Acute aortic regurgitation and hemodynamic collapse after balloon aortic valvuloplasty

Loncar, Sasa; Perlman, Gidon; Planer, David; Meroz, Yuval; Gilon, Dan; Lotan, Chaim; Danenberg, Haim

doi:10.1016/j.ijcard.2013.11.063

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…Given the rapid emergence of TAVR, this procedure must be recognized as a new and important cause of acute AR. Since LV hypertrophy and impaired relaxation are inherent features of severe AS, the hemodynamic consequences of acute AR imposed by TAVR can be expected to be particularly detrimental compared to acute AR of nonstenostic native valves . Although LV diastolic dysfunction has been shown to improve acutely with TAVR , AR post of even relatively small volumes might be expected to overwhelm the chronically‐limited filling capacity of the LV, explaining the increased risk of death due to advanced heart failure in patients with AR post .…”

Section: Discussionmentioning

confidence: 99%

Aortic regurgitation following transcatheter aortic valve replacement: Impact of preprocedural left ventricular diastolic filling patterns on late clinical outcomes

Halkin

Steinvil

Aviram

et al. 2015

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Aortic regurgitation following transcatheter aortic valve replacement: Impact of preprocedural left ventricular diastolic filling patterns on late clinical outcomes

Halkin

Steinvil

Aviram

et al. 2015

Cathet Cardio Intervent

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“…It was reported that up to 67% of patients with severe AS who undergo TAVR have some degree of LVDD [ 11 ]. Although TAVR was suggested to be an effective approach for afterload and wall stress reduction [ 13 ], some degree of LVDD may persist after aortic valve replacement [ 3 ].…”

Section: As and Diastolic Dysfunctionmentioning

confidence: 99%

“…Elimination of AS-induced afterload by TAVR can improve cardiac function in an acute phase and also reverse LV remodeling in a slower process [ 13 ]. In general, myocardium hypertrophy regresses much faster than the fibrotic tissue, and fibrosis reduction may happen during the delayed phase, if at all [ 14 ].…”

Section: Lvdd Improvement After Tavrmentioning

confidence: 99%

Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review

Aalaei‐Andabili

Bavry

2019

Cardiol Ther

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Aortic stenosis (AS) is the most common valvular disease that can lead to increased afterload, left ventricular (LV) remodeling, and myocardial fibrosis. We reviewed the literature addressing the impact of transcatheter aortic valve replacement (TAVR) on LV remodeling and patients’ outcomes by elimination of AS-related high afterload. TAVR reduces afterload and improves LV remodeling recovery. However, myocardial fibrosis may not completely reverse after the TAVR. The LV diastolic dysfunction (LVDD) induced by AS is an independent predictor of post-TAVR mortality, and mortality increases with severity of LVDD. The impact of diastolic dysfunction on patient outcomes emerges at 30 days but continues to persist during mid-term follow-up. Based on severity of the baseline LVDD, some patients may tolerate post-TAVR aortic regurgitation (AR), but even minimal post-TAVR AR in patients with severe baseline LVDD can have an additive negative impact on survival. It is crucial to consider TAVR prior to development of advanced LVDD. Appropriate device selection and deployment technique are important in improvement of TAVR outcomes via elimination of AR.

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“…Acute aortic regurgitation (AR) is a rare complication of BAV that is reported as to occur in 0.8-1.5% of all procedures [1][2]. This complication is clinically important, as a sudden hemodynamic collapse can lead to a fatal outcome.…”

Section: Introductionmentioning

confidence: 99%

Non-TAVR Bailout for Acute Severe Aortic Regurgitation After Balloon Aortic Valvuloplatsy by Using Fogarty® Catheter

Komatsu¹,

Mitsuhashi²,

Ito³

2018

jshd

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Acute severe aortic regurgitation (AR) after balloon aortic valvuloplasty (BAV), which rarely occurs, can cause catastrophic deterioration of a patient's hemodynamics. The emergent conversion of transcatheter aortic valve replacement (TAVR) or open heart surgery can be considered as bailout procedures for this situation; however, these are not ideal or safe options. We developed a novel bailout method for acute AR without TAVR or surgical conversion. The patient was an 82-year-old woman with severe aortic stenosis who had been treated for interstitial pneumonia for more than 10 years and in whom BAV was scheduled for worsening dyspnea. Through BAV performed using a retrograde approach with an 18-mm balloon, we treated the entrapment of the non-coronary leaflet, the vital sign of which had deteriorated due to severe AR. We attempted to manipulate a pigtail catheter to push back the entrapped leaflet; however, the attempt failed. Next, we advanced a Fogarty catheter into the space between the wall of the sinus of Valsalva and the entrapped non-coronary leaflet with the aim of pushing it back. Inflating the balloon restored the leaflet movement, which successfully reduced AR and obtained hemodynamic stability. This procedure successfully avoided further invasive bailout procedures.

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Acute aortic regurgitation and hemodynamic collapse after balloon aortic valvuloplasty

Cited by 7 publications

References 10 publications

Aortic regurgitation following transcatheter aortic valve replacement: Impact of preprocedural left ventricular diastolic filling patterns on late clinical outcomes

Aortic regurgitation following transcatheter aortic valve replacement: Impact of preprocedural left ventricular diastolic filling patterns on late clinical outcomes

Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review

Non-TAVR Bailout for Acute Severe Aortic Regurgitation After Balloon Aortic Valvuloplatsy by Using Fogarty® Catheter

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