Transcatheter aortic valve implantation in aortic coarctation.
A 77-year-old male patient was scheduled for transcatheter aortic valve implantation for symptomatic and severe aortic valve stenosis. Severe multidirectional kinking of the aorta based on aortic coarctation did not allow for the transfemoral, but only for the transapical approach. The procedure was complicated because of the technically challenging retrograde passage of the transfemorally inserted pig-tail catheter required for intraoperative angiography of the aortic root. Correct positioning of the pig-tail catheter into the ascending aorta was accomplished by use of a loop snare, which was advanced into the descending aorta via the antegrade route, passing the cardiac apex, the stenotic aortic valve, and the coarctation-associated kinking. The pig-tail catheter tip was manipulated into the loop snare, pulled traverse the coarctation, and released within the proximal ascending aorta. Subsequent procedures were uneventful and followed the standardized protocol. A 29 mm Edwards Lifescience transcatheter Sapien bioprosthesis was successfully implanted.
Clinic of Cardiac Surgery, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany. reneschramm@live.de
René
R
Schramm
Christian
C
Kupatt
Christoph
C
Becker
René
R
Bombien
Bruno
B
Reichart
Ralf
R
Sodian
Christoph
C
Schmitz
D000368:Aged; D001017:Aortic Coarctation / Q000150:complications* / Q000175:diagnosis; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001027:Aortography / Q000379:methods; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome