Good outcome and valve function despite Medtronic-corevalve underexpansion.
An 80-year old nun with severe calcific aortic stenosis and a bicuspid aortic valve was referred for transcatheter aortic valve implantation. She was declined for conventional surgery on the basis of poor left ventricular function, frailty, and a logistic EuroSCORE of 29.66. A 29-mm Medtronic-Corevalve bioprosthesis was implanted by transfemoral route. The inflow portion of the stent frame was grossly underexpanded. However, aortic valve area at 1.3 cm(2) was more than satisfactory for a body surface area of 1.29 m(2) (indexed area 1.0 cm(2)/m(2), peak gradient 23, and mean 16 mmHg). There was an early sustained improvement in New York Heart Association (NYHA) status, and there was no change in valvular function at 2 year follow-up. This case highlights that gross underexpansion of the Medtronic-Corevalve stent frame is compatible with good bioprosthetic function and excellent symptomatic recovery.
Department of Interventional Cardiology, Montreal Heart Institute, Quebec, Canada.
Hasan
H
Jilaihawi
Anita
A
Asgar
Raoul
R
Bonan
D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D011474:Prosthesis Design; D020127:Recovery of Function; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left