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Transcatheter Aortic Valve Implantation (Edwards SAPIEN XT Valve) with Peripheral Balloon Angioplasty
- Operator : Seung-Jung Park
Transcatheter Aortic Valve Implantation (Edwards SAPIEN XT Valve) with Peripheral Balloon Angioplasty |
- Operator: Seung-Jung Park, MD |
Case Presentation |
An 86 years-old gentleman was admitted with dyspnea on exertion (NYHA class III-IV). He has a past medical history of hypertension, and old MI. He has history of balloon PTA at right internal iliac artery and stent insertion at the left common iliac artery. His logistic EuroSCORE was 27.82%. His coronary angiography showed mild coronary disease. First, we recommended open heart surgery but patient refused. |
Echocardiographic Findings |
1. Transthoracic echocardiography showed severe degenerative AS, noderate to severe AR, and concentric LVH with normal LV systolic function (EF=72%). AV area by continuity equation was 0.62 cm©÷. TransAV maximal velocity was 4.8 m/s. Mean and peak pressure gradient were 91 and 53 mmHg. 2. Transesophageal echocardiography showed the opening limitation of AV because of severe calcification and degenerative thickening. Her AV was tricuspid and annulus size by TEE was 21mm (Figure 1, Figure 2). |
CT Findings |
1. Annulus size by CT was 24.70 - 28.04 mm and perimeter was 83.5mm and Aunnulus area was 509.6 mm2 (Figure 3, Figure 4, Figure 5). 2. Distance from annulus to LM and RCA ostium was 12.8 and 12.1 mm, respectively (Figure 6, Figure 7). There were stenosis in right common iliac artery, and the minimal diameter was 3.11 mm (Figure 8, Figure 9). And the stent in left common iliac artery was crushed at proximal portion. So both iliac arteries were not enough to access. Therefore we decided to perform PTA just before TAVI prodecure. |
Procedure |
Because the annulus size by TEE and CT was 24.70 - 28.04 mm and annulus area by CT was 509.6 mm2, we selected the 26mm Edwards SAPIEN XT valve for implantation. Under general anesthesia, 6 Fr sheath and temporary pacemaker were inserted through left femoral vein, and 7 Fr sheath was were inserted through left femoral artery. And we tried to advance 6 Fr pig-tail catheter, but it was not possible. So we checked the left peripheral aniogram. It showed moderate stenosis at the left common iliac artery ( |
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