应后台粉丝儿留言，今天分享一篇心脏外科学文献病例分析：主要介绍一例心脏移植23年后出现主动脉瓣反流的多器官移植（心、肾）患者，因其既往胸骨严重感染移除胸骨且处于免疫抑制状态，传统开胸手术风险极高。通过实施经导管主动脉瓣置换术（TAVR），成功治疗了移植心脏新发的主动脉瓣病变。
BACKGROUND: Clinicians continue to expand the availability of transcatheter aortic valve replacement (TAVR) for patients who historically would have been ineligible for surgical aortic valve replacement. Historically, reoperative aortic valve surgery after transplant was immensely complicated and high risk due to the repeat sternotomy approach, and the immunosuppression in transplant patients. As heart transplant patients continue to live longer, patients are beginning to develop novo aortic pathology of the transplanted organ. In these patients, TAVR may be a valuable rescue therapy for those with de-novo aortic valve disease.
CASE PRESENTATION: Here, we present a single case of a 70-year-old man with a history of heart transplant 23 years prior complicated by severe sternal infection and subsequent removal of his sternum. Additionally, this patient had a recent history of kidney transplant due to renal cell carcinoma necessitating nephrectomy. He subsequently developed progressive symptomatic aortic insufficiency and underwent a successful TAVR to treat his new aortic disease.
CONCLUSIONS: To our knowledge, this represents only the second case report of TAVR for severe aortic insufficiency and one of the first reports of TAVR in a multiple organ recipient. TAVR may represent an important rescue therapy for post-transplant valve pathologies instead of high-risk reoperative surgical aortic valve replacement.
一、长难句分析
1.Clinicians continue to expand the availability of transcatheter aortic valve replacement (TAVR) for patients who historically would have been ineligible for surgical aortic valve replacement.
主句： Clinicians continue to expand the availability of TAVR for patients
主语：Clinicians（临床医生）
谓语：continue to expand（持续扩大）
宾语：the availability of TAVR（TAVR的适用性）
状语：for patients（为某一类患者）
定语从句： who historically would have been ineligible for surgical aortic valve replacement
引导词/关系代词：who（指代先行词 patients）
从句主语：who
从句谓语：would have been ineligible（虚拟语气，表示“过去本应不具备资格”）
状语1：historically（从历史上看）
状语2：for surgical aortic valve replacement（对于外科主动脉瓣置换术）
一、难词汇总
1、TAVR (Transcatheter Aortic Valve Replacement) / 经导管主动脉瓣置换术
2、Surgical Aortic Valve Replacement / 外科主动脉瓣置换术
3、De-novo aortic valve disease / 新发主动脉瓣疾病
4、Reoperative aortic valve surgery / 再次主动脉瓣手术
5、Repeat sternotomy / 再次胸骨切开术
6、Immunosuppression / 免疫抑制
7、Severe sternal infection / 严重胸骨感染
8、Aortic insufficiency (AI) / 主动脉瓣关闭不全（反流）
9、Multiple organ recipient / 多器官接受者
10、Renal cell carcinoma / 肾细胞癌
11、Nephrectomy / 肾切除术
三、本段翻译
背景：临床上，经导管主动脉瓣置换术（TAVR）的适用人群正不断扩大，其中包含了许多既往被认为无法接受外科主动脉瓣置换术的患者。历史上，心脏移植术后因新发主动脉瓣病变而需要再次进行主动脉瓣手术的情况极为复杂且风险极高，这主要归因于再次开胸的手术入路以及移植患者的免疫抑制状态。随着心脏移植患者生存期的延长，移植心脏本身开始出现新发的主动脉瓣病变。对于这部分出现新发主动脉瓣疾病的患者，TAVR可能成为一种有价值的挽救性疗法。
病例介绍：本文报告一例70岁男性患者，他在23年前曾接受心脏移植，且术后并发严重胸骨感染，导致胸骨被移除。此外，该患者近期因肾细胞癌接受肾切除术后，又进行了肾移植。他随后出现进行性加重的症状性主动脉瓣关闭不全，并成功接受了TAVR来治疗这一新发的主动脉瓣疾病。
结论：据我们所知，这是全球第二例使用TAVR治疗重度主动脉瓣关闭不全的病例报告，也是首批在多器官移植（心、肾）受者中实施TAVR的报告之一。对于移植术后的心脏瓣膜病变，相较于高风险的再次外科主动脉瓣置换术，TAVR可能代表了一种重要的挽救性治疗选择。
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