Journal of Structural Heart Disease, October 2018, Volume 4, Issue 5:240-245
Left Main Protection and Emergency Stenting During TAVR with Self-Expandable Valve
1 MC Medicor, Izola, Slovenia
2 Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia
3 Department of Radiology, General Hospital Izola, Izola, Slovenia
4 Cardiovascular Intervention Center, Cedars-Sinai Heart Institute, Los Angeles, California, United States
5 Interventional Cardiology Department, Cardiology & Cardiovascular Institute. Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
Left main (LM) obstruction is rare but life-threatening complication of transcatheter aortic valve replacement (TAVR) which occurs by displacement of left coronary leaflet toward the ostium or by direct occlusion by the covered skirt of the prosthesis. We report an 88- year old lady with severe aortic stenosis, short distance from annulus to left main origin, shallow/low sinus of Valsalva, and calcification of the left aortic leaflet undergoing TAVR with a self-expandable valve. Instead of recently described “Chimney” stenting with protrusion of a very long stent segment from LM above the prosthesis leaflets and behind the valve frame, a “T-stenting” with stent protrusion only into the left sinus Valsalva was used to secure the LM patency.
Video 1Aortogram before complete valve deployment. Both coronary arteries are well perfused.
Video 2Aortogram with decreased left compared to right coronary flow after complete valve deployment despite moving of the stent from LAD back to the guiding catheter.
Video 3Injection through the guiding catheter revealed a mass protruding toward the LM ostium.
Video 4Stent deployment from the LM toward the valve frame.
Video 5Post procedural guide injection showed widely patent LM, LAD and left circumflex artery with normal flow.
Video 6Final aortogram with comparable left and right coronary flow.
Cite this article as: Noc M, Cveticanin B, Kar S, Mendiz OA. Left Main Protection and Emergency Stenting During TAVR with Self-Expandable Valve. Structural Heart Disease 2018;4(5):240-245. DOI: 10.12945/j.jshd.2018.008.18
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