J Lipid Atheroscler.  2013 Dec;2(2):85-90. 10.12997/jla.2013.2.2.85.

Transcatheter Aortic Valve Implantation Using CoreValve by Transaortic Approach

• Chun KH
• Ko YG
• Shim JY
• Lee S
• Chang BC
• Shim JK
• Kwak YR
• Hong MK

• KMID: 1845573
• DOI: http://doi.org/10.12997/jla.2013.2.2.85

Abstract

INTRODUCTION
Transcatheter aortic valve implantation (TAVI) is now considered as an alternative treatment option for severe aortic stenosis (AS) patients who cannot undergo surgical aortic valve replacement (AVR).
CASE REPORT
We describe the first Korean case of transaortic TAVI with mini-sternotomy using CoreValve. A 83-year-old woman with severe AS and recent history of non-ST elevation myocardial infarction was referred to our institution for TAVI intervention. There was no amenable peripheral vascular access for transfemoral or trans-subclavian approach. Considering the relatively high procedural risk of transapical approach in this patient, we performed transaortic TAVI with mini-sternotomy.
CONCLUSION
The present case suggests transaortic approach may be an effective and safe strategy for TAVI in high risk severe AS patients without eligible femoral or subclavian access routes.

Keyword

Heart valve prosthesis implantation; Aortic stenosis; Vascular access devices

MeSH Terms

Aged, 80 and over
Aortic Valve Stenosis
Aortic Valve*
Female
Heart Valve Prosthesis Implantation
Humans
Myocardial Infarction
Vascular Access Devices

Figure

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  Fig. 1 Transthoracic echocardiography before the transcatheter aortic valve implantation. (A) Parasternal long axis view shows heavily calcified stenotic aortic valve, (B) Pressure gradient over aortic valve by Doppler (maximal pressure gradient 97 mmHg, mean pressure gradient 63 mmHg). AV; aortic valve, Ao; aorta, LV; left ventricle, LA; left atrium.

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  Fig. 2 CT images of aorta and iliofemoral arteries. Bilaterally, iliofemoral arteries were not eligible for the transcatheter aortic valve implantation route due to insufficient size (diameter <6 mm). CIA; common iliac artery, EIA; external iliac artery, CFA; common femoral artery.

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  Fig. 3 Transcatheter aortic valve implantation by transaortic approach. (A) Exposure of ascending aorta by mini-sternotomy, (B) Insertion of a 18F sheath into ascending aorta, (C) Partial deployment of self-expanding CoreValve within aortic valve, (D) Complete implantation of CoreValve.

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  Fig. 4 Transthoracic echocardiography after the transcatheter aortic valve implantation. (A) Parasternal long axis view shows implanted CoreValve, (B) Pressure gradient over aortic valve by Doppler (maximal pressure gradient 17 mmHg, mean pressure gradient 8 mmHg). AV; aortic valve, Ao; aorta, LV; left ventricle, LA; left atrium.

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  Fig. 5 Electrocardiogram (ECG) findings. (A) ECG before the procedure, (B) ECG after the procedure.

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