术,近日因双侧脚趾上的皮肤出现紫色斑驳病变到院就诊。

 

据该患者称,在一个月前,他曾接受过经导管主动脉瓣置换术(TAVR)。 

体格检查可见,其脚趾皮肤变色(如图A和B)和网状青斑一致。 

此外,实验室的检查结果显示血清肌酐水平2.8mg/dl,白细胞计数为10200/微升和嗜酸性粒细胞13%,计数为1170/微升。 

取皮肤样本活检显示,可见中型动脉阻塞性胆固醇结晶,这证实胆固醇栓塞综合征的诊断(如图C、D)。 

在临床上,这种综合征通常是是由远端胆固醇晶体随血管流动引起栓塞导致的,累及多个器官系统,包括外周血管,肾脏和大脑等。 

一般情况下,动脉造影、血管外科手术、溶栓治疗和TAVR等容易导致该并发症的发生。 

最后,该患者遵医嘱口服泼尼松和他汀类药物进行治疗。3周后,该患者脚趾上的皮肤病变明显有好转的迹象,但是,其肾功能并没有得到恢复正常。

原始出处:

Lu Devy, M.D., and Florence Brunet-Possenti, M.D. Cholesterol Embolization after Transcatheter Aortic-Valve ReplacementN Engl J Med 2016; 375:e25

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    2017-05-22 yxch48
  3. 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    2016-09-19 lhl629

    很好的内容,谢谢分享。

    0

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encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415075, encodeId=961014150e5ae, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510054, encodeId=2230151005422, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=)]
    2016-09-18 lhl629

    很好的内容,谢谢分享。

    0

  5. 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encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415075, encodeId=961014150e5ae, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510054, encodeId=2230151005422, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=)]
    2016-09-17 doctorJiangchao

    继续学习

    0

  6. 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encryptionId=b6222320322, topicName=主动脉瓣置换术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0b24249, createdName=medsci246, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415075, encodeId=961014150e5ae, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510054, encodeId=2230151005422, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Fri Sep 16 22:55:00 CST 2016, time=2016-09-16, status=1, ipAttribution=)]
    2016-09-17 doctorJiangchao

    继续关注

    0

  7. 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    2016-09-16 lsj631

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