Postcardiac transplant transcatheter core valve implantation for aortic insufficiency secondary to Impella device placement.
Conventional cardiac surgical procedures or transcatheter interventions after orthotopic heart transplantation are generally uncommon. We report the case of a 45-year-old woman who developed severe aortic insufficiency after insertion of a 5-L Impella device 16 weeks after heart transplantation. After joint evaluation by the transcatheter valve team, transcatheter aortic valve implantation was planned because of associated comorbid conditions. A 29-mm CoreValve prosthesis (Medtronic, Minneapolis, MN) was inserted percutaneously. At 6 months after prosthesis implantation, the patient was asymptomatic in New York Heart Association functional class II, and the echocardiogram showed a mean transvalvular gradient of 1 mm Hg, an aortic valve area of 1.5 cm2, and no paravalvular aortic insufficiency.
Division of Cardiovascular Surgery and Cardiology, Toronto General Hospital, Toronto, Ontario, Canada. r_chandola@rediffmail.com
Rahul
R
Chandola
Robert
R
Cusimano
Mark
M
Osten
Eric
E
Horlick
D017130:Angioplasty / Q000379:methods*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D002303:Cardiac Output, Low / Q000601:surgery*; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D020878:Device Removal; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000628:therapy; D016027:Heart Transplantation; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011474:Prosthesis Design; D012086:Reoperation