Left ventricular outflow tract rupture during transcatheter aortic valve implantation: anatomic evidence of the vulnerable area

2017 ◽  
Vol 29 ◽  
pp. 7-10 ◽  
Author(s):  
Giuseppe Tarantini ◽  
Cristina Basso ◽  
Luca Nai Fovino ◽  
Chiara Fraccaro ◽  
Gaetano Thiene ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Vulnerable Area ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Outflow ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Recurrence of Left Ventricular Outflow Tract Obstruction Requiring Alcohol Septal Ablation after Transcatheter Aortic Valve Implantation

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Hideki Kitahara ◽  
Kaoru Mastuura ◽  
Atsushi Sugiura ◽  
Akiko Yoshimura ◽  
Takahiro Muramatsu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Alcohol Septal Ablation ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Outflow ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Left ventricular outflow tract (LVOT) obstruction is sometimes observed in patients with severe aortic stenosis (AS). It is still controversial how to manage the remaining severe AS, when LVOT obstruction is well-controlled by medical therapy. We report a case with acute recurrence of LVOT obstruction requiring emergent alcohol septal ablation (ASA) after transcatheter aortic valve implantation (TAVI), even in a stable state on beta-blockers. For the ASA procedure, transesophageal echocardiography was useful to clearly observe the perfusion area of the target septal branch by injecting microbubble contrast. Since it took some time to cause the recurrence of LVOT obstruction in this case, careful evaluation should be done after TAVI in high-risk patients for LVOT obstruction before terminating the TAVI procedure.

Prosthetic Valve Escaping during Transcatheter Aortic Valve Implantation

2015 ◽  
Vol 10 (6) ◽  
pp. 425-427
Author(s):  
Nobuyuki Furukawa ◽  
Werner Scholtz ◽  
Smita Scholtz ◽  
Lothar Faber ◽  
Stephan Ensminger ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Prosthetic Valve ◽  
Left Ventricular Outflow Tract ◽  
Balloon Catheter ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Outflow ◽  
Aortic Valve Implantation ◽  
Valve Implantation

We performed transapical transcatheter aortic valve implantation on an 87-year-old woman with severe aortic valve stenosis. Because of the narrow left ventricular outflow tract, annular positioning of the prosthetic valve proved challenging. During positioning, the prosthetic valve was accidentally dislodged from the balloon catheter and dropped into the left ventricle. Attempted catheter retrieval was unsuccessful. We therefore converted to open surgery without delay. After aortotomy, to our surprise, the prosthesis could not be found, neither in the left ventricle nor in the ascending aorta. Transesophageal echocardiography failed to reveal the location of the missing prosthesis. Fluoroscopy finally displayed the prosthesis in the descending aorta at the level of the left atrium. We proceeded with aortic and mitral valve replacement and closed the sternum. Under fluoroscopic guidance, the prosthetic valve was secured to the wall of the abdominal aorta in an infrarenal position by dilatation with a balloon catheter. This case shows that we should be alert to septum hypertrophy or a narrow left ventricular outflow tract during transapical aortic valve implantation. In such anatomical situations, we recommend advancing the sheath of the application system directly below the annular plane and positioning the prosthesis from this point.

scholarly journals Treatment of severe aortic stenosis and left ventricular outflow tract mass with transcutaneous aortic valve implantation: a case report

2019 ◽  
Author(s):  
Hesham A Naeim ◽  
Waleed Saeed ◽  
Ibraheem Alharbi ◽  
Reda Abuelatta
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Left Ventricular Outflow Tract ◽  
Severe Aortic Stenosis ◽  
Transoesophageal Echocardiography ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Left Ventricular Outflow ◽  
Aortic Valve Implantation ◽  
Valve Implantation

AbstractBackgroundPercutaneous implantation of aortic valve for severe aortic stenosis (AS) in the presence of pedunculated mobile left ventricular outflow tract (LVOT) mass not reported before. In this case report, we address the feasibility of this procedure.Case summaryAn 80-year-old patient who presented with presyncope, transthoracic echocardiogram (TTE), and transoesophageal echocardiography (TOE) revealed severe calcific AS and LVOT mass measuring 2.1*1.5 cm. The patient was turned down for surgery. It was decided that transcatheter aortic valve implantation (TAVI) be performed because the valve compresses the mass against the proximal part of the interventricular septum. The mass peduncle was 1.4 cm, and it was 4 mm away from the annulus. This meant the valve was needed to be deployed 18 mm below the annulus to cover the mass completely. Gentle manipulation and direct valve deployment without preballoon dilation to decrease the possibility of fragment embolization were necessary. Self-expandable core valve deployed as low as possible, after initial deployment, the distance of LVOT covered by the valve measured by TOE 1.66 cm, the whole mass was covered, then the valve was fully deployed. The patient was extubated in the catheterization room; there was no clinical evidence of embolization. The patient was discharged home after 2 days. A follow-up TTE after 6 months showed a well-functioning valve and the LVOT mass then disappeared.DiscussionPedunculated LVOT mass should be resected surgically. In high-risk surgical patients, direct TAVI to compress the mass is feasible in experienced canters. The safety issues need more research and more cases to judge. Transoesophageal echocardiography during the procedure is mandatory to guide the valve position.

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