Thorac Cardiovasc Surg 2013; 61(04): 336-339
DOI: 10.1055/s-0031-1295575
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Transcatheter Aortic Valve Implantation in Aortic Coarctation

René Schramm
1   Clinic of Cardiac Surgery, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
,
Christian Kupatt
2   Department of Internal Medicine I, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
,
Christoph Becker
3   Institute for Clinical Radiology, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
,
René Bombien
1   Clinic of Cardiac Surgery, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
,
Bruno Reichart
1   Clinic of Cardiac Surgery, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
,
Ralf Sodian
1   Clinic of Cardiac Surgery, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
,
Christoph Schmitz
1   Clinic of Cardiac Surgery, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
› Author Affiliations
Further Information

Publication History

20 May 2011

22 June 2011

Publication Date:
03 January 2012 (online)

Abstract

A 77-year-old male patient was scheduled for transcatheter aortic valve implantation for symptomatic and severe aortic valve stenosis. Severe multidirectional kinking of the aorta based on aortic coarctation did not allow for the transfemoral, but only for the transapical approach. The procedure was complicated because of the technically challenging retrograde passage of the transfemorally inserted pig-tail catheter required for intraoperative angiography of the aortic root. Correct positioning of the pig-tail catheter into the ascending aorta was accomplished by use of a loop snare, which was advanced into the descending aorta via the antegrade route, passing the cardiac apex, the stenotic aortic valve, and the coarctation-associated kinking. The pig-tail catheter tip was manipulated into the loop snare, pulled traverse the coarctation, and released within the proximal ascending aorta. Subsequent procedures were uneventful and followed the standardized protocol. A 29 mm Edwards Lifescience transcatheter Sapien bioprosthesis was successfully implanted.

 
  • References

  • 1 Vahanian A, Baumgartner H, Bax J , et al; Task Force on the Management of Valvular Hearth Disease of the European Society of Cardiology; ESC Committee for Practice Guidelines. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28 (2) 230-268
  • 2 Bonow RO, Carabello BA, Chatterjee K , et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease); Society of Cardiovascular Anesthesiologists. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48 (3) e1-e148
  • 3 Vahanian A, Alfieri O, Al-Attar N , et al; European Association of Cardio-Thoracic Surgery; European Society of Cardiology; European Association of Percutaneous Cardiovascular Interventions. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2008; 29 (11) 1463-1470
  • 4 Aboyans V, Kownator S, Lafitte M , et al; Working Group for Vascular Diseases/Thrombosis, French Society of Cardiology; Council of Echocardiography, French Society of Cardiology. Screening abdominal aorta aneurysm during echocardiography: literature review and proposal for a French nationwide study. Arch Cardiovasc Dis 2010; 103 (10) 552-558
  • 5 Ben-Dor I, Waksman R, Hanna NN , et al. Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation. Am J Cardiol 2010; 105 (10) 1461-1464
  • 6 Gerber RT, Osborn M, Mikhail GW. Delayed mortality from aortic dissection post transcatheter aortic valve implantation (TAVI): the tip of the iceberg. Catheter Cardiovasc Interv 2010; 76 (2) 202-204
  • 7 Reents W, Froehner S, Diegeler A, Urbanski PP. Ascending-to-descending bypass for simultaneous surgery of aortic coarctation with other cardiac pathologies. Thorac Cardiovasc Surg 2011; ; April 7 (Epub ahead of print)
  • 8 Kolh P, Wijns W, Danchin N , et al; Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS); European Association for Percutaneous Cardiovascular Interventions (EAPCI). Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2010; 38 (Suppl): S1-S52