血管医学および外科ジャーナル

概要

Complicated Case for Tavi-off-Label Indication

Diana Trendafilova, Julia Jorgova, Dimitar Petkov and Gencho Nachev

This report describes the case of a 76-year-old female with reconstruction of the ascending aorta without aortic valve replacement in 2003 due to Type-Aaortic dissection .One year later she was diagnosed withsevere aortic regurgitation up to III degree. The last 3-4 years, the patient developed heart failure with dyspnea and frequent admissions for congestive heart failure. After thorough multidisciplinary assessment between cardiologists and thoracic surgeons, TAVI was offered to the patient, who consented and accepted the risks of this intervention.The TAVI procedure was performed under general anesthesia. The left subclavian artery was chosen to introduce the valve prosthesis.Immediately after adjusting the prosthesisposition under fluoroscopyandreleaseditfrom the introduction system,the prosthesis dislocated in left ventriclewith huge aortic insufficiency.After unsuccessful attempts to reposition by pulling with a snare, a second valve –“ valve in valve”was implanted. The patient was dischargedon the 7 th day after procedure in stable clinical condition.

Conclusion : TAVI has to be considered as an alternative treatment option to conservative treatment in selective cases with aortic regurgitation, if the patients are inoperable and have a poor prognosis