Acute Antegrade TAVI Migration Successfully Treated with Snare Utilization and Near Valve-in-Valve (Viv) Implantation

Cardiology and cardiovascular medicine Pub Date : 2022-01-01 DOI:10.26502/fccm.92920290

Nikolaos Tsanaxidis, B. Wrigley, J. Cotton, Deepu Balakrishnan

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Abstract

, Abstract 90-year-old woman admitted urgently in Cardiology ward at New Cross with acute heart failure symptoms on background of severe aortic stenosis. Also reported previous syncopal episodes. On admission echocardiogram performed which revealed aortic valve area of 0.48 cm 2 and mean pressure gradient of 41mmHg. Her Left Ventricular Ejection Fraction was 35%. After stabilizing her with diuresis, she underwent computed tomography TAVI workup.This revealed reasonable ilio-femoral access and estimation of valvular annular size undertaken. Trans-catheter aortic valve implantation eventually took place. Ultrasound guidance used to gain access.6Fr sheath inserted into left femoral artery (graduated pigtail for aortogram),7Fr into left femoral vein (temporary pacing wire) and 6Fr into right femoral artery (RFA) which was pre-closed with 2 Proglides and upgraded to 9Fr sheath. Immediately,the aortic valve crossed in conventional manner and a 26mm Medtronic Evolut pro was implanted [1]. Unfortunately post release the valve migrated into ascending aorta,with pendular movements in an aneurysmal aorta [2]. As the patient was haemodynamically stable we implanted a larger valve after snaring the

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利用诱捕器和近瓣膜植入成功治疗急性TAVI顺行性移位

一名90岁的女性因主动脉严重狭窄而出现急性心力衰竭症状，急诊入住新十字医院心内科病房。也曾报告晕厥发作。入院时超声心动图显示主动脉瓣面积0.48 cm2，平均压力梯度41mmHg。左心室射血分数为35%。在利尿稳定她的病情后，她接受了计算机断层扫描TAVI检查。这显示了合理的髂-股通路和对瓣膜环大小的估计。最终进行了经导管主动脉瓣植入术。用超声波引导进入。6Fr鞘置入左股动脉(主动脉造影呈刻度辫状)，7Fr鞘置入左股静脉(临时起搏导线)，6Fr鞘置入右股动脉(RFA)， RFA经2次Proglides预闭合后升级为9Fr鞘。立即以常规方式穿过主动脉瓣，植入26mm美敦力Evolut pro。不幸的是，释放后瓣膜移位到升主动脉，并在动脉瘤性主动脉[2]出现钟摆运动。由于患者血流动力学稳定，我们植入了一个更大的瓣膜

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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Cardiology and cardiovascular medicine

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