ENDOVASCULAR - Aorta Disease and Intervention
A Novel Snare Assisted Retrieval of Embolized Percutaneous Aortic Valve and Completion of Transcatheter Aortic Valve Implantation
Davinder Singh Chadha1, Keshava Murthy2
Manipal Hospital, India1, Army Hospital (Research & Referral), India2,
A 65-year-old gentleman, a diagnosed case of Primary Hypertension, Chronic Obstructive Pulmonary Disease (COPD), Chronic Kidney Disease (CKD)presented with progressive breathlessness on exertion. Clinically vitals were stable. Cardiovascular system examination revealed heaving apical impulseand reverse splitting of second heart sound. He had late peaking mid systolic murmur in right second intercostal space radiating to right carotid.Other systems were unremarkable.
ECG showed sinus rhythm with ST depression and T inversion in leads I, AVL, V5, V6.
Chest X Ray showed features of COPD
Echocardiography showed global left ventricular hypokinesia with Left Ventricular ejection Fraction (LVEF) 25%. Aortic Valve was calcified with maximum
gradient 48 and mean gradient 22 mmHg. There was no Aortic Regurgitation. There was concentric LVH and bi atrial enlargement. PA pressure was 60 mmHg.
Diagnosis - Severe Calcific Aortic stenosis with low flow low gradient
Aortic root angiography showed calcified Aortic Valve, No aortic regurgitation.
In view of severe LV dysfunction, Aortic Valve Balloon dilatation (AVBD) was done with 16 x 40 mm balloon in stage I.
Result was good.
Patient symptomatically improved but still was in NYHA class III.
LVEF improved from 25 % to 55% after AVBD. Now the mean gradient across aortic valve was 45 mmHg. 1 Aortogram (Converted).mov 2 AVBD pre implant (Converted).mov
Transcatheter Aortic Valve Replacement has been established as a viable alternative and unexpected complications and challenges are bound to emerge as more and more procedures are done. Meticulous assessment of aortic valve anatomy is the most important step in the success of the procedure. All the hardware listed for the procedure should be available on the shelf. Innovations in the cath lab are welcome but nothing should be done at the cost of patient safety.
Overall experience and expertise in handling catheters and complications go a long way in bailing out of tricky situations.