Author + information
- Akimitsu Tanaka1
Patient initials or identifier number
Relevant clinical history and physical exam
A 82 year-old man came to our hospital with a complaint of shortness of breath.
Echocardiography revealed severe aortic stenosis.
His height is 156 cm
His weight is 46kg
His past history is hypertension and post cerebral infarction
And his STS score is over 4 and we decided to perform TAVI.
Relevant test results prior to catheterization
The CT findings showed that his anulas area is 439 mm2, perimeter is 75.3 mm.
His left and right coronary height is enough and his sinus of valsalva is wide enough.
And his iliac artery is enough thick for trans-femoral approach TAVI.
Relevant catheterization findings
We performed trans-femoral approach TAVI with Corevalve under general anesthegia.
We deployed Corevalve 29 mm without any trouble.
After deploying Corevalve with the Safariwire, we checked paravalvular leak by transesophageal echocardiography.
An Echocardiologist judged aortic valve regurgitation was moderate. So we decided to add post-dilatation. But it was necessary for us to reinsert the wire because we had already pull outside from left ventricle.We cross the wire through Corevalve again .And then, we insert 20 mm balloon catheter and by using that, dilated his aortic annulus. After that, we were going to finish the procedure, however, we couldn’t pull out the balloon catheter because it was stuck to Corevalve strut. We noticed that the wire crossed through Corevalve strut for the first time at this point. What should we do next? At first, we pulled it with vibration to change the direction of shaft thorough strut and repeated balloon inflation and deflation gently. But it was failed. Next, we exchange the Safari wire to softer Radi focus wire plus repeated balloon inflation and deflation.
There by, we could pull it out to some extent, but we couldn’t finish pulling it out completely.Then we inserted another balloon we usually used when we perform TEVAR. The aim was to change the direction of the tip of balloon catheter stuck to strut and to lock Corevalve because we were afraid of migration.In addition to this method, we pull with vibration during repeated balloon inflation and deflation. And finally, we succeeded to removed the stuck balloon catheter without Corevalve migration.
The situation of balloon stuck to Corevalve strut like this case may be rare, but it can happen because of structure of Corevalve.
To know this bailout procedure is useful for us interventional cardiologists.