Case Studies
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Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:240-245
DOI: 10.12945/j.jshd.2018.008.18
Left Main Protection and Emergency Stenting During TAVR with Self-Expandable Valve
Marko Noc, MD, PhD1,2*, Branko Cveticanin, MD1,3, Saibal Kar, MD1,4, Oscar A. Mendiz, MD1,5
1 MC Medicor, Izola, Slovenia
2 Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
3 Department of Radiology, General Hospital Izola, Izola, Slovenia
4 Cardiovascular Intervention Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States
5 Interventional Cardiology Department, Cardiology & Cardiovascular Institute. Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
Abstract
Left main (LM) obstruction is rare but life-threatening complication of transcatheter aortic valve replacement (TAVR) which occurs by displacement of left coronary leaflet toward the ostium or by direct occlusion by the covered skirt of the prosthesis. We report an 88- year old lady with severe aortic stenosis, short distance from annulus to left main origin, shallow/low sinus of Valsalva, and calcification of the left aortic leaflet undergoing TAVR with a self-expandable valve. Instead of recently described “Chimney” stenting with protrusion of a very long stent segment from LM above the prosthesis leaflets and behind the valve frame, a “T-stenting” with stent protrusion only into the left sinus Valsalva was used to secure the LM patency.
Video 1
Aortogram before complete valve deployment. Both coronary arteries are well perfused.
Video 2
Aortogram with decreased left compared to right coronary flow after complete valve deployment despite moving of the stent from LAD back to the guiding catheter.
Video 3
Injection through the guiding catheter revealed a mass protruding toward the LM ostium.
Video 4
Stent deployment from the LM toward the valve frame.
Video 5
Post procedural guide injection showed widely patent LM, LAD and left circumflex artery with normal flow.
Video 6
Final aortogram with comparable left and right coronary flow.
Cite this article as: Noc M, Cveticanin B, Kar S, Mendiz OA. Left Main Protection and Emergency Stenting During TAVR with Self-Expandable Valve. Structural Heart Disease 2018;4(5):240-245. DOI: 10.12945/j.jshd.2018.008.18
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Case Studies
Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:240-245
DOI: 10.12945/j.jshd.2018.008.18
Left Main Protection and Emergency Stenting During TAVR with Self-Expandable Valve
Marko Noc, MD, PhD1,2*, Branko Cveticanin, MD1,3, Saibal Kar, MD1,4, Oscar A. Mendiz, MD1,5
1 MC Medicor, Izola, Slovenia
2 Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
3 Department of Radiology, General Hospital Izola, Izola, Slovenia
4 Cardiovascular Intervention Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States
5 Interventional Cardiology Department, Cardiology & Cardiovascular Institute. Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
Abstract
Left main (LM) obstruction is rare but life-threatening complication of transcatheter aortic valve replacement (TAVR) which occurs by displacement of left coronary leaflet toward the ostium or by direct occlusion by the covered skirt of the prosthesis. We report an 88- year old lady with severe aortic stenosis, short distance from annulus to left main origin, shallow/low sinus of Valsalva, and calcification of the left aortic leaflet undergoing TAVR with a self-expandable valve. Instead of recently described “Chimney” stenting with protrusion of a very long stent segment from LM above the prosthesis leaflets and behind the valve frame, a “T-stenting” with stent protrusion only into the left sinus Valsalva was used to secure the LM patency.
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Cite this article as: Noc M, Cveticanin B, Kar S, Mendiz OA. Left Main Protection and Emergency Stenting During TAVR with Self-Expandable Valve. Structural Heart Disease 2018;4(5):240-245. DOI: 10.12945/j.jshd.2018.008.18
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