Abstract
We describe the case of a degenerative, sutureless bioprosthetic valve (BPV) with deformation and stent infolding in a patient with elevated surgical risk. Following discussion among the heart team, balloon valve fracture was performed to facilitate deployment of an aortic valve-in-valve transcatheter heart valve. Post-procedural imaging demonstrated BPV frame protrusion and contained annular rupture, which required operative intervention. (Level of Difficulty: Intermediate.)
Highlights
A n 81-year-old female presented with New York Heart Association functional class III symptoms of breathlessness
Following review of the imaging and clinical history, the heart team consensus was to proceed with aortic valve-in-valve transcatheter heart valve (THV) implantation using a 23-mm Sapien S3 (Edwards Lifesciences, Irvine, California) and previous fracture of the distorted bioprosthetic valve frame
The valve-in-valve procedure was performed through the transfemoral route under transesophageal echocardiographic (TEE) guidance
Summary
A n 81-year-old female presented with New York Heart Association functional class III symptoms of breathlessness. She had undergone implantation of a 19-mm Perceval (LivaNova, Markham, Ontario, Canada) sutureless bioprosthetic valve (BPV) 2 years previously for high-risk severe native aortic stenosis. Computed tomography (CT) demonstrated stent infolding and collapse (Figure 1A). Transthoracic echocardiography confirmed degenerative BPV failure with severe valvular and paravalvular aortic regurgitation [1].
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