scholarly journals How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice

2021 ◽  
Author(s):  
F. Contorni ◽  
M. Fineschi ◽  
A. Iadanza ◽  
A. Santoro ◽  
G. E. Mandoli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricle Ejection Fraction ◽  
Low Flow ◽  
Diagnostic Tools ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

AbstractLow-flow low-gradient aortic stenosis (LFLG AS) with reduced left ventricle ejection fraction (LVEF) is still a diagnostic and therapeutic challenge. The aim of this paper is to review the latest evidences about the assessment of the valvular disease, usually difficult because of the low-flow status, and the therapeutic options. Special emphasis is given to the available diagnostic tools for the characterization of LFLG AS without functional reserve at stress echocardiography and to the factors that clinicians should evaluate to choose between surgical aortic valve repair, transcatheter aortic valve implantation, or medical therapy.

Transcatheter Aortic Valve Dislocation into the Left Ventricle Caused by the Watermelon Effect

2021 ◽  
Vol 4 (8) ◽  
pp. 01-04
Author(s):  
Matjaž Bunc ◽  
Joško Bulum ◽  
Strozzi Maja ◽  
Anić Darko ◽  
Tadej Žlahtič ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Severe Aortic Regurgitation ◽  
Prosthetic Valves ◽  
Urgent Surgery ◽  
Transcatheter Aortic Valve ◽  
Edwards Sapien ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is a well-established method for treating severe aortic stenosis. Prosthetic valve dislocation immediately after deployment is a rare and feared complication. We present a case of a patient with severe, symptomatic aortic stenosis who was admitted for TAVI. During balloon inflation the valve (Edwards SAPIEN XT) dislocated into the left ventricle as a result of the watermelon effect caused by a narrow, severely calcified sino-tubular junction. A second valve of the same type and size was immediately implanted in a suboptimal position in order to reduce severe aortic regurgitation. This facilitated the use of veno-arterial extracorporeal membrane oxygenation support (V-A ECMO). The patient was thereafter stabilized and transferred for urgent surgery, where both prosthetic valves were removed. The aortic valve was replaced with an additional reconstruction of the ascending aorta.

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