title: Feasibility of transapical aortic valve replacement through a left ventricular apical diverticulum.
abstract: Transapical aortic valve replacement is an established technique performed in high-risk patients with symptomatic aortic valve stenosis and vascular disease contraindicating trans-vascular and trans-aortic procedures. The presence of a left ventricular apical diverticulum is a rare event and the treatment depends on dimensions and estimated risk of embolisation, rupture, or onset of ventricular arrhythmias. The diagnosis is based on standard cardiac imaging and symptoms are very rare. In this case report we illustrate our experience with a 81 years old female patient suffering from symptomatic aortic valve stenosis, respiratory disease, chronic renal failure and severe peripheral vascular disease (logistic euroscore: 42%), who successfully underwent a transapical 23 mm balloon-expandable stent-valve implantation through an apical diverticulum of the left ventricle. Intra-luminal thrombi were absent and during the same procedure were able to treat the valve disease and to successfully exclude the apical diverticulum without complications and through a mini thoracotomy. To the best of our knowledge, this is the first time that a transapical procedure is successfully performed through an apical diverticulum.
authors.affiliation: Department of Cardiovascular surgery, CHUV, University Hospital of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland. enricoferrari@bluewin.ch
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrari
authors.forename: Mathieu
authors.initials: M
authors.lastname: Van Steenberghe
authors.forename: Jegaruban
authors.initials: J
authors.lastname: Namasivayam
authors.forename: Denis
authors.initials: D
authors.lastname: Berdajs
authors.forename: Lars
authors.initials: L
authors.lastname: Niclauss
authors.forename: Ludwig Karl
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D004240:Diverticulum / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D018487:Ventricular Dysfunction, Left / Q000601:surgery*