Transcatheter aortic valve replacement in membranous interventricular septum aneurysm with left ventricular outflow tract extension

Abstract

We report a challenging case of a 81-year-old male with history of severe calcific aortic valve stenosis and aneurysmal membranous interventricular septum. The presence of anomalies in the sub-annular area can lead to valve malpositioning and its consequences. transcatheter aortic valve implantation (TAVR) in patients with aneurysm of the perimembranous interventricular septum extending into the left ventricular outflow tract has not been previously reported. This case describes a successful transfemoral TAVR with an Edwards SAPIEN XT valve (Edwards Lifesciences, Irvine, CA, United States) with such anomaly.

Transcatheter aortic valve implantation in a patient with interventricular membranous septal aneurysm resulted in cardiac tamponade of unclear etiology

“…Three previous reports offered data on this uncommon association in TAVI patients. Concerns about the procedure were raised in all three cases, but valve deployment was uneventful [5][6][7].…”

“…The presence of structural defects in the sub-annular area could cause prosthesis malposition resulting in significant paravalvular leaks or device embolization. There are only three previous reports about the association between AMS and transfemoral TAVI [5][6][7].…”

Large interventricular membranous septal aneurysm renders the anatomy unsuitable for transcatheter aortic valve replacement

“…An interventricular membranous septal aneurysm, though rare, can coexist with aortic valve stenosis. Patients with both these conditions have reportedly been treated with TAVR successfully 1,2 . However, in such patients, the aneurysm and its connection with the aortic root were present below the level of the aortic annulus; thus, the TAVR valves could seal a paravalvular leak at the annulus level in a standard implanted position.…”