Transcatheter Release of a Stuck Mechanical Valve in Aortic Position With Cerebral Embolic Protection

Abstract

A 69-year-old man underwent aortic valve replacement (AVR) in 2000 with a 21-mm tilting disc valve. Nineteen years later, he underwent redo AVR with a 20-mm ATS AP360 valve (Medtronic) for a pannus ingrowth and an increased gradient. Three years after the second surgery, the patient presented with subacute onset of dyspnea on exertion. The international normalized ratio was 2.1. A transthoracic echocardiogram showed a mean gradient of 91 mm Hg with grade II valvular leak across the aortic mechanical valve without a thrombus.