Limited Expansion of the Self-expandable Transcatheter Aortic Valve Prosthesis in Severe Aortic Stenosis with Bicuspid Aortic Valve
- Operator : Seung-Jung Park
|Limited Expansion of the Self-expandable Transcatheter Aortic Valve Prosthesis in Severe Aortic Stenosis with Bicuspid Aortic Valve|
|- Operator: Seung-Jung Park, MD|
|A 81-year-old female patient was hospitalized for dyspnea. There was no significant coronary artery stenosis on the coronary angiogram. Electrocardiography showed normal sinus rhythm and left ventricular hypertrophy. Our heart team decided that she was a candidate for transcatheter aortic valve replacement(TAVR) on the basis of her high operative risk (STS score 2.913%, EuroSCORE I 11.59% and EuroSCORE II 2.01%)|
Considering the bicuspid AV and small annulus, we prepared the CoreValve¢ā Evolut¢ā R(Medtronic, Minneapolis, Minnesota) to minimize the risk of annulus rupture.
The procedure was performed in local anesthesia. After femoral access, we performed pre-dilation with a 20 mm Z-MED II¢ā balloon(NuMED, Canada) ( Movie 1). A 29 mm CoreValve¢ā Evolut¢ā R was implanted( Movie 2). The simultaneous left ventricular and aortic pressure tracing showed a mean pressure gradient of 45 mmHg(Figure 4) and the fluoroscopy confirmed a not fully expanded valve( Movie 3). Therefore, we performed post-dilatation using a 20 mm Z-med II¢ā balloon, but it was not successful( Movie 4). We performed post-dilatation again using a high-pressure 20mm ATLAS¢ē balloon(BARD, Tempe, Arizona)( Movie 5). On fluoroscopy the CoreValve¢ā Evolut¢ā R prothesis was expanded more than before, but not fully expanded( Movie 6). The simultaneous left ventricular and aortic pressure tracing showed a mean pressure gradient of 27 mmHg(Figure 5). The operative and postoperative course was uneventful. Final echocardiography showed a good result with a mean pressure gradient of 12 mmHg and mild paravalvular leak. The patient did not complain dyspnea afterward.
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