Balloon-assisted bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction with en face view for patients exhibiting severe calcified leaflet: a case report.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
European Heart Journal: Case Reports Pub Date : 2024-12-06 eCollection Date: 2024-12-01 DOI:10.1093/ehjcr/ytae643
Yuta Kobayashi, Yusuke Enta, Masaki Nakashima, Norio Tada
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引用次数: 0

Abstract

Background: Balloon-assisted bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BA-BASILICA) enables valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) in patients at risk of coronary artery obstruction. However, its efficacy in patients with severely calcified leaflets remains unclear.

Case summary: We report a 78-year-old woman with a deteriorated 21 mm Carpentier-Edwards PERIMOUNT Magna valve. Computed tomography showed severe calcification in the left coronary leaflet, extending above the left coronary artery (LCA) ostium, with a virtual transcatheter heart valve to coronary ostium distance of 3.7 mm, indicating a high risk of coronary obstruction after ViV-TAVI. We performed ViV-TAVI using the BA-BASILICA because of the patient's high surgical risks. Traversal of the calcified leaflet was successfully achieved using both en face and side views to visualize the traversal system's position in an area without calcification and in front of the LCA. After traversal, the leaflet was dilated with a balloon and accidentally split into two. A 20 mm SAPIEN 3 Ultra RESILIA valve was deployed. Despite initial procedural success, severe LCA stenosis developed due to leaflet compression. This was resolved by orthotopic stenting using an en face view to identify cells not covered by the bioprosthetic leaflet generated by BA-BASILICA.

Discussion: To our knowledge, this is the first report of ViV-TAVI using the BA-BASILICA with an en face view of severely calcified leaflets. This case suggests that BA-BASILICA with an en face view could be effective for patients at high risk of coronary obstruction with severely calcified leaflets.

背景:球囊辅助生物假体或原生主动脉瓣扇贝故意撕裂以防止先天性冠状动脉阻塞(BA-BASILICA)可在有冠状动脉阻塞风险的患者中实现瓣中瓣经导管主动脉瓣植入术(ViV-TAVI)。病例摘要:我们报告了一名 78 岁女性的病例,她的 21 毫米 Carpentier-Edwards PERIMOUNT Magna 瓣膜已经恶化。计算机断层扫描显示左冠状动脉瓣叶严重钙化,并延伸至左冠状动脉(LCA)骨膜上方,经导管心脏瓣膜到冠状动脉骨膜的虚拟距离为 3.7 mm,这表明 ViV-TAVI 术后冠状动脉阻塞的风险很高。由于患者的手术风险较高,我们使用 BA-BASILICA 进行了 ViV-TAVI 手术。使用正视图和侧视图观察穿越系统在无钙化区域和 LCA 前方的位置,成功穿越了钙化的瓣叶。横切后,用球囊扩张小叶,意外地将其一分为二。随后植入了20毫米的SAPIEN 3 Ultra RESILIA瓣膜。尽管手术取得了初步成功,但由于瓣叶受压,LCA出现了严重狭窄。通过正位支架植入术,利用正视图确定了未被BA-BASILICA生成的生物人工瓣叶覆盖的细胞,从而解决了这一问题:据我们所知,这是第一例使用 BA-BASILICA 进行 ViV-TAVI 的报道,使用的是严重钙化叶的正视图。本病例表明,BA-BASILICA 正面视图对于严重钙化心叶的冠状动脉阻塞高危患者是有效的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Heart Journal: Case Reports
European Heart Journal: Case Reports Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.30
自引率
10.00%
发文量
451
审稿时长
14 weeks
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