Transcatheter aortic valve implantation for a patient with both severe aortic stenosis and membranous ventricular septal aneurysm: a case report.

IF 0.8 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
European Heart Journal: Case Reports Pub Date : 2025-05-08 eCollection Date: 2025-05-01 DOI:10.1093/ehjcr/ytaf230
Naoto Murakami, Nobuaki Kokubu, Shunsaku Otomo, Masato Furuhashi
{"title":"Transcatheter aortic valve implantation for a patient with both severe aortic stenosis and membranous ventricular septal aneurysm: a case report.","authors":"Naoto Murakami, Nobuaki Kokubu, Shunsaku Otomo, Masato Furuhashi","doi":"10.1093/ehjcr/ytaf230","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There have been few reports on transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) and a membranous ventricular septal aneurysm (MSA).</p><p><strong>Case summary: </strong>A 77-year-old female complaining of dyspnoea was transferred to our hospital. Transthoracic echocardiography (TTE) showed progressive very severe AS with reduced left ventricular (LV) systolic function. The patient was scheduled for TAVI due to high surgical risk. Preoperative computed tomography showed a MSA located between the right coronary cusp and the non-coronary cusp, therefore a part of the annulus rim was lacking. We draw a virtual annulus line to assess her true annulus size and selected a 29 mm size of Evolut Pro Plus. Since the bottom end of the valve was positioned into the MSA, the valve was begun to expand with a lack of coaxiality and massive paravalvular leak (PVL) occurred. Therefore, we decided to retrieve the 29 mm valve. An up-sized 34 mm Evolut was tried, but it was too large and caused the phenomenon of stent-frame infolding. We had to retrieve the 34 mm valve again, and tried to deploy another 29 mm valve at a position as high as possible and pushed the delivery system during the final release to maintain good coaxiality. Postoperative TTE showed significant recovery of LV systolic function, and the PVL was mild.</p><p><strong>Discussion: </strong>In patients with both MSA and severe AS, it is difficult to measure the precise annulus size for ensuring stability of the self-expanding valve and preventing PVL.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf230"},"PeriodicalIF":0.8000,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090047/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal: Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ehjcr/ytaf230","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Background: There have been few reports on transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) and a membranous ventricular septal aneurysm (MSA).

Case summary: A 77-year-old female complaining of dyspnoea was transferred to our hospital. Transthoracic echocardiography (TTE) showed progressive very severe AS with reduced left ventricular (LV) systolic function. The patient was scheduled for TAVI due to high surgical risk. Preoperative computed tomography showed a MSA located between the right coronary cusp and the non-coronary cusp, therefore a part of the annulus rim was lacking. We draw a virtual annulus line to assess her true annulus size and selected a 29 mm size of Evolut Pro Plus. Since the bottom end of the valve was positioned into the MSA, the valve was begun to expand with a lack of coaxiality and massive paravalvular leak (PVL) occurred. Therefore, we decided to retrieve the 29 mm valve. An up-sized 34 mm Evolut was tried, but it was too large and caused the phenomenon of stent-frame infolding. We had to retrieve the 34 mm valve again, and tried to deploy another 29 mm valve at a position as high as possible and pushed the delivery system during the final release to maintain good coaxiality. Postoperative TTE showed significant recovery of LV systolic function, and the PVL was mild.

Discussion: In patients with both MSA and severe AS, it is difficult to measure the precise annulus size for ensuring stability of the self-expanding valve and preventing PVL.

经导管主动脉瓣植入术治疗重度主动脉瓣狭窄合并膜性室间隔动脉瘤1例。
背景:经导管主动脉瓣植入术(TAVI)治疗严重主动脉瓣狭窄(AS)合并膜性室间隔动脉瘤(MSA)的报道很少。病例总结:一名77岁女性主诉呼吸困难转至我院。经胸超声心动图(TTE)显示进行性非常严重的AS伴左室收缩功能降低。由于手术风险高,患者被安排进行TAVI。术前计算机断层扫描显示MSA位于右冠状动脉尖和非冠状动脉尖之间,因此缺少部分环缘。我们画了一个虚拟环空线来评估她的真实环空大小,并选择了一个29毫米的Evolut Pro Plus尺寸。由于瓣膜底端位于MSA内,瓣膜开始膨胀,缺乏同轴度,发生大量瓣旁泄漏(PVL)。因此,我们决定取出29毫米的瓣膜。尝试了34 mm的大尺寸Evolut,但由于太大,导致支架框架内折现象。我们不得不再次取出34毫米的阀门,并试图在尽可能高的位置部署另一个29毫米的阀门,并在最终释放时推动输送系统以保持良好的同轴度。TTE术后左室收缩功能恢复明显,左室轻。讨论:在MSA和严重AS患者中,难以测量精确的环隙大小,以确保自膨胀瓣膜的稳定性和预防PVL。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
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
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信