Severe Valvular Regurgitation and Late Prosthesis Embolization After Percutaneous Aortic Valve Implantation

Clavel, Marie‐Annick; Dumont, Éric; Pîbarot, Philippe; Doyle, D. John; Larochellière, Robert De; Villeneuve, Jacques; Bergeron, Sébastien; Couture, Christian; Rodés‐Cabau, Josep

doi:10.1016/j.athoracsur.2008.06.059

Cited by 60 publications

(30 citation statements)

References 4 publications

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“…Optimal positioning of the prosthetic valve during PAVI is crucial in order to avoid valve embolization, coronary ostial obstruction, and perivalvular regurgitation [7,8]. Valve deployment is performed under rapid pacing with the expectation of rapid patient hemodynamic deterioration; therefore, it needs to be done as quickly and safely as possible.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous aortic valve implantation using novel imaging guidance

Dvir

Kornowski

2010

Cathet Cardio Intervent

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Thorough imaging of the aortic valve and related structures is highly important before and during percutaneous valve implantation. However, imaging modalities currently used in the catheterization room, namely, conventional aortography and transesophageal echocardiography are limited in guiding the precise valve placement during the implantation procedure. A novel real-time imaging modality capable of three-dimensional reconstruction of the ascending aorta has recently been introduced (CardioOp-THV, C-THV, Paieon Inc., Park Afek, Israel). We applied this system during a complex procedure of percutaneous aortic valve implantation in a patient with severe aortic tortuosity, large aortic-valve angulation, and asymmetric septal hypertrophy. We found the guidance system very helpful not only for accurate positioning of the valve but also for selecting the optimal projection for valve implantation, selecting the prosthetic valve size, and evaluating the results after deployment.

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Section: Discussionmentioning

confidence: 99%

Percutaneous aortic valve implantation using novel imaging guidance

Dvir

Kornowski

2010

Cathet Cardio Intervent

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“…Clavel et al [3] have recently described the late migration of two aortic bioprosthesis trans-apically implanted in a single patient. After percutaneous valve deployment, TEE revealed severe central insufficiency and a second valve was implanted inside the dysfunctional prosthesis.…”

Section: Discussionmentioning

confidence: 98%

Delayed dislocation of a transapically implanted aortic bioprosthesis

Maroto

Rodríguez

Cobiella

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…Ibebuogu and colleagues 2 reviewed the literature on device embolization and found that embolization occurred within one hour of implantation in 90% of cases and later (range, 4 hr-43 d) in 10% of cases. [7][8][9][10][11][12] In the case reported by Clavel and colleagues, 11 a 79-year-old man went into cardiogenic shock 2 days after a valve-in-valve procedure when the valves migrated into the LV, causing LVOT obstruction. The patient died during the operation intended to remove the bioprosthetic valves and to perform standard AV replacement.…”

Section: Discussionmentioning

confidence: 99%

Balloon Repositioning of Transcatheter Aortic Valve after Migration into the Left Ventricular Outflow Tract, Followed by Valve-in-Valve Procedure

Ito¹,

Tada²,

Hara³

2017

Texas Heart Institute Journal

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P atients with severe aortic stenosis and coexisting conditions are not good candidates for surgical aortic valve (AV) replacement because they face a high risk of perioperative complications. Transcatheter AV replacement (TAVR) provides a less invasive treatment option for these patients, 1 but the procedure is not without risk. Transcatheter heart valve (THV) migration is a rare but serious TAVR complication that usually occurs during or up to an hour after the procedure.2 Downward migration into the left ventricular outflow tract (LVOT) or left ventricle (LV) is life-threatening and necessitates an urgent bailout procedure; however, such procedures can be complex and may result in serious secondary complications. 3 We report an unusual case of late downward THV migration into the LVOT, which occurred one day after TAVR, and the procedure we used to correct it. Case ReportIn June 2015, an 82-year-old woman with symptomatic, severe aortic stenosis was referred to our hospital for TAVR evaluation. Transthoracic echocardiograms revealed severe aortic stenosis (AV area, 0.93 cm 2 ), a peak pressure gradient of 95 mmHg, a mean pressure gradient of 57 mmHg, an aortic annular diameter of 21 mm, and an LV ejection fraction of 0.85. On multidetector computed tomography (MDCT), the calculated aortic annular area was 3.82 cm 2 (Fig. 1). The patient's risk of operative death was 5.42% according to the logistic EuroScore 4 and 5.3% according to the Society of Thoracic Surgeons score.5 Her Clinical Frailty Scale score was 6. 6The patient underwent TAVR, performed under general anesthesia via a transfemoral approach and with fluoroscopic and transesophageal echocardiographic (TEE) guidance. After confirming the dimensions of the annulus by means of aortography from the perpendicular view, we implanted a 23-mm Edwards Sapien XT valve (Edwards Lifesciences LLC; Irvine, Calif ) with nominal inflation volume under rapid pacing (180 beats/min). After deployment, aortograms revealed good THV expansion and mild aortic regurgitation. Transesophageal echocardiograms revealed several areas of mild paravalvular leakage (PVL) that were not associated with annular calcification (Fig. 2). Aortograms showed that the THV was appropriately positioned at the annulus at the left coronary and noncoronary cusps; however, the THV appeared to be inclined with respect to the annular line. Therefore, we adjusted the C-arm angle to view the THV perpendicularly, and this confirmed that the THV was deployed slightly below the right coronary cusp (RCC) (Fig. 3). We considered performing balloon postdilation but decided not to, because the patient was hemodynamically stable. Accordingly, we completed the routine procedure.The patient remained hemodynamically stable overnight but had an audible systolic murmur the next morning. Transthoracic echocardiograms revealed that the Case Reports

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Severe Valvular Regurgitation and Late Prosthesis Embolization After Percutaneous Aortic Valve Implantation

Cited by 60 publications

References 4 publications

Percutaneous aortic valve implantation using novel imaging guidance

Percutaneous aortic valve implantation using novel imaging guidance

Delayed dislocation of a transapically implanted aortic bioprosthesis

Balloon Repositioning of Transcatheter Aortic Valve after Migration into the Left Ventricular Outflow Tract, Followed by Valve-in-Valve Procedure

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