Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-202
TAVR With Horizontal Aorta and Suicidal Left Ventricl
By Siddharth Bajaj, P.C Rath, Rufus Demel, Manoj Kumar Agarwala
Presenter
Siddharth Bajaj
Authors
Siddharth Bajaj1, P.C Rath1, Rufus Demel1, Manoj Kumar Agarwala1
Affiliation
Apollo Hospitals, India1,
View Study Report
TCTAP C-202
STRUCTURAL HEART DISEASE - Valvular Intervention: Aortic
TAVR With Horizontal Aorta and Suicidal Left Ventricl
Siddharth Bajaj1, P.C Rath1, Rufus Demel1, Manoj Kumar Agarwala1
Apollo Hospitals, India1,
Clinical Information
Patient initials or Identifier Number
TBSR
Relevant Clinical History and Physical Exam
76 years gentleman hypertensive, Parkinson's disease, presented to the hospital with breathlessness on minimal exertion and orthopnoea. His ECG revealed left ventricular hypertrophy and 2D echocardiography revealed left ventricular hypertrophy with severe calcified Aortic Stenosis with Peak pressure gradient of 83 mm Hg and Mean gradient of 46 mm Hg .
Relevant Test Results Prior to Catheterization
CT TAVR -
Tricuspid Aortic Valve , mild aortic valve calcification
Sinus of Valsalva - Height - 9.9 mm , Left - 33.7 , Right - 32.3 , Non - 33.8
Aortic Annulus - avg - 21.1 mm , Perimeter - 65.9 mm , Perimeter derived Annulus size - 21 mm
LVOT - 20.0 mm
RCA Height - 18.0 mm , LCA Height - 14.6 mm
Horizontal Aorta - Aorta - LVOT angle - 65 degrees
Severe Calcification observed at Arch of Aorta
Adequate Femoral artery size
hemoglobin - 13.1 gm/dl , serum creat - 0.74 mg/dl
Relevant Catheterization Findings
Coronary Angiogram - Ectatic RCA with Slow flow , Ectatic LAD with Slow flow and Mild disease in LCXLV Aorta gradient - 90 mm Hg
Interventional Management
Procedural Step
Primary Access - Right femoral artery - 6F sheath upgraded to 14 F SheathLeft Femoral Artery - For Pig tail , Left femoral vein - For Temporary PacemakerAfter vascular access and securing the Temporary Pacemaker at the Rv Apex - 6F Perclose Proglide suture was positioned Aortic valve was crossed with AL Catheterv and 0.035 wire was exchanged for Confida wire.Predilatation was done with 18mm x 40 mm Zumed balloon.A 26 mm EvoluteR Core Valve was positioned in the cusp overlap viewed slowly released with pacing at 120/min.Patient developed acute pulmonary oedema and became hypotensive - he was intubated Intraprocedure TEE and angiogram showed a well seated prosthetic valve with no paravalvular leak , No Aortic regurgitation , No pericardial effusion, no coronary obstruction and no access site complications.His Mean arterial pressure remained low around 50 inspite of ionotropes.Bed side TEE revealed a hyperdynamic LV with obliteration of mid-distal cavity.Patient was managed with aggressive fluid administration and over a period of 24 hours the blood pressure imposed and ionotropes were weaned off.
Case Summary
Suicidal left ventricle is a rare but dreaded com[plication post TAVR in patients with severe Aortic Stenosis due to severe concentric LVH , small LV Cavity and chronic pressure overload where once the fixed obstruction is relieved the increased lV contactility is unmasked.
A detailed pre procedure planning and heart team meet regarding the anatomy and potential complications is important.
In a challenging anatomy two experienced operators can make a difference in event of any complication.
A self expanding valve is an effective and feasible tool in Horizontal aorta with less complication.