Implantation of three transcatheter aortic valves for embolization of two valves caused by under-expansion: a case report
| Autor: | Ryu Shutta, Jun Tanouchi, Masaki Tsuda, Masami Nishino |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Aortic valve
medicine.medical_specialty Transcatheter aortic viruses medicine.medical_treatment 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine medicine.artery Case report Ascending aorta Medicine Fluoroscopy AcademicSubjects/MED00200 030212 general & internal medicine Embolization Transcatheter aortic valve implantation medicine.diagnostic_test business.industry Aortic stenosis virus diseases respiratory system Massive calcification Surgery medicine.anatomical_structure Valve embolization Balloon dilation Delivery system Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | European Heart Journal: Case Reports |
| ISSN: | 2514-2119 |
| DOI: | 10.1093/ehjcr/ytaa497 |
| Popis: | Background Transcatheter aortic valve embolization is one of the serious complications of transcatheter aortic valve implantation (TAVI). We present a case of TAVI that needed implantation of three transcatheter aortic valves owing to the embolization of two self-expandable valves (SEVs). Case summary An 88-year-old woman underwent TAVI using a 26-mm SEV. After valve deployment, the SEV embolized to the ascending aorta during the removal of the delivery system (DS) of the SEV (DS-SEV) from the SEV. An additional SEV was implanted, which also embolized upwards. Multi-directional fluoroscopy revealed extreme under-expansion of the second SEV, which caused valve embolization due to catching of the DS-SEVs in the SEVs. Finally, a 23-mm balloon-expandable valve was successfully implanted, which was also under expanded on fluoroscopic assessment. The patient was stable without sequelae at the 1-month follow-up. Discussion Pre-procedurally predicting SEV under-expansions was difficult because pre-procedural computed tomography revealed no massive calcification on the aortic valve, and fluoroscopy indicated adequate expansion of the SEVs at the angle where the valves were deployed. We verified the possibility of catching of a DS-SEV in an under-expanded SEV in an in vitro test, which showed that the DS-SEV was caught in the extremely under-expanded SEV. Furthermore, balloon dilation might release the catch of the DS-SEV by changing the DS-SEV position. Therefore, we recommend performing multi-directional fluoroscopy to evaluate SEV expansion before DS-SEV removal from an SEV. Furthermore, if catching of a DS-SEV occurs, balloon dilation might be useful for releasing the catch and safely removing the DS-SEV. |
| Databáze: | OpenAIRE |
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