1
|
Verreault-Julien L, Toleva O, Robertson G, Rinfret S. Rare Cause of Late Left Aortic Sinus Obstruction Following Transcatheter Aortic Valve Replacement. JACC Case Rep 2023; 14:101828. [PMID: 37152700 PMCID: PMC10157083 DOI: 10.1016/j.jaccas.2023.101828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 05/09/2023]
Abstract
A 74-year-old woman with a history aortic stenosis with prior transcatheter aortic valve replacement presented with non-ST-segment elevation myocardial infarction secondary to a delayed left coronary sinus obstruction. With physiology and intravascular ultrasound guidance, the patient was treated with stents through the valve struts and to the left main. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Louis Verreault-Julien
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Heart and Vascular, Department of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Olga Toleva
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Heart and Vascular, Department of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Gregory Robertson
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Heart and Vascular, Department of Medicine, Division of Cardiology, Atlanta, Georgia, USA
| | - Stéphane Rinfret
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Heart and Vascular, Department of Medicine, Division of Cardiology, Atlanta, Georgia, USA
- Address for correspondence: Dr Stéphane Rinfret, Emory Saint Joseph’s Hospital, 5665 Peachtree Dunwoody Road, Atlanta, Georgia 30342, USA. @RinfretStephane
| |
Collapse
|
2
|
Vogl BJ, Darestani YM, Lilly SM, Thourani VH, Alkhouli MA, Lindman BR, Hatoum H. Impact of blood pressure on coronary perfusion and valvular hemodynamics after aortic valve replacement. Catheter Cardiovasc Interv 2021; 99:1214-1224. [PMID: 34936723 DOI: 10.1002/ccd.30052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Our objective was to evaluate the impact of various blood pressures (BPs) on coronary perfusion and valvular hemodynamics following aortic valve replacement (AVR). BACKGROUND Lower systolic and diastolic (SBP/DBP) pressures from the recommended optimal target range of SBP < 120-130 mmHg and DBP < 80 mmHg after AVR have been independently associated with increased cardiovascular and all-cause mortality. METHODS The hemodynamic assessment of a 26 mm SAPIEN 3 transcatheter aortic valve (TAV), 29 mm Evolut R TAV, and 25 mm Magna Ease surgical aortic valve (SAV) was performed in a pulsed left heart simulator with varying SBP, DBP, and heart rate (HR) conditions (60 and 120 bpm) at 5 L/min cardiac output (CO). Average coronary flow (CF), effective orifice areas (EOAs), and valvulo-arterial impedance (Zva) were calculated. RESULTS At HR of 60 bpm, at SBP < 120 mmHg and DBP < 60 mmHg, CF decreased below the physiological lower limit with several different valves. Zva and EOA were found to increase and decrease respectively with increasing SBP and DBP. The same results were found with an HR of 120 bpm. The trends of CF variation with BP were similar in all valves however the drop below the lower physiological CF limit was valve dependent. CONCLUSION In a controlled in vitro system, with different aortic valve prostheses in place, CF decreased below the physiologic minimum when SBP and DBP were in the range targeted by blood pressure guidelines. Combined with recent observations from patients treated with AVR, these findings underscore the need for additional studies to identify the optimal BP in patients treated with AVR for AS.
Collapse
Affiliation(s)
- Brennan J Vogl
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
| | - Yousef M Darestani
- Department of Civil, Environmental and Geospatial Engineering, Michigan Technological University, Houghton, Michigan, USA
| | - Scott M Lilly
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian R Lindman
- Structural Heart and Valve Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA.,Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, USA.,Health Research Institute, Michigan Technological University, Houghton, Michigan, USA
| |
Collapse
|
3
|
Ohya M, Fuku Y, Shimamoto T, Kadota K. Delayed Valsalva obstruction after transcatheter self-expandable aortic valve implantation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33634230 PMCID: PMC7891291 DOI: 10.1093/ehjcr/ytaa443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/07/2020] [Accepted: 10/17/2020] [Indexed: 12/05/2022]
Abstract
Background Delayed coronary obstruction after transcatheter aortic valve implantation has been reported to occur more commonly after self-expandable aortic valve implantation than balloon-expandable valve. Case summary An 86-year-old woman treated by transcatheter self-expandable aortic valve implantation had acute coronary syndrome 3 months after the procedure. Emergent coronary angiography showed decreased blood flow in the left coronary artery. Balloon angioplasty between the valve frame and the left coronary cusp was performed, and her ischaemia resolved. Contrast-enhanced computed tomography showed a commissural post of the supra-annular valve overlying the left coronary cusp, and serial computed tomography showed the valve frame expanding over time. She received coronary bypass grafting using saphenous vein grafts for the left anterior descending and left circumflex arteries. Four months after surgery for the left anterior descending artery, the patient had recurrent chest pain, and computed tomography showed a graft occlusion in the left anterior descending artery. Shortly afterwards, she died of sudden cardiac arrest. Discussion In this report, we describe delayed Valsalva obstruction after transcatheter self-expandable aortic valve implantation, which can be detectable by serial computed tomography. The sealing of a coronary cusp by a commissural post of the valve may be one of the causes of delayed coronary ischaemia after transcatheter self-expandable aortic valve implantation.
Collapse
Affiliation(s)
- Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki 710-8602, Japan
| | - Yasushi Fuku
- Department of Cardiology, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki 710-8602, Japan
| | - Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki 710-8602, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, 1-11 Miwa, Kurashiki 710-8602, Japan
| |
Collapse
|
4
|
Takiguchi H, Yamaji K, Shirai S, Ando K. Percutaneous coronary intervention for delayed coronary obstruction due to endothelialization of self-expandable transcatheter heart valve: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-7. [PMID: 33426447 PMCID: PMC7780463 DOI: 10.1093/ehjcr/ytaa288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/05/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022]
Abstract
Background Coronary obstruction is one of the serious complications associated with transcatheter aortic valve implantation (TAVI). Delayed coronary obstruction (DCO) is a rare manifestation of coronary obstruction. Case summary A 91-year-old woman was diagnosed with severe aortic stenosis. She underwent TAVI with a self-expandable valve, without any complications. After 8 months, she was readmitted to our hospital for effort angina. Transthoracic echocardiogram and myocardial scintigraphy suggested left coronary artery ischaemia. Computed tomography revealed that the transcatheter heart valve (THV) frame was covered with a low-density mass that occluded the left coronary sinus (LCS). Transoesophageal echocardiogram showed a Doppler signal flowing from the non-coronary sinus to the LCS through the roundabout route between the aortic wall and the THV. Percutaneous coronary intervention was performed for the roundabout route. Although intravascular ultrasound after the implantation of one drug-eluting stent showed the underexpansion of the stent, another stent deployment improved the expansion. After the procedure, her symptom improved. Discussion Reportedly, the mechanism of DCO occurring months or years after TAVI is thought to be thrombus formation or THV endothelialization. In our case, the low-density mass was considered to be endothelium which developed along the THV frame. Low sinotubular junction height and higher THV position could be the underlying mechanisms of DCO. Percutaneous coronary intervention is a possible treatment option for DCO caused by THV endothelialization.
Collapse
Affiliation(s)
- Hiroshi Takiguchi
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| | - Kenji Ando
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan
| |
Collapse
|
5
|
Fukuhara S, Brescia AA, Shiomi S, Rosati CM, Yang B, Kim KM, Deeb GM. Surgical explantation of transcatheter aortic bioprostheses: Results and clinical implications. J Thorac Cardiovasc Surg 2020; 162:539-547.e1. [PMID: 32037245 DOI: 10.1016/j.jtcvs.2019.11.139] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) and worldwide interest in its implantation, TAVR valve explantation has not been well described. METHODS We retrospectively reviewed 1442 consecutive patients who underwent a TAVR procedure between 2011 and 2019, in which TAVR explantation was performed in 15 patients (1.0%). In addition, 2 patients from outside institutions also underwent TAVR explantation at our institution. We reviewed the clinical details of these 17 patients. RESULTS The frequency of TAVR explant increased over time from 0 to 1 during the period from 2011 to 2015 to 6 in 2019. The mean age was 73.0 ± 9.3 years. The majority of patients (88.2%) were in New York Heart Association functional class IV heart failure. The Society of Thoracic Surgeons Predicted Risk of Mortality score was significantly higher at the time of explantation than at the time of the original TAVR (3.5% vs 9.9%; P < .001). The indication for explantation included structural valve degeneration (23.5%), severe paravalvular leak (41.2%), TAVR procedure-related complications (23.5%), endocarditis (5.9%), and bridge-to-definitive surgery (5.9%). Neoendothelialization of the TAVR valve into the aortic wall requiring intense aortic endarterectomy was noted in all 5 of the TAVR valves older than 1 year, in which 2 (40%) required unplanned aortic root repair. There were 2 (11.8%) in-hospital mortalities. CONCLUSIONS Surgical TAVR valve explant is increasing and may become common in the near future. The clinical effects of explanting chronically implanted valves with the potential need for aortic repair is not negligible. These data should be used to more appropriately select TAVR candidates as TAVR practices expand into younger and lower risk patients.
Collapse
Affiliation(s)
- Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
| | | | - Suzuna Shiomi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Carlo M Rosati
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| |
Collapse
|
6
|
Shishido K, Yamanaka F, Noguchi K, Ota T, Fushimi T, Saito S. Novel Mechanism of Delayed Coronary Obstruction after Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis: "Uppercut Phenomenon". CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:79-84. [PMID: 31350193 DOI: 10.1016/j.carrev.2019.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/22/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
Delayed coronary obstruction is a rare complication after transcatheter aortic valve replacement (TAVR), and leads to a high in-hospital mortality rate. Here, we present a case of unpredictable delayed coronary obstruction in the left main trunk (LMT) after self-expandable device implantation because the left coronary height was enough over 15 mm. LMT obstruction was caused by a heavy calcification that was pushing up from the outside of the LMT, like an "uppercut" phenomenon. Stent-in-stent technique was a useful option for this type of LMT obstruction.
Collapse
Affiliation(s)
- Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takashi Ota
- Department of Anesthesiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takahiro Fushimi
- Department of Radiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| |
Collapse
|
7
|
Jabbour RJ, Latib A. The "new" syndrome of delayed coronary obstruction after transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:81-83. [PMID: 30314834 DOI: 10.1016/j.carrev.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
| |
Collapse
|