Author + information
Patient initials or identifier number
Case1: MT, Case2: TT, Case3: KH
Relevant clinical history and physical exam
This is an 84-year-old man with HT and COPD.
This is an 89-year-old woman with HT.
This is a 79-year-old man with HT, DM, Hyperuricemia and CKD.
They are found to have symptomatic aortic stenosis. Transfemoral transcatheter aortic valve implantation was planned.
Relevant test results prior to catheterization
Echo confirmed severe AS (AVA=0.61 cm square) with LVH and EF of 54%, trivial MR, and moderate AR. CT-derived aortic annulus area was 347 mm.
Echo confirmed severe AS (AVA= 0.67 cm square) with LVH and EF of 61%, moderate MR, and trivial AR. CT-derived aortic annulus area was 370 mm.
Echo confirmed severe AS (AVA=0.84 cm square) and EF of 62%, moderate MR/AR, and PHT. CT-derived aortic annulus area was 402 mm.
Relevant catheterization findings
Coronary CT showed patent coronary arteries. His Logistic Euro Score for open heart surgery was 14.23%.
Coronary CT showed patent coronary arteries. Her Logistic Euro Score for open heart surgery was 8.37%.
Coronary CT showed patent coronary arteries. His Logistic EuroSCORE for open heart surgery was 10.63%.
All patients were operated under ETGA with TEE guidance. Transfemoral valve implantation performed by surgical dissection of the femoral artery. A transient pacemaker wire placed transvenously. Under fluoroscopy control, the prosthesis crimped on the delivery catheter, placed in the aortic annulus. The Core Valve prosthesis then gradually released on the beating heart. Details of the implantation procedures described previously. Prosthesis function assessed by angiography and intraoperative transesophageal echocardiography.
In case 1, a completely deployed CoreValve prosthesis dislocated into the ascending aorta, and a second prosthesis implanted in the correct annular position within the first prosthesis.
In Case 2, a partially deployed CoreValve prosthesis dislocated into the ascending aorta, and it could be treated by retrieval of the partially deployed prosthesis through the introducer sheath and a second prosthesis was implanted in the correct annular position.
In case 3, a partially deployed CoreValve prosthesis dived into LV, and it could be retracted into the descending aorta, and a second prosthesis was implanted in the correct annular position.
Prosthesis dislocation during TAVI is a rare but serious complication. It managed effectively by implanting the second device and leaving the dislocated device safely in the aorta or complete retrieval of the valve.