scholarly journals Electrophysiological features and possibilities of ablation of ectopic atrial tachycardia from the area of the non-coronary cusp of the aortic valve

2019 ◽  
Vol 16 (4) ◽  
pp. 204-216
Author(s):  
S.Yu. Serguladze ◽  
I.V. Pronicheva ◽  
M.R. Dishekov ◽  
E.V. Lubkina ◽  
Zh.K. Tembotova ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Atrial Tachycardia ◽  
Ectopic Atrial Tachycardia ◽  
Coronary Cusp

scholarly journals 229-02: Focal para-hisian atrial tachycardia: Comparison of ablation from the right atrial ventricular junction with ablation from the non coronary cusp of the aortic valve

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i159-i159
Author(s):  
Mauro Toniolo ◽  
Luca Rebellato ◽  
Elisabetta Daleffe ◽  
Massimiliano Manfrin ◽  
Alessandro Proclemer
Keyword(s):  
Aortic Valve ◽  
Atrial Tachycardia ◽  
Right Atrial ◽  
Coronary Cusp ◽  
The Right

scholarly journals P24: MANAGEMENT OF RHEUMATIC VALVE DISEASE OF THE AORTIC VALVE USING THE OZAKI PROCEDURE WITH AUTOLOGOUS PERICARDIUM

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
A Asif ◽  
M Caputo
Keyword(s):  
Aortic Valve ◽  
Intraoperative Complications ◽  
Valve Disease ◽  
Severe Aortic Regurgitation ◽  
Autologous Pericardium ◽  
End Diastolic Volume ◽  
Rheumatic Valve Disease ◽  
Coronary Cusp ◽  
Valve Pathology ◽  
Diastolic Murmur

Abstract Case-Study A 15-year-old boy was referred to our tertiary centre from his local paediatric services with a background of rheumatic fever, severe aortic regurgitation (AR) and mild to moderate mitral regurgitation. He had a history of angina and dyspnoea on exertion, a 2/6 ejection systolic murmur and 2/4 end diastolic murmur. Transthoracic echocardiography showed severe aortic valve insufficiency (with flow reversal seen in the descending aorta and an LV end diastolic volume of 173 ml/m2) and trivial pulmonary valve regurgitation. Autograft failure following the favoured Ross procedure deemed the patient as a candidate for an Ozaki procedure. Autologous pericardium was used to replace the diseased aortic valve. Intraoperative transoesophageal echocardiography showed a deficient left coronary cusp leaflet and a retracted right coronary cusp leaflet. The patient was under cardiopulmonary bypass for 124 minutes and on cross-clamping for 99 minutes with no intraoperative complications. Histological examination of the aortic valve leaflets showed neovascularisation, myxoid changes and disarray of the fibrous stroma. Postoperative recovery was uneventful. The postoperative echocardiogram showed trivial AR, end diastolic volume 217ml, end systolic volume 12 ml and 40% ejection fraction. There was full resolution of the dyspnoea, angina and diastolic murmur on follow-up 4-months postoperatively as supported by healthy valve function on echocardiography. This case highlights that in those of risk of multiple valve pathology, such as in rheumatic valve disease, an Ozaki procedure using autologous pericardium is a viable surgical option for paediatric aortic valve repair with good outcomes. Take-home message In cases of systemic conditions affecting the heart valves where there is multiple valve pathology and risk of autograft failure, such as rheumatic valve disease, the use of autologous pericardium to replace these valves has shown to be a viable option in this paediatric case.

An Unusual Femoral Sheath Severing with Successful Recapture: A Case Report

Reports ◽  
2021 ◽  
Vol 4 (4) ◽  
pp. 34
Author(s):  
Frane Runjić ◽  
Andrija Matetic ◽  
Matjaž Bunc ◽  
Nikola Crnčević ◽  
Ivica Kristić
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Balloon Catheter ◽  
Proximal Part ◽  
Ascending Aorta ◽  
Introducer Sheath ◽  
Transcatheter Aortic Valve ◽  
Coronary Cusp

This study presents a case of a successful severed femoral sheath recapture during transfemoral transcatheter aortic valve replacement (TAVR). During skin tunneling with a scalpel, the discontinuity of the femoral sheath occurred. Grasping of the distal sheath with the surgical hemostat was attempted unsuccessfully. A proximal part of the severed sheath was removed and Medtronic Sentrant introducer sheath (14 French) was then placed over the existing Confida wire which permanently remained in position, followed by the introduction of the Amplatz Left 2 (AL2) catheter which pushed the severed sheath in the ascending aorta over the Confida wire. The crucial maneuver was the entanglement of the severed sheath in the aortic non-coronary cusp which allowed for its entrapment by the AL2 catheter. This allowed for the coronary guidewire BMW Universal (0.014”) placement and a slow balloon retrieval (SeQuent NEO 2.5 x 25 mm) of the severed sheath into the introducer sheath. The guidewire/balloon catheter was then exchanged for the support wire (0.035”) followed by the removal of the introducer sheath, AL2 catheter and the severed sheath. In conclusion, sheath severing is a complex accidental event during TAVR, which can be solved by intra-aortic recapture and retraction.

scholarly journals P249 Iatrogenic aortic cusp laceration causing severe acute traumatic aortic regurgitation secondary to complex percutaneous coronary intervention using rotablator;3DTEE-anatomic correlates

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Vadgaonkar ◽  
H Tarief ◽  
S Shivappa ◽  
L Sulaibikh ◽  
S Saif ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
High Speed ◽  
Past History ◽  
Case Reports ◽  
Free Margin ◽  
Severe Aortic Regurgitation ◽  
Percutaneous Coronary ◽  
Coronary Cusp

Abstract Clinical case 59 years old male known case of long standing diabetes and dyslipidemia presented to our institute with Non-STEMI.His past history was significant for multiple admissions with acute coronary syndromes and percutaneous coronary interventions(PCI). Echocardiogram in this presentation showed preserved biventricular systolic function with no valvulopathies. He was taken up for coronary angiogram which showed significant calcified angulated lesion in LAD/LCX(Left anterior descending and circumflex) with diffuse disease in Ramus/RCA. Mode of revascularisation was discussed in detail with the patient for Rotablation-guided PCI to LAD/LCX vs CABG.He preferred and underwent complex PCI to LAD. During the procedure he developed acute heart failure which was managed conservatively. Immediate TTE showed new severe aortic regurgitation(AR) with probable left coronary cusp(LCC) perforation and preserved LVEF.After stabilization, he was scheduled for TEE which showed tear in the LCC with complex fragmented jet of holodiastolic AR filling the entire LVOT.There was new late diastolic to early systolic MR.3DTEE Enface view of the aortic valve was evident of ovoid shaped laceration in LCC extending till the free margin (Fig 1C). There were additional tears in Non-coronary cusp(NCC) extending till the free margin of right coronary cusp(RCC).3DTEE colour was notable for regurgitant jet origin from LCC/NCC (Fig 2B). Based on above findings,He was offered aortic valve intervention but was reluctant initially.He presented 2 months later with exertional dyspnoea, mild LV dilatation and drop in LVEF to 50%.He consented for surgery and underwent bioprosthetic Aortic valve replacement because of extensive cusp tear and deformation of the valve along with complete revascularisation of the remaining diseased coronaries.Post-operative course was complicated by vasoplegic arrest and acute renal failure which was successfully managed conservatively. Discussion We report this case for the rarity of this post-PCI iatrogenic complication and the incremental role of 3DTEE in identifying the exact pathology.It was proposed that during PCI multiple stalling of rotatbur in calcified LAD caused traction and eventually disengagement of guide causing rotabur to freely hang in ascending aorta close to the cusps.Possibly this rotablator with very high speed(180000rpm) would have momentarily come in contact with the aortic cusps causing cuspal perforation and heart failure in Cath lab.3DTEE correlated very well with the anatomo-pathology and matched with intraoperative finding as shown in figures 2A & 2C.These findings prior to aortic cross clamp could significantly reduce time of surgery as he had an additional CABG procedure to be performed.There are few isolated case reports of post PCI aortic valve perforation but probably ours is the first one secondary to the use of rotablator with near involvement of all the cusps and reasonably accurate 3DTEE-anatomic characterisation. Abstract P249 Figure.

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