Case Reports
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Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:21-27
DOI: 10.12945/j.jshd.2018.038.17
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 hemodynamics. The emergent conversion of transcatheter aortic valve replacement (TAVR) or open heart surgery can be considered as bailout procedures for this situation; however, these are not ideal or safe options. We developed a novel bailout method for acute AR without 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 leaflet, the vital sign of which had deteriorated due to severe AR. We attempted to manipulate a pigtail catheter to push back the entrapped leaflet; 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 leaflet with the aim of pushing it back. Inflating the balloon restored the leaflet movement, which successfully reduced AR and obtained hemodynamic stability. This procedure successfully avoided further invasive bailout procedures.
Cite this article as: Komatsu I, Mitsuhashi H, Ito J. Non-TAVR Bailout for Acute Severe Aortic Regurgitation After Balloon Aortic Valvuloplatsy by Using Fogarty® Catheter. Structural Heart Disease 2018;4(1):21-27. DOI: 10.12945/j.jshd.2018.038.17
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Case Reports
Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:21-27
DOI: 10.12945/j.jshd.2018.038.17
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 hemodynamics. The emergent conversion of transcatheter aortic valve replacement (TAVR) or open heart surgery can be considered as bailout procedures for this situation; however, these are not ideal or safe options. We developed a novel bailout method for acute AR without 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 leaflet, the vital sign of which had deteriorated due to severe AR. We attempted to manipulate a pigtail catheter to push back the entrapped leaflet; 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 leaflet with the aim of pushing it back. Inflating the balloon restored the leaflet movement, which successfully reduced AR and obtained hemodynamic stability. This procedure successfully avoided further invasive bailout procedures.
Supplemental Media
Video 1: Intracardiac echocardiography showing the entrapped non-coronary leaflet. Motion loss and entrapment of the non-coronary leaflet are observed.
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Video 2: Cineangiography showing inflation of the Fogarty catheter.
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Cite this article as: Komatsu I, Mitsuhashi H, Ito J. Non-TAVR Bailout for Acute Severe Aortic Regurgitation After Balloon Aortic Valvuloplatsy by Using Fogarty® Catheter. Structural Heart Disease 2018;4(1):21-27. DOI: 10.12945/j.jshd.2018.038.17
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