Page 28 - Journal of Structural Heart Disease Volume 3, Issue 4

Case Report
Journal of Structural Heart Disease, August 2017, Volume 4, Issue 3:115-118
DOI: https://doi.org/10.12945/j.jshd.2017.015.16
Received: November 24, 2016 Accepted: January 02, 2017 Published online: August 2017
Transcatheter Aortic Valve Replacement for Inoperable Severe Rheumatic Aortic Stenosis with Prior Mitral Valve Prosthesis
Imad A. Alhaddad, MD, FACC, FACP
The Cardiovascular Center, Jordan Hospital, Amman, Jordan
Abstract
Transcatheter aortic valve replacement (TAVR) is tradi- tionally indicated for calci c aortic stenosis. Rheumat- ic aortic valve disease is treated surgically due to the younger age of patients and a lack of signi cant calci - cation that can anchor transcatheter valves. However, severe comorbidities may increase surgical risk, neces- sitating less invasive therapeutic modalities. Here, we present the rst case report of severe rheumatic aortic stenosis with prior mechanical mitral valve prosthe- sis and liver cirrhosis that was successfully treated by TAVR.
Copyright © 2017 Science International Corp.
Key Words:
Aortic stenosis • Rheumatic valve disease • Mitral valve prosthesis • Transcatheter aortic valve replacement
Introduction
Transcatheter aortic valve replacement (TAVR) has become the procedure of choice for treating inopera- ble and high surgical risk patients with calci c degen- erative severe symptomatic aortic stenosis [1, 2, 3, 4, 5, 6]. However, the utilization of TAVR for severe aortic stenosis caused by rheumatic valve disease is uncer- tain due to the lack of signi cant calci cation neces- sary to anchor transcatheter valves. Here, we report a case of severe rheumatic aortic stenosis with prior mechanical mitral valve prosthesis and high surgical
risk related to liver cirrhosis that was treated success- fully with TAVR.
Case Presentation
A 62-year-old woman with rheumatic heart disease and chronic atrial brillation underwent mitral valve replacement using a mechanical valve prosthesis in 1991. The surgery was complicated by hepatitis C re- sulting from the recent development of liver cirrho- sis. The patient presented with progressive dyspnea, orthopnea, and severe uid overload consistent with class IV congestive heart failure. Diagnostic evalu- ation revealed severe aortic stenosis and tricuspid valve regurgitation, and she was referred for surgical aortic valve replacement and tricuspid valve repair. Hepatology evaluation suggested very high surgical risk due to chronic liver disease. Thus, she was re- ferred for TAVR in the face of high surgical risk [7, 8].
Echocardiography revealed a D-shape septum with a left ventricular ejection fraction of 50%, dilated left atrium and huge right atrium, and mildly dilated right ventricle with hypertrophy and normal systolic func- tion. The aortic valve was brotic without signi cant calci cation (consistent with rheumatic disease) with severe aortic stenosis and mild to moderate aortic re- gurgitation (annulus 20 mm, peak gradient 65 mmHg, mean gradient 42 mmHg, and calculated aortic valve area = 0.8 cm2). The mechanical mitral valve prosthesis was functioning well, and the tricuspid valve exhibited
* Corresponding Author:
Imad A. Alhaddad, MD, FACC, FACP
The Cardiovascular Center
Jordan Hospital
Queen Nour Street, Amman, Jordan
Tel.: +962 656 26197; Fax: +962 656 26198; E-Mail: alhaddad63@gmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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