1 / 9

CoreValve – ICE Awards Italian CoreValve Experts

Balloon valvuloplasty after Transcatheter Aortic Valve Implantation (TAVI): always safe? Dr Salvi A, Dr Fabris E, Dr Perkan A Cardiovascular Department, Ospedali Riuniti and University of Trieste, Italy. CoreValve – ICE Awards Italian CoreValve Experts. Dati Basali.

barbra
Download Presentation

CoreValve – ICE Awards Italian CoreValve Experts

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Balloon valvuloplasty after Transcatheter Aortic Valve Implantation (TAVI): always safe? Dr Salvi A, DrFabris E, DrPerkan A Cardiovascular Department, OspedaliRiuniti and University of Trieste, Italy CoreValve – ICE AwardsItalianCoreValveExperts

  2. Dati Basali • 82 year old man • Referred to our Center for a severe symptomatic aortic stenosis • Selected by the Heart Team for TAVI because of a high surgical risk (log. EuroSCORE 21%) • Diameters of the aortic annulus (on computed tomographic) were 32 x 22 mm, the perimeter was 87 mm • A 31 mm CoreValve™ prosthesis (Medtronic, Minneapolis, MN, USA) was selected

  3. Sheath cover retracting under fluoroscopic guidance Intervento • Femoral access with a 18 Frsheath • Stiff guidewire was placed in the left ventricle • Prosthesis was advanced across the stenotic valve without prior Balloon Valvuloplasty

  4. Intervento Release of the prosthesis The position of the CoreValve™ seemed optimal with the distal end 5 mm below the “angiographic” annulus

  5. Difficoltà incontrate • Good placement but compression of the distal part of the prosthesis • Presence of significant aortic regurgitation

  6. Soluzione scelta Balloonvalvuloplasty (BV) during rapid pacing • We performed a BV with a Cristal Balloon 28x50 (Balt, Montmorency, France). • The balloon was advanced across the valve and was inflated and deflated during rapid pacing

  7. Immagini post-operatorie Angiography after balloon deflation: acute dislocation of the prosthesis The valve showed an appropriate expansion but hadmoved upwards now with the distal part ending apparently just above the “angiographic” annulus

  8. The valve seemed anchored without further upward movements • The patient was stable • Systolic gradient was absent • Final angiography showed only a mild AR • A persistent good result was documented at follow up echo after two weeks

  9. Conclusioni • In our case a post implantation balloon valvuloplasty (BV) caused an acute accidental dislocation of CoreValve™ with potential risk of valve embolization • BV after CoreValve™ implantation performed without a prior dilatation is an effective procedure but it may cause accidental movements of the prosthesis despite a meticulous technique • This may be relevant because the strategy of performing TAVI without balloon predilatation is becoming common

More Related