It’s Never too Late: Late-Stage Aortic Stenosis Treated With Transcatheter Aortic Valve In A Patient With Significant Aortic Root Enlargement With Measurements Beyond Those Recommended By The Valve Manufacturers

Abstract

A patient with severe calcific bicuspid aortic valve stenosis, revealed by Transthoracic Echocardiogram (TEE), was markedly symptomatic with recurrent decompensation of diastolic heart failure. TEE also revealed moderate insufficiency with large annulus measurements beyond the parameters of currently available valve prostheses. Most valve companies initially declined to provide their device due to the size mismatch, raising concern about valve embolization and potential residual paravalvular leak (PVL). Ultimately, we decided that the calcification in both leaflets may be able to hold onto a 29 mm Edwards-SAPIEN valve, and after a prolonged informed consent the patient was considered for TAVR.