Transcatheter aortic valve replacement (TAVR) is the best treatment for severe aortic stenosis with high surgical risk, and low body weight significantly increased the risk of surgery and postoperative all-cause mortality. A case of elderly female diagnosed with severe aortic valve stenosis and extremely low body weight was presented in this article. Additionally, horizocardia and low located coronary orifice were also found in this patient, which markedly increased the risk and complexity of the TAVR procedure. During the operation, circulatory collapse occurred, and prosthetic valve was quickly released under emergency cardiopulmonary resuscitation. The operation was successful and the patient’s vital signs recovered soon. The follow-up showed that the patient was in good condition.
ObjectiveTo analyze the characteristics and cardiac anatomy of patients with conduction block after transcatheter aortic valve replacement (TAVR) with Venus-A valve.MethodsRetrospective analysis was conducted on the clinical data of patients with severe aortic stenosis who underwent TAVR with Venus-A valve in the Second Affiliated Hospital of Army Military Medical University from October 2017 to May 2020. According to the occurrence of heart conduction block after TAVR, the patients were divided into the blocked group and the unblocked group, and the differences in characteristics and cardiac anatomy between the two groups were compared.ResultsForty-nine patients with severe aortic stenosis were included in the analysis, including 29 in the blocked group and 20 in the unblocked group. The incidence of atrial fibrillation in the blocked group was higher than that in the unblocked group (P=0.015), and there was no statistically significant difference in other preoperative indicators (P>0.05). There was no statistically significant difference in postoperative indicators between the blocked group and the unblocked group (P>0.05). Among bicuspid aortic valve, the ellipticity of left ventricular outflow tract and annulus in the blocked group were higher than those in the unblocked group (P<0.05), and the ratio of the short diameter of the left ventricular outflow tract to the bottom diameter of the implanted valve was smaller than that of the unblocked group (t=2.225, P=0.043). There was no significant difference in other cardiac anatomical indicators (P>0.05). As to tricuspid aortic valve cases, there was no significant difference in cardiac anatomic parameters between the blocked group and the unblocked group (P>0.05).ConclusionsFor bicuspid aortic valve patients with severe aortic stenosis and implanted with Venus-A valve, larger elliptic rate of annulus or left ventricular outflow tract, smaller proportion of left ventricular outflow tract diameter to the bottom diameter of implanted valve are associated with conduction block after TAVR. These anatomical patterns might be used as potential clinical indicators to predict postoperative conduction block.