title: Management of severe aortic regurgitation in a patient with cardiogenic shock using a percutaneous left ventricular assist device and transcatheter occlusion of the failed aortic valve homograft as a bridge to surgical valve replacement.
abstract: Acute hemodynamic compromise due to severe aortic regurgitation remains a difficult problem. The optimal management strategy and timing of surgery continues to evolve as new technologies become available. Here, we report the case of a young woman presenting with severe regurgitation of an aortic homograft who developed precipitous cardiogenic shock and multi-organ dysfunction. Her mortality risk with emergent surgery was prohibitive, and no percutaneous valve-in-valve device was available. We stabilized her condition by placing an Amplatz-type Atrial Septal Defect (ASD) occluder across her aortic valve in conjunction with a percutaneous left ventricular assist device as a bridge to surgical valve replacement. She went on to a successful surgery and recovered well.
authors.affiliation: Department of Internal Medicine, University of Virginia Health System, Rochester, Minnesota.
authors.forename: Peter
authors.initials: P
authors.lastname: Pollak
authors.forename: D Scott
authors.initials: DS
authors.lastname: Lim
authors.forename: John
authors.initials: J
authors.lastname: Kern
mesh_terms: D000328:Adult; D064591:Allografts; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation; D018618:Echocardiography, Doppler, Color; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D011475:Prosthesis Failure; D012086:Reoperation; D055989:Septal Occluder Device; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: cardiopulmonary support; valvular heart disease; ventricular support devices