Abstract
In recent years, catheter-based aortic valve interventions have become established procedures for the treatment of high-risk and advanced age patients with aortic valve pathologies. One of the limitations of the widespread applicability of this procedure is the annulus size. Until recently, no prosthesis was available to treat patients with a large annulus. We report on a patient with high-grade aortic stenosis (AS) and a 27-mm annulus, who underwent transapical implantation (TAP) of an Edwards SAPIEN® 29-mm prosthesis (Edwards LifeScience, Irvine, CA, USA). Due to insufficient dilation of his heavily calcified, functionally bicuspid aortic valve leaflets during balloon aortic valvuloplasty (BAV), the TAP prosthesis did not anchor adequately. This was determined during follow-up as he developed progressive aortic insufficiency and orthopnea, and an echocardiography revealed that the valve had been displaced into the LVOT. A conventional aortic valve replacement and ascending aorta replacement were performed, at which time the TAP prosthesis was removed. The patient recovered uneventfully, and was discharged with a well-functioning aortic bioprosthetic valve and in good general condition.
Key words
Aortic valve and root - heart valve - transapical - percutaneous - heart failure
References
-
1
Borger M A, Ivanov J, Armstrong S, Christie-Hrybinsky D, Feindel C M, David T E.
Twenty-year results of the Hancock II bioprosthesis.
J Heart Valve Dis.
2006;
15
49-55
-
2
Blackstone E H, Cosgrove D M, Jamieson W R et al.
Prosthesis size and long term survival after aortic valve replacement.
J Thorac Cardiovasc Surg.
2003;
126
783-796
-
3
Beyersdorf F.
Transapical transcatheter aortic valve implantation.
Eur J Cardiothorac Surg.
2007;
31
7-8
-
4
Cribier A, Eltchaninoff H, Bash A et al.
Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortiv stenosis. First human case description.
Circulation.
2002;
106
3006-3008
-
5
Walther T, Falk V, Borger M A et al.
Minimally invasive transapical beating heart aortic valve implantation – proof of concept.
Eur J Cardiothorac Surg.
2007;
31
9-15
-
6
Zegdi R, Ciobotaru V, Noghin M et al.
Is it reasonable to treat all calcified stenotic aortic valves with a valved stent? Results from a human anatomic study in adults.
J Am Coll Cardiol.
2008;
51
579-584
-
7
Wijesinghe N, Ye J, Rodes-Cabau J et al.
Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis.
J Am Coll Cardiol Intv.
2010;
3
1122-1125
-
8
Walther T, Simon P, Dewey T et al.
Transapical minimally invasive aortic valve implantation – multicenter experience.
Circulation.
2007;
116 (Suppl. I)
I-240-I-245
Dr. Thomas Schroeter, MD
Department of Cardiac Surgery
Heart Center Leipzig
Struempellstrasse 39
04289 Leipzig
Germany
Telefon: +49 3 41 86 50
Fax: +49 34 18 65 14 53
eMail: thomas-schroeter@gmx.de
