CT-GUIDED VALVULOPLASTY FOR ELEVATED AORTIC GRADIENT AFTER TAVR
Tématický okruh: Vrozené vady | |
| Typ: Poster - lékařský , Číslo v programu: 160 | |
| Brázdil V.1, Garot P.2, Ndao S.2, Akodad M.3, Benamer H.2, Champagne S.2, Garot J.2, Hovasse T.2, Unterseeh T.2, Laforgia P.2, Neylon A.4, Sanguineti F.2 1 Interni kardiologická klinika, FN Brno a LF MU, Brno, 2 Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France, 3 Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, 4 Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier | |
A 73-year-old female with severe aortic stenosis presented with dyspnea. After CT analysis, the Heart Team recommended Transcatheter Aortic Valve Replacement with the ACURATE neo2 valve. Pre-dilatation was performed as planned. Post-implantation echocardiography confirmed proper valve placement, but a persistent mean gradient of 26 mmHg remained. Post-dilatation was decided, but during the procedure, the left ventricular wire was accidentally removed. Despite multiple attempts using recrossing techniques, it was impossible to avoid passing the pigtail catheter behind the stabilizing arches, risking valve migration during balloon retrieval. After several unsuccessful attempts, the patient became hemodynamically unstable, with signs of pericardial effusion, likely due to LV wire perforation, necessitating emergency drainage. The patient recovered quickly and was discharged. Due to continued symptoms and the elevated gradient, we decided to attempt late dilatation of the prosthesis. Post-TAVR CT was crucial for evaluating the prosthesis and planning the post-dilatation procedure. CT imaging revealed a stabilizing arch protruding into the aortic lumen, which had previously obstructed recrossing. Detailed CT analysis provided the optimal view of the protruding arch, allowing safe and efficient recrossing. Using the best projection data, recrossing was successfully completed. The free side-to-side movement of the wire between the overlapping and isolated stabilizing arch confirmed the wire was not trapped. After successful post-dilatation, the final gradient was reduced to 16 mmHg, with improved prosthesis expansion on CT. Post-TAVR CT played a key role in identifying the cause of the complication, detecting the under-expanded prosthesis, confirming the need for post-dilation, and determining the safest method for reattempting valve post-dilatation. | |
