Page 27 - Journal of Structural Heart Disease Volume 4, Issue 2

Case Report
48
Video 11. TTE 2D short axis view of the aortic valve upon fol- low-up after the procedure demonstrating progressive peri- valvular regurgitation. View supplemental video at https://doi. org/10.12945/j.jshd.2018.042.17.vid.11.
Video 13. Balloon dilation of the Sapien 3 valve using a 24- mm VIDA balloon. View supplemental video at https://doi. org/10.12945/j.jshd.2018.042.17.vid.13.
Video 12. Aortic root angiogram in the lateral projection 10
months post-initial valve deployment demonstrating down-
ward migration of the valve and severe perivalvular regurgita-
tion. View supplemental video at https://doi.org/10.12945/j. doi.org/10.12945/j.jshd.2018.042.17.vid.14. jshd.2018.042.17.vid.12.
ated the procedure well, and follow-up echocardiog- raphy 4 months post-procedure demonstrated mild perivalvular regurgitation and stable valve position (Figure 3; Videos 15 and 16).
Discussion
TAVR in the ACHD population has been mostly limited to patients with calci c stenotic BAV. Initially, some studies showed a higher risk of perivalvular re- gurgitation in BAV TAVR with earlier generation valves including the CoreValve (Medtronic Inc, Minneapolis, MN, USA) and Sapien XT (Edwards Lifesciences) [1]. In later studies, however, this risk was mitigated with the use of newer generation valves such as the Lotus (Boston Scienti c, Marlborough, MA, USA) and Sa-
pien-3 (Edwards Lifesciences), which have a sealing system that decreases perivalvular regurgitation [2]. Nevertheless, the use of TAVR in the ACHD population has been scant, and many patients present with pre- dominant AR without calci cation. The present case illustrates the bene ts and potential pitfalls of TAVR in an ACHD patient with primary AR. Although the he- mashield graft served as an anchor for valve deploy- ment well below the coronary artery buttons, there was evidence of gradual downward migration and development of severe perivalvular regurgitation despite initial valve placement at nominal balloon volume, indicating a potential role for deployment at greater than nominal volumes and the importance of adequate post-dilation. Several newer generation transcatheter valves are currently in preclinical or ear-
Video 14. Aortic root angiogram post-dilation demonstrating better apposition of the Sapien 3 valve and only mild residual perivalvular regurgitation. View supplemental video at https://
Journal of Structural Heart Disease, April 2018
Volume 4, Issue 2:42-49