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Lots of interesting abstracts and cases were submitted for TCTAP 2024. 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-212

Valve-In-Valve TAVR in a Patient of Degenerated Trifecta-21 With Severe Aortic Regurgitation and History of Implantation of AAA Stent Graft for Abdominal Aortic Aneurysm

By Debdatta Bhattacharyya, Manik Chopra, Snehil Goswami

Presenter

Snehil Goswami

Authors

Debdatta Bhattacharyya1, Manik Chopra2, Snehil Goswami3

Affiliation

R N Tagore Hospital Mukundapur, India1, NH-Rabindranath Tagore International Institute of Cardiac Sciences, India2, NH MMI Hospital, India3,
View Study Report
TCTAP C-212
Structural - Aortic Valve Intervention - Valve in Valve TAVR

Valve-In-Valve TAVR in a Patient of Degenerated Trifecta-21 With Severe Aortic Regurgitation and History of Implantation of AAA Stent Graft for Abdominal Aortic Aneurysm

Debdatta Bhattacharyya1, Manik Chopra2, Snehil Goswami3

R N Tagore Hospital Mukundapur, India1, NH-Rabindranath Tagore International Institute of Cardiac Sciences, India2, NH MMI Hospital, India3,

Clinical Information

Patient initials or Identifier Number

Relevant Clinical History and Physical Exam

 A 77 year old gentleman presented with severe shortness of breath (NYHA III) with recent history of recurrent hospital admissions (3 episodes) with heart failure. On examination, he was average built, conscious co-operative with bounding regular pulse and  a wide pulse pressure (BP: 126/40mmHg). His cardiovascular examination revealed a high pitched decrescendo diastolic murmur.  Chest examination did not have any significant findings. 

Relevant Test Results Prior to Catheterization

His 12 lead ECG  showed sinus rhythm without any conduction abnormalities.  ECHO revealed a bioprosthetic valve at aortic position with degenerative changes of the leaflets and severe transvalvular aortic regurgitation. CT analysis (TAVI Protocol) revealed aortic annulus  20.3mm in diameter, the annulus to LCA Height was 10.6mm, RCA height was 7.1mm. Iliofemoral analysis showed adequate sized peripheral arteries with tortuous femoral and external iliac arteries and a AAA graft .The SOV were large .


Relevant Catheterization Findings

Aortogram  showed the Trifecta valve frame and severe AR . The aortic pressure confirmed the presence of AR .

Interventional Management

Procedural Step

Fluoroscopy guided femoral artery puncture was carried out . The aortic valve was crossed and the wire exchanged over a pigtail catheter to a SAFARI extra small wire. Pre-deployment aortogram revealed severe aortic regurgitation with aortic pressure of 110/16mmg (invasive).  a 21.5 mm MYVAL was deployed at the implanters view  in the lao caudal projection .Post deployment, there was no aortic regurgitation with significant improvement in the aortic diastolic pressure (110/60 mmHg).There was no evidence of coronary occlusion. Although the coronary heights were low we were confident that due to the large Sinus of Valsalva dimensions and the VIRTUAL VALVE TO CORONARY DISTANCE , the risk of occlusion was minimal. 

Case Summary

Current surgical bioprosthetic valves in the aortic position tend to degenerate after 8-10 years  resulting in severe AS or like in this case severe AR. Both balloon expandable and self expanding valves   have been used to treat ViV lesions. The Trifecta valve cannot be cracked with balloon dilatation; since the patient had pre-dominant AR and there was no evidence of patient prosthesis mismatch with the first valve with a 21mm TRIFECTA we concluded it would be safe to implant a 21.5 mm MYVAL as a valve in valve in this patient . Our conviction was borne out by the satisfactory gradient post procedure  which remained stable at 22/13 mm hg  at 3 months follow up.