ISOLATED CONGENITAL ABSENT AORTIC VALVE CUSPS IN A FETUS: A CASE REPORT

Abstract Background Fatal thrombo-embolic events like cerebral stroke or myocardial infarction are rare complications of prosthetic heart valve leaflet thrombosis. Nevertheless, prevention and management of leaflet thrombosis is gaining increased attention, particularly with the widespread adoption of transcatheter heart valves. Case summary We herein present the case of a 79-year-old man who had undergone a transcatheter aortic valve implantation procedure. Seven months later, he presented with a non-ST-segment elevation myocardial infarction. Coronary angiography did not reveal obstructive lesions. A dedicated cardiac computed tomography scan showed thrombosis of both right- and non-coronary leaflets of the prosthetic aortic valve, while prosthetic valve function was normal on echocardiography. Transmural myocardial infarction lesions in the midventricular and apical inferior wall were detected by cardiac magnetic resonance imaging. Discussion Subclinical leaflet thrombosis of prosthetic aortic valves is a common finding. In this case report, we show that myocardial infarction presumably due to leaflet thrombosis was the first symptom in an otherwise asymptomatic patient. This finding raises the question of the validity in distinguishing between subclinical and clinical leaflet thrombosis based on prosthetic valve function.

Download Full-text

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

Reports ◽

10.3390/reports4040034 ◽

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.

Download Full-text