Transcatheter aortic valve replacement for aortic stenosis characterized by large aortic annulus and severe calcification: a case report_West China Medical Journal

Authors：

CHENG Yiheng , LI Xi , ZHAO Zhengang , XIONG Tianyuan , LI Yijian , XU Yuanning ,  FENG Yuan ,  CHEN Mao

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FENG Yuan, Email: fynotebook@hotmail.com; CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Transcatheter aortic valve replacement; Calcification; Large annulus diameter

DOI：

10.7507/1002-0179.202003059

Video：

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Abstract Full text Figures/Tables Video References Cited by

Reports about the application of transcatheter aortic valve replacement (TAVR) for patients with aortic stenosis, whose valve sizes exceed the maximum recommended annular diameter of the largest artificial valve, is rarely in China. This paper reports an aortic stenosis patient characterized by large aortic annulus diameter with severe calcification and treated by TAVR. A comprehensive and careful operation plan was made before the operation. The anterior and posterior balloon dilatation and coronary artery protection were used during the operation. The patient was followed up for 2 years and was in stable condition.

Citation： CHENG Yiheng, LI Xi, ZHAO Zhengang, XIONG Tianyuan, LI Yijian, XU Yuanning, FENG Yuan, CHEN Mao. Transcatheter aortic valve replacement for aortic stenosis characterized by large aortic annulus and severe calcification: a case report. West China Medical Journal, 2020, 35(4): 434-437. doi: 10.7507/1002-0179.202003059 Copy

1.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
2.	Barr P, Ormiston J, Stewart J, et al. Transcatheter aortic valve implantation in patients with a large aortic annulus. Heart Lung Circ, 2018, 27(3): e11-e14.
3.	Tang GHL, Zaid S, George I, et al. Impact of aortic root anatomy and geometry on paravalvular leak in transcatheter aortic valve replacement with extremely large annuli using the edwards SAPIEN 3 valve. JACC Cardiovasc Interv, 2018, 11(14): 1377-1387.
4.	Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol, 2013, 62(11): 1002-1012.
5.	Rodés-Cabau J, Pibarot P, Suri RM, et al. Impact of aortic annulus size on valve hemodynamics and clinical outcomes after transcatheter and surgical aortic valve replacement: insights from the PARTNER Trial. Circ Cardiovasc Interv, 2014, 7(5): 701-711.
6.	Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the american college of cardiology task force on clinical expert consensus documents. J Am Coll Cardiol, 2017, 69(10): 1313-1346.
7.	王玺, 李怡坚, 欧袁伟翔, 等. 经导管主动脉瓣置换术中 Venus A-Valve 与进口瓣膜临床应用的比较. 华西医学, 2019, 34(4): 379-384.
8.	Fink N, Segev A, Kornowski R, et al. Balloon dilatation and outcome among patients undergoing trans-femoral aortic valve replacement. Int J Cardiol, 2017, 230: 537-541.
9.	Grube E, Naber C, Abizaid A, et al. Feasibility of transcatheter aortic valve implantation without balloon pre-dilation: a pilot study. JACC Cardiovasc Interv, 2011, 4(7): 751-757.
10.	Kim RJ, McGehee E, Mack MJ. Left main occlusion secondary to aortic root rupture following transcatheter aortic valve replacement managed by left main stenting. Catheter Cardiovasc Interv, 2014, 83(1): E146-E149.
11.	Yamamoto M, Shimura T, Kano S, et al. Impact of preparatory coronary protection in patients at high anatomical risk of acute coronary obstruction during transcatheter aortic valve implantation. Int J Cardiol, 2016, 217: 58-63.
12.	Riberiro HB, Nombela-Franco L, Urena M, et al. Coronary obstruction follwing transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv, 2013, 6(5): 452-461.
13.	Nietlispach F, Maisano F. Balloon post-dilation after transcatheter aortic valve replacement: a solution worth trying in patients with residual aortic insufficiency. JACC Cardiovasc Interv, 2014, 7(7): 790-791.
14.	Ibrahim R, Ben-Shoshan J. The oversizing versus post-dilatation trade-off: focus on the SAPIEN 3. JACC Cardiovasc Interv, 2018, 11(17): 1719-1720.
15.	Sathananthan J, Sellers S, Barlow A, et al. Overexpansion of the SAPIEN 3 transcatheter heart valve. JACC Cardiovasc Interv, 2018, 11(17): 1696-1705.

1. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
2. Barr P, Ormiston J, Stewart J, et al. Transcatheter aortic valve implantation in patients with a large aortic annulus. Heart Lung Circ, 2018, 27(3): e11-e14.
3. Tang GHL, Zaid S, George I, et al. Impact of aortic root anatomy and geometry on paravalvular leak in transcatheter aortic valve replacement with extremely large annuli using the edwards SAPIEN 3 valve. JACC Cardiovasc Interv, 2018, 11(14): 1377-1387.
4. Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol, 2013, 62(11): 1002-1012.
5. Rodés-Cabau J, Pibarot P, Suri RM, et al. Impact of aortic annulus size on valve hemodynamics and clinical outcomes after transcatheter and surgical aortic valve replacement: insights from the PARTNER Trial. Circ Cardiovasc Interv, 2014, 7(5): 701-711.
6. Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the american college of cardiology task force on clinical expert consensus documents. J Am Coll Cardiol, 2017, 69(10): 1313-1346.
7. 王玺, 李怡坚, 欧袁伟翔, 等. 经导管主动脉瓣置换术中 Venus A-Valve 与进口瓣膜临床应用的比较. 华西医学, 2019, 34(4): 379-384.
8. Fink N, Segev A, Kornowski R, et al. Balloon dilatation and outcome among patients undergoing trans-femoral aortic valve replacement. Int J Cardiol, 2017, 230: 537-541.
9. Grube E, Naber C, Abizaid A, et al. Feasibility of transcatheter aortic valve implantation without balloon pre-dilation: a pilot study. JACC Cardiovasc Interv, 2011, 4(7): 751-757.
10. Kim RJ, McGehee E, Mack MJ. Left main occlusion secondary to aortic root rupture following transcatheter aortic valve replacement managed by left main stenting. Catheter Cardiovasc Interv, 2014, 83(1): E146-E149.
11. Yamamoto M, Shimura T, Kano S, et al. Impact of preparatory coronary protection in patients at high anatomical risk of acute coronary obstruction during transcatheter aortic valve implantation. Int J Cardiol, 2016, 217: 58-63.
12. Riberiro HB, Nombela-Franco L, Urena M, et al. Coronary obstruction follwing transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv, 2013, 6(5): 452-461.
13. Nietlispach F, Maisano F. Balloon post-dilation after transcatheter aortic valve replacement: a solution worth trying in patients with residual aortic insufficiency. JACC Cardiovasc Interv, 2014, 7(7): 790-791.
14. Ibrahim R, Ben-Shoshan J. The oversizing versus post-dilatation trade-off: focus on the SAPIEN 3. JACC Cardiovasc Interv, 2018, 11(17): 1719-1720.
15. Sathananthan J, Sellers S, Barlow A, et al. Overexpansion of the SAPIEN 3 transcatheter heart valve. JACC Cardiovasc Interv, 2018, 11(17): 1696-1705.

West China Medical Journal

Transcatheter aortic valve replacement for aortic stenosis characterized by large aortic annulus and severe calcification: a case report

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