Page 30 - Journal of Structural Heart Disease Volume 4, Issue 1

Case Report
Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:21-27
DOI: https://doi.org/10.12945/j.jshd.2018.038.17
Received: August 22, 2017 Accepted: September 13, 2017 Published online: February 2018
Non-TAVR Bailout for Acute Severe Aortic
Regurgitation After Balloon Aortic Valvuloplatsy
by Using Fogarty® Catheter
Ikki Komatsu, MD1*, Hirotsugu Mitsuhashi, MD, PhD1, Joji Ito, MD2
1 Department of Cardiology, St. Luke’s International Hospital, Heart Center, Tokyo, Japan
2 Department of Cardiovascular Surgery, St. Luke’s International Hospital, Heart Center, Tokyo, Japan
Abstract
Acute severe aortic regurgitation (AR) after balloon aortic valvuloplasty (BAV), which rarely occurs, can cause catastrophic deterioration of a patient's hemo- dynamics. The emergent conversion of transcatheter aortic valve replacement (TAVR) or open heart surgery can be considered as bailout procedures for this situa- tion; however, these are not ideal or safe options. We developed a novel bailout method for acute AR with- out TAVR or surgical conversion. The patient was an 82-year-old woman with severe aortic stenosis who had been treated for interstitial pneumonia for more than 10 years and in whom BAV was scheduled for worsening dyspnea. Through BAV performed using a retrograde approach with an 18-mm balloon, we treated the entrapment of the non-coronary lea et, the vital sign of which had deteriorated due to severe AR. We attempted to manipulate a pigtail catheter to push back the entrapped lea et; however, the attempt failed. Next, we advanced a Fogarty catheter into the space between the wall of the sinus of Valsalva and the entrapped non-coronary lea et with the aim of push- ing it back. In ating the balloon restored the lea et movement, which successfully reduced AR and ob- tained hemodynamic stability. This procedure success- fully avoided further invasive bailout procedures. Copyright © 2018 Science International Corp.
Key Words
Balloon aortic valvuloplasty • Complication • Acute aortic regurgitation • Bailout procedure • Transcatheter
Introduction
Balloon aortic valvuloplasty (BAV) was the only interventional therapeutic option for patients su er- ing from severe aortic stenosis (AS) for whom open heart surgery is not indicated. With the emergence of transcatheter aortic valve replacement (TAVR) as an alternative treatment option for such situations, the indications for BAV as a bridging therapy for TAVR have expanded.
Acute aortic regurgitation (AR) is a rare complica- tion of BAV that is reported as to occur in 0.8–1.5% of all procedures [1-2]. This complication is clinically important, as a sudden hemodynamic collapse can lead to a fatal outcome. However, the risk of AR is dif- cult to predict before BAV, and emergent actions are therefore required. The emergent conversion of TAVR or open heart surgery can be considered as bailout procedures for this situation [3-4]. However, these are not ideal or su ciently safe, as they require additional manpower, preparation time, and availability of valve devices. Furthermore, it is obviously not adequate for institutions without experience to rapidly switch and
* Corresponding Author:
Ikki Komatsu, MD
Department of Cardiology
St. Luke’s International Hospital, Heart Center
9-1 Akashicho, Chūō, Tokyo, 104-8560, Japan
Tel.: +81 3 3541 5151; Fax: +81 3 3541 5151; E-Mail: ikki2002@msn.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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