Page 42 - Journal of Structural Heart Disease Volume 5, Issue 5

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Case Report
Figure 8. Stent balloon successfully snared and retrieved out of body.
The stent was successfully wired, dilating the su- perior entry strut. A 4.0 mm by 26 mm long stent ex- tending vertically to the THV/SAPIEN 3 frames was deployed at the level of the sinotubular junction. This was followed by intravascular ultrasound (IVUS) eval- uation, which revealed that the stent was undersized. The stent with a 5.0 mm non-compliant balloon was dilated and the procedure ended with a kissing left main. Balloon aortic valvuloplasty was performed us- ing a 5.0 mm coronary balloon and a 24 mm Z-MED balloon. This concluded with an excellent angio- graphic result (Figure 9). A year later the patient was seen in the office with no recurrent admissions to the
hospital or any cardiac events. Mean gradient across the THV valve was 14 mmHg following one year after the procedure.
Discussion
Transcatheter aortic valve replacement procedures are gaining more popularity with expanding indica- tions. TAVR is already an approved indication for a fail- ing surgical valve. Even though the TAVR procedure has become easier to perform with less complication rates, what remains critical is for the operators to be able to do a thorough analysis of the anatomy. In the case of the VIV procedure, both the structure of the surgical valve and the THV valve must be understood. One must have the ability to predict a complication and have a plan to manage it critically. Unpredicted complications can occur, such as the one reported in this case.
Retrospectively, the images reviewed at the end of the procedure showed an interaction occurred. This occurred during the inflation of the SAPIEN 3 stent valve balloon between the expanding SAPIEN 3 frame and the coronary stent catheter shaft. If noted during the procedure, it could have alerted to the fact that the coronary stent catheter shaft was coursing in-be-
Figure 9. Panel A. (A1) IVUS catheter in L main stent. (A2) Wire through superior strut of left main stent. Panel B. (B1) Second left main stent creating a chimney path course through a superior strut of the first stent. (B2) Wire through a superior strut of the first left main stent.
Kassas S. et al. Entrapment of Coronary Stent Catheter in VIV/TAVR