Post on 01-Apr-2015
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CoreValve – ICE AwardsItalian CoreValve ExpertsBalloon valvuloplasty after Transcatheter Aortic Valve Implantation (TAVI): always safe?Dr Salvi A, Dr Fabris E, Dr Perkan ACardiovascular Department, Ospedali Riuniti and University of Trieste, Italy
• 82 year old man • Referred to our Center for a severe
symptomatic aortic stenosis • Selected by the Heart Team for TAVI
because of a high surgical risk (log. EuroSCORE 21%)
• Diameters of the aortic annulus (on computed tomographic) were 32 x 22 mm, the perimeter was 87 mm
• A 31 mm CoreValve™ prosthesis (Medtronic, Minneapolis, MN, USA) was selected
Dati Basali
Intervento
• Femoral access with a 18 Fr sheath
• Stiff guidewire was placed in the left ventricle
• Prosthesis was advanced across the stenotic valve without prior Balloon Valvuloplasty
Sheath cover retracting under fluoroscopic guidance
Intervento
The position of the CoreValve™ seemed optimal with the distal
end 5 mm below the
“angiographic” annulus
Release of the prosthesis
Difficoltà incontrate
• Good placement but compression of the distal part of the prosthesis
• Presence of significant aortic regurgitation
Soluzione sceltaBalloon valvuloplasty (BV) during rapid pacing
• We performed a BV with a Cristal Balloon 28x50 (Balt, Montmorency, France).
• The balloon was advanced across the valve and was inflated and deflated during rapid pacing
Angiography after balloon deflation:acute dislocation of the prosthesis
Immagini post-operatorie
The valve showed an appropriate
expansion but had moved upwards now with the distal
part ending apparently just
above the “angiographic”
annulus
• The valve seemed anchored without further upward movements
• The patient was stable• Systolic gradient was absent • Final angiography showed only a mild
AR• A persistent good result was
documented at follow up echo after two weeks
Conclusioni
• In our case a post implantation balloon valvuloplasty (BV) caused an acute accidental dislocation of CoreValve™ with potential risk of valve embolization
• BV after CoreValve™ implantation performed without a prior dilatation is an effective procedure but it may cause accidental movements of the prosthesis despite a meticulous technique
• This may be relevant because the strategy of performing TAVI without balloon predilatation is becoming common