A case report of emergency transcatheter aortic valve replacement in a patient with cardiogenic shock caused by severe aortic stenosis_West China Medical Journal

Authors：

SHAO Ruochen ¹ , ZHAO Zhengang ¹ , WEI Xin ¹ , LI Yijian ¹ , LI Xi ¹ , WANG Zijie ¹ , XU Yuanning ¹ ,  FENG Yuan ¹ ,  CHEN Mao ¹

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; Transesophageal echocardiography; Aortic stenosis; Cardiogenic shock

DOI：

10.7507/1002-0179.202003065

Video：

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Aortic stenosis accounts for a large proportion of valvular heart disease in China. This article described an unusual case of severe aortic stenosis with severe cardiopulmonary decompensation treated by emergency transcatheter aortic valve replacement. Preoperative assessment was performed by transesophageal echocardiography. The extracorporeal membrane oxygenation team was informed to be ready. During the operation, no obvious perivalve leakage was observed after valve released. The transvalvular pressure gradient decreased to 7 mm Hg (1 mm Hg=0.133 kPa).The patient’s symptoms were completely relieved after the operation, and no adverse events occurred during the hospitalization. After discharge, color Doppler echocardiography showed that stenosis was eliminated, cardiac function was improved, no significant perivalvular leakage was observed, and pulmonary hypertension reduced to moderate. The success of this operation confirmed the efficacy of emergency transcatheter aortic valve replacement, and showed that after a rigorous evaluation, emergency transcatheter aortic valve replacement may be a reasonable choice for patients with severe aortic valve stenosis.

Citation： SHAO Ruochen, ZHAO Zhengang, WEI Xin, LI Yijian, LI Xi, WANG Zijie, XU Yuanning, FENG Yuan, CHEN Mao. A case report of emergency transcatheter aortic valve replacement in a patient with cardiogenic shock caused by severe aortic stenosis. West China Medical Journal, 2020, 35(4): 430-433. doi: 10.7507/1002-0179.202003065 Copy

1.	Hu P, Liu XB, Liang J, et al. A hospital-based survey of patients with severe valvular heart disease in China. Int J Cardiol, 2017, 231: 244-247.
2.	Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
3.	Kapadia SR, Tuzcu EM, Makkar RR, et al. Long-term outcomes of inoperable patients with aortic stenosis randomly assigned to transcatheter aortic valve replacement or standard therapy. Circulation, 2014, 130(17): 1483-1492.
4.	Piérard S, de Meester C, Seldrum S, et al. Impact of preoperative symptoms on postoperative survival in severe aortic stenosis: implications for the timing of surgery. Ann Thorac Surg, 2014, 97(3): 803-809.
5.	Daniec M, Nawrotek B, Sorysz D, et al. Acute and long-term outcomes of percutaneous balloon aortic valvuloplasty for the treatment of severe aortic stenosis. Catheter Cardiovasc Interv, 2017, 90(2): 303-310.
6.	Bongiovanni D, Kühl C, Bleiziffer S, et al. Emergency treatment of decompensated aortic stenosis. Heart, 2018, 104(1): 23-29.
7.	Uehara K, Minakata K, Saito N, et al. Use of extracorporeal membrane oxygenation in complicated transcatheter aortic valve replacement. Gen Thorac Cardiovasc Surg, 2017, 65(6): 329-336.
8.	中华医学会心血管病学分会结构性心脏病学组, 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 中国经导管主动脉瓣置换术临床路径专家共识. 中国介入心脏病学杂志, 2018, 26(12): 661-668.
9.	Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging, 2017, 18(3): 254-275.
10.	Cerillo AG, Mariani M, Berti S, et al. Sizing the aortic annulus. Ann Cardiothorac Surg, 2012, 1(2): 245-256.
11.	Ng AC, Delgado V, van der Kley F, et al. Comparison of aortic root dimensions and geometries before and after transcatheter aortic valve implantation by 2- and 3-dimensional transesophageal echocardiography and multislice computed tomography. Circ Cardiovasc Imaging, 2010, 3(1): 94-102.
12.	Doddamani S, Bello R, Friedman MA, et al. Demonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: implications for the determination of aortic valve area. Echocardiography, 2007, 24(8): 860-866.
13.	Smith LA, Dworakowski R, Bhan A, et al. Real-time three-dimensional transesophageal echocardiography adds value to transcatheter aortic valve implantation. J Am Soc Echocardiogr, 2013, 26(4): 359-369.
14.	Vaquerizo B, Spaziano M, Alali J, et al. Three-dimensional echocardiography vs. computed tomography for transcatheter aortic valve replacement sizing. Eur Heart J Cardiovasc Imaging, 2016, 17(1): 15-23.
15.	Husser O, Holzamer A, Resch M, et al. Prosthesis sizing for transcatheter aortic valve implantation--comparison of three dimensional transesophageal echocardiography with multislice computed tomography. Int J Cardiol, 2013, 168(4): 3431-3438.
16.	黄朝旭, 蒲朝霞, 夏向阳, 等. eSie Valves 三维自动定量分析在经导管主动脉瓣置换术前评估主动脉根部的应用价值. 中华超声影像学杂志, 2017, 26(6): 478-483.
17.	魏薪, 刘古月, 李茜, 等. 经导管主动脉瓣置换术前实时三维经食管超声自动测量主动脉瓣环径. 中国医学影像技术, 2019, 35(9): 1300-1304.
18.	Jánosi RA, Plicht B, Kahlert P, et al. Quantitative analysis of aortic valve stenosis and aortic root dimensions by three-dimensional echocardiography in patients scheduled for transcutaneous aortic valve implantation. Curr Cardiovasc Imaging Rep, 2014, 7: 9296.
19.	Gloria T, Laura F, Paola G, et al. Feasibility and accuracy of 3DTEE versus CT for the evaluation of aortic valve annulus to left main ostium distance before transcatheter aortic valve implantation. JACC Cardiovasc Imaging, 2012, 5(6): 579-588.
20.	Ben-Dor I, Pichard AD, Satler LF, et al. Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients. JACC Cardiovasc Interv, 2010, 3(11): 1150-1156.
21.	Moretti C, Chandran S, Vervueren PL, et al. Outcomes of patients undergoing balloon aortic valvuloplasty in the TAVI era:a multicenter registry. J Invasive Cardiol, 2015, 27(12): 547-553.
22.	Landes U, Orvin K, Codner P, et al. Urgent transcatheter aortic valve implantation in patients with severe aortic stenosis and acute heart failure: procedural and 30-day outcomes. Can J Cardiol, 2016, 32(6): 726-731.
23.	Frerker C, Schewel J, Schlüter M, et al. Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis. EuroIntervention, 2016, 11(13): 1530-1536.
24.	Singh V, Patel SV, Savani C, et al. Mechanical circulatory support devices and transcatheter aortic valve implantation (from the national inpatient sample). Am J Cardiol, 2015, 116(10): 1574-1580.
25.	Banjac I, Petrovic M, Akay MH, et al. Extracorporeal membrane oxygenation as a procedural rescue strategy for transcatheter aortic valve replacement cardiac complications. ASAIO J, 2016, 62(1): e1-e4.

1. Hu P, Liu XB, Liang J, et al. A hospital-based survey of patients with severe valvular heart disease in China. Int J Cardiol, 2017, 231: 244-247.
2. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
3. Kapadia SR, Tuzcu EM, Makkar RR, et al. Long-term outcomes of inoperable patients with aortic stenosis randomly assigned to transcatheter aortic valve replacement or standard therapy. Circulation, 2014, 130(17): 1483-1492.
4. Piérard S, de Meester C, Seldrum S, et al. Impact of preoperative symptoms on postoperative survival in severe aortic stenosis: implications for the timing of surgery. Ann Thorac Surg, 2014, 97(3): 803-809.
5. Daniec M, Nawrotek B, Sorysz D, et al. Acute and long-term outcomes of percutaneous balloon aortic valvuloplasty for the treatment of severe aortic stenosis. Catheter Cardiovasc Interv, 2017, 90(2): 303-310.
6. Bongiovanni D, Kühl C, Bleiziffer S, et al. Emergency treatment of decompensated aortic stenosis. Heart, 2018, 104(1): 23-29.
7. Uehara K, Minakata K, Saito N, et al. Use of extracorporeal membrane oxygenation in complicated transcatheter aortic valve replacement. Gen Thorac Cardiovasc Surg, 2017, 65(6): 329-336.
8. 中华医学会心血管病学分会结构性心脏病学组, 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 中国经导管主动脉瓣置换术临床路径专家共识. 中国介入心脏病学杂志, 2018, 26(12): 661-668.
9. Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging, 2017, 18(3): 254-275.
10. Cerillo AG, Mariani M, Berti S, et al. Sizing the aortic annulus. Ann Cardiothorac Surg, 2012, 1(2): 245-256.
11. Ng AC, Delgado V, van der Kley F, et al. Comparison of aortic root dimensions and geometries before and after transcatheter aortic valve implantation by 2- and 3-dimensional transesophageal echocardiography and multislice computed tomography. Circ Cardiovasc Imaging, 2010, 3(1): 94-102.
12. Doddamani S, Bello R, Friedman MA, et al. Demonstration of left ventricular outflow tract eccentricity by real time 3D echocardiography: implications for the determination of aortic valve area. Echocardiography, 2007, 24(8): 860-866.
13. Smith LA, Dworakowski R, Bhan A, et al. Real-time three-dimensional transesophageal echocardiography adds value to transcatheter aortic valve implantation. J Am Soc Echocardiogr, 2013, 26(4): 359-369.
14. Vaquerizo B, Spaziano M, Alali J, et al. Three-dimensional echocardiography vs. computed tomography for transcatheter aortic valve replacement sizing. Eur Heart J Cardiovasc Imaging, 2016, 17(1): 15-23.
15. Husser O, Holzamer A, Resch M, et al. Prosthesis sizing for transcatheter aortic valve implantation--comparison of three dimensional transesophageal echocardiography with multislice computed tomography. Int J Cardiol, 2013, 168(4): 3431-3438.
16. 黄朝旭, 蒲朝霞, 夏向阳, 等. eSie Valves 三维自动定量分析在经导管主动脉瓣置换术前评估主动脉根部的应用价值. 中华超声影像学杂志, 2017, 26(6): 478-483.
17. 魏薪, 刘古月, 李茜, 等. 经导管主动脉瓣置换术前实时三维经食管超声自动测量主动脉瓣环径. 中国医学影像技术, 2019, 35(9): 1300-1304.
18. Jánosi RA, Plicht B, Kahlert P, et al. Quantitative analysis of aortic valve stenosis and aortic root dimensions by three-dimensional echocardiography in patients scheduled for transcutaneous aortic valve implantation. Curr Cardiovasc Imaging Rep, 2014, 7: 9296.
19. Gloria T, Laura F, Paola G, et al. Feasibility and accuracy of 3DTEE versus CT for the evaluation of aortic valve annulus to left main ostium distance before transcatheter aortic valve implantation. JACC Cardiovasc Imaging, 2012, 5(6): 579-588.
20. Ben-Dor I, Pichard AD, Satler LF, et al. Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients. JACC Cardiovasc Interv, 2010, 3(11): 1150-1156.
21. Moretti C, Chandran S, Vervueren PL, et al. Outcomes of patients undergoing balloon aortic valvuloplasty in the TAVI era:a multicenter registry. J Invasive Cardiol, 2015, 27(12): 547-553.
22. Landes U, Orvin K, Codner P, et al. Urgent transcatheter aortic valve implantation in patients with severe aortic stenosis and acute heart failure: procedural and 30-day outcomes. Can J Cardiol, 2016, 32(6): 726-731.
23. Frerker C, Schewel J, Schlüter M, et al. Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis. EuroIntervention, 2016, 11(13): 1530-1536.
24. Singh V, Patel SV, Savani C, et al. Mechanical circulatory support devices and transcatheter aortic valve implantation (from the national inpatient sample). Am J Cardiol, 2015, 116(10): 1574-1580.
25. Banjac I, Petrovic M, Akay MH, et al. Extracorporeal membrane oxygenation as a procedural rescue strategy for transcatheter aortic valve replacement cardiac complications. ASAIO J, 2016, 62(1): e1-e4.

West China Medical Journal

A case report of emergency transcatheter aortic valve replacement in a patient with cardiogenic shock caused by severe aortic stenosis

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