Page 21 - Journal of Structural Heart Disease Volume 4, Issue 2

Case Report
Journal of Structural Heart Disease, April 2018, Volume 4, Issue 2:42-49
DOI: https://doi.org/10.12945/j.jshd.2018.042.17
Received: October 18, 2017 Accepted: November 28, 2017 Published online: April 2018
Transcatheter Aortic Valve Replacement in Transposition of the Great Arteries Following Arterial Switch Operation
Joanna Ghobrial, MD, MSc1*, Eric H. Yang, MD2, Olcay Aksoy, MD2, William Suh, MD2,
Jamil Aboulhosn, MD1, 2
1 Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, Los Angeles, California, USA
2 Division of Cardiology, University of California, Los Angeles, Los Angeles, California, USA
Abstract
Transcatheter aortic valve replacement (TAVR) for the treatment of congenital heart disease has been mostly limited to patients with bicuspid aortic valve stenosis. We present a case of a 19 year old Jehovah's witness patient with D-Transposition of the great ar- teries (D-TGA) who underwent an arterial switch opera- tion, followed by a valve sparing aortic root repair with a hemashield graft, who later developed severe aortic valve regurgitation and successfully underwent a tran- scatheter aortic valve replacement (TAVR) with the Ed- wards Sapien-3 valve.
Copyright © 2018 Science International Corp.
Key Words
Transcatheter Aortic Valve Replacement (TAVR) • Transposition of the Great Arteries (TGA) • Arterial Switch Surgery
Introduction
The minimally invasive technique of transcatheter aortic valve replacement (TAVR) may be ideal for the growing population of adult congenital heart disease (ACHD) patients, many of whom may be at increased risk of adverse events associated with surgical valve
replacement. TAVR has had limited application in the ACHD population to this point, mostly utilized for the treatment of bicuspid aortic valve (BAV) stenosis or valve-in-valve replacement of dysfunctional aortic bioprostheses. Aortic stenosis or aortic regurgitation (AR) in ACHD patients may be due to isolated valvular abnormality such as BAV or as a component of addi- tional congenital anomalies such as hypoplastic left heart syndrome. Both aortic stenosis and AR can oc- cur following aortic valve repair or replacement with bioprostheses, homografts, or pulmonary autografts as in the Ross procedure or in arterial switch opera- tions. We herein present a case of TAVR in an ACHD patient with D-transposition of the great arteries (D-TGA) post status arterial switch and subsequent valve sparing aortic root repair with resultant severe AR.
Case Presentation
A 19-year-old woman of Jehovah’s Witness faith with D-TGA, membranous ventricular septal defect, and subpulmonic stenosis underwent a right modi- ed Blalock-Taussig-Thomas shunt and Blalock-Han- lon atrial septectomy at 1 year of age; arterial switch operation, sub-pulmonic stenosis resection, and atri-
* Corresponding Author:
Joanna Ghobrial, MD, MSc
Heart and Vascular Institute
Cleveland Clinic Foundation
9500 Euclid Avenue/J2-4, Cleveland, OH 44195, USA
Tel. +1 216 444 5923; Fax: +216 445 6163; E-Mail: joannaghobrial@gmail.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
Accessible online at:
http://structuralheartdisease.org/