Transcatheter Aortic Valve Replacement for Aortic Stenosis with Complicated Anatomy;Report of a Case
Takahashi, K.; Domoto, S.; Isomura, S.; Jujo, K.; Otsuki, H.; Yamaguchi, J.; Niinami, H.
Kyobu Geka. Japanese Journal of Thoracic Surgery 72(9): 694-697
2019
ISSN/ISBN: 0021-5252 PMID: 31506411 Document Number: 698443
An 89-year-old female was admitted with progressive dyspnea. She had history of old myocardial infarction. Echocardiography revealed severe aortic valve stenosis (AS) with bicuspid aortic valve (BAV). Computed tomography (CT) detected an ascending aortic aneurysm and a left ventricular apex aneurysm. CT confirmed the BAV with severe calcification and tight horizontal angulation. We scheduled transfemoral transcatheter aortic valve replacement (TAVR). While careful wire manipulation, the valve was successfully implanted. BAV is frequently associated with dilation of the ascending aorta. The coexistence of an ascending aortic aneurysm would indicate surgery in order to be able to treat both lesions simultaneously and to avoid catastrophic stent-related complications, such as prosthesis dislodgment and aneurysm rupture. In the present case, there was also risk of left ventricular rupture due to wire manipulation. The horizontal aorta also complicates accurate positioning of the prosthesis during TAVR. This case highlights TAVR for AS with complicated anatomy.