Successful treatment of a paravalvular leak with balloon cracking and valve-in-valve TAVR.
Aged, 80 and over
Aortic Valve
/ diagnostic imaging
Aortic Valve Insufficiency
/ diagnostic imaging
Bioprosthesis
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
/ adverse effects
Hemodynamics
Humans
Male
Prosthesis Design
Prosthesis Failure
Recovery of Function
Transcatheter Aortic Valve Replacement
/ instrumentation
Treatment Outcome
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
01 03 2020
01 03 2020
Historique:
received:
26
06
2019
revised:
30
10
2019
accepted:
21
11
2019
pubmed:
4
12
2019
medline:
21
10
2020
entrez:
4
12
2019
Statut:
ppublish
Résumé
Transcatheter heart valve implantation into degenerated bioprosthetic valves (ViV-THV implantation) has become an established procedure for high risk patients. In general, paravalvular leak (PVL) is a contraindication for valve-in-valve-TAVR (ViV-TAVR). Herein, we report on a 81-year-old patient presenting with acute heart failure for a failing aortic bioprosthesis (Medtronic Mosaic 27 mm). Intraoperative transesophageal echocardiography during urgent ViV-TAVR revealed a PVL previously not detected. After transfemoral implantation of a 26 mm-Evolut-R, balloon-fracturing of the bioprosthetic ring was performed using a 24 mm True Dilatation balloon for treatment of the PVL. Afterward, left ventricular to aortic peak-to-peak pressure gradient measured 2-4mmHg. Transesophageal echocardiography merely revealed trace PVL. Aortic root angiography showed no PVL. At discharge, echocardiography measured a transprosthetic mean gradient of 5mmHg detecting no PVL. Intentional ring-fracturing of an aortic valve prostheses may prove not only to be effective in lowering transvalvular gradients after valve-in-valve-TAVR, but may also be a tool to treat PVL alongside degenerated surgical aortic bioprostheses in certain patients.
Types de publication
Case Reports
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
859-862Informations de copyright
© 2019 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals, Inc.
Références
Bleiziffer S, Erlebach M, Simonato M, et al. Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve. Heart. 2018;104(10):828-834.
Allen KB, Chhatriwalla AK, Cohen DJ, et al. Bioprosthetic valve fracture to facilitate transcatheter valve-in-valve implantation. Ann Thorac Surg. 2017;104(5):1501-1508.
Chhatriwalla AK, Allen KB, Saxon JT, et al. Bioprosthetic valve fracture improves the hemodynamic results of valve-in-valve transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2017;10(7):e005216.
Loyalka P, Montgomery KB, Nguyen TC, Smalling RW, Howe M, Rajagopal K. Valve-in-valve transcatheter aortic valve implantation: a novel approach to treat paravalvular leak. Ann Thorac Surg. 2017;104(4):e325-e327.