title: Transseptal strategy in retrograde transcatheter valve-in-valve implantation for failed surgical aortic bioprosthesis.
abstract: We report a challenging case of transcatheter aortic valve-in-valve implantation in an elderly patient with failed surgical bioprosthesis. The transthoracic echocardiogram demonstrated a severe stenosis with a peak gradient of 142 mm Hg. The patient was a high-risk candidate for reoperative valve replacement; therefore, transfemoral implantation of a CoreValve (Medtronic Inc, Minneapolis, MN) was decided. During the procedure, we were unable to introduce the delivery catheter system across the bioprosthesis due to its poor alignment with the aortic annulus and the severity of the stenosis. With strategies involving transseptal puncture and externalization of a guidewire in an antegrade manner, the CoreValve was successfully positioned and deployed. This case illustrated the utility of transseptal strategies in challenging retrograde transcatheter aortic valve-in-valve implantation.
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany.
authors.forename: Simon Cheung
authors.initials: SC
authors.lastname: Chi Lam
authors.forename: Stefan
authors.initials: S
authors.lastname: Bertog
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D063126:Balloon Valvuloplasty; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011677:Punctures; D015641:Radiography, Interventional; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: aorta; transseptal catheterization; valvular heart disease