title: Successful implantation of a second-generation aortic valve in severe aortic regurgitation secondary to a traumatic cusp lesion.
abstract: A 67-year-old man with a dilated cardiomyopathy and severe aortic regurgitation (AR) secondary to a traumatic cusp lesion was referred to our institution because of progressive worsening of dyspnea. After formal discussion in the heart team, the patient was scheduled for TAVI (transcatheter aortic valve implantation). The pre procedural computed tomography scan revealed a minimum amount of calcium on the aortic valve and low position of coronary ostia. The TAVI procedure was performed with the implantation of a fully retrievable and repositionable aortic valve prosthesis (Direct Flow 29 mm, Direct Flow Medical, Santa Rosa, California) with an excellent result and no paravalvular leak. The TAVI devices designed for the treatment of calcific aortic stenosis have numerous limitations for the treatment of pure AR such as the risk of residual AR, the lack of repositionability and retrievability, and the need for valve- in-valve implantation. We believe that treatment of selected cases of pure AR with the Direct Flow valve is feasible and takes advantage of the retrievability of the prosthesis.
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mangieri
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy. Electronic address: info@emocolumbus.it.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Aurelio
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy.
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Rosa
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Stella
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Spagnolo
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castiglioni
authors.affiliation: Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D006335:Heart Injuries / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D011474:Prosthesis Design; D015641:Radiography, Interventional; D016896:Treatment Outcome
keywords: Aortic regurgitation; Transcatheter aortic valve replacement