Transkateter Aort Kapak İmplantasyonu Sonrası Sol Ventriküle Protez Embolizasyonunun Yönetimi: Bir Olgu Sunumu
Abstract
İleri aort darlığında, cerrahiye uygun olmayan yaşlı hastalarda transkateter aort kapak implantasyonu önerilmektedir. Kapak embolizasyonu hayatı tehdit eden en önemli komplikasyonlardan biridir. 61 yaşında erkek hasta nefes darlığı şikayetiyle takip ediliyordu. Koroner arter baypas greft operasyonu öyküsü vardı. Transtorasik ekokardiyografide ciddi aort darlığı saptandı. Hastaya transfemoral transkateter aort kapak implantasyonu yapıldı, ancak balon kapaktan geçerken kapak ventrikülü embolize oldu. Hasta daha sonra operasyona alındı. Doğal aort kapağı rezeke edildi, ventriküle embolize olan kapak kesilerek çıkarıldı ve cerrahi aort kapak replasmanı yapıldı. Uygun hastalarda endovasküler yöntemler tercih edilebilir ancak başarısız olunduğu durumlarda acil açık kalp ameliyatı gerekir. En önemli noktalardan biri embolizasyon sırasında kılavuz telin çıkarılmamasıdır.
References
- Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632.
- Vallabhajosyula P, Bavaria JE. Transcatheter aortic valve implantation: complications and management. J Heart Valve Dis. 2011;20(5):499-509.
- Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation. 2010;122(1):62-9.
- Frumkin D, Pietron M, Kind A, Brand A, Knebel F, Laule M, et al. Valve embolization during transcatheter aortic valve implantation: Incidence, risk factors and follow-up by computed tomography. Front Cardiovasc Med. 2022;9:928740.
- Makkar RR, Jilaihawi H, Chakravarty T, Fontana GP, Kapadia S, Babaliaros V, et al. Determinants and outcomes of acute transcatheter valve-in-valve therapy or embolization: a study of multiple valve implants in the U.S. PARTNER trial (Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve). J Am Coll Cardiol. 2013;62(5):418-30.
- Cuttone F, Ivascau C, Grollier G, Massetti M. Distal embolization of Edwards SAPIEN prosthesis during transcatheter aortic valve implantation. G Chir. 2013;34(9-10):275-7.
- Gul M, Erkanli K, Erol MK, Bakir I. Ventricular embolization of Edwards SAPIEN prosthesis following transcatheter aortic valve implantation. J Invasive Cardiol. 2012;24(10):537-8.
- Masson JB, Kovac J, Schuler G, Ye J, Cheung A, Kapadia S, et al. Transcatheter aortic valve implantation: review of the nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv. 2009;2(9):811-20.
- Tiroch K, Schleiting H, Karpettas N, Schmitz E, Vetter HO, Seyfarth M, et al. How should I treat dislocation of a TAVI SAPIEN prosthesis into the left ventricle? EuroIntervention. 2015;10(11):1370-2.
- Otalvaro L, Damluji A, Alfonso CE, Williams DB, Heldman AW. Management of transcatheter aortic valve embolization into the left ventricle. J Card Surg. 2015;30(4):360-3.
- Astarci P, Desiron Q, Glineur D, El Khoury G. Transapical explantation of an embolized transcatheter valve. Interact Cardiovasc Thorac Surg. 2011;13(1):1-2.
- Seecheran N, Ittleman F, Dauerman H. Left ventricular outflow tract embolization and balloon assisted recapture of a SAPIEN XT prosthesis during transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2016;88(3):E89-92.
Management of Prosthesis Embolization into Left Ventricle after Transcatheter Aortic Valve Implantation: A Case Report
Abstract
Transcatheter aortic valve implantation is recommended in advanced aortic stenosis, in elderly patients who are not suitable for surgery. Valve embolization is one of the most important complications that is life-threatening. A 61-year-old male patient was being followed up with a complaint of shortness of breath. He had a history of coronary artery bypass graft operation. Transthoracic echocardiography revealed severe aortic stenosis. Transfemoral transcatheter aortic valve implantation was performed, but while the balloon passed through the valve, the valve embolized the ventricle. The patient was then taken into operation. The native aortic valve was resected, the valve embolized into the ventricle was cut and removed, and surgical aortic valve replacement was performed. Endovascular methods can be preferred in suitable patients, but in cases where they fail, urgent open-heart surgery is required. One of the most important points is that the guidewire should not be removed when embolization.
References
- Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632.
- Vallabhajosyula P, Bavaria JE. Transcatheter aortic valve implantation: complications and management. J Heart Valve Dis. 2011;20(5):499-509.
- Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation. 2010;122(1):62-9.
- Frumkin D, Pietron M, Kind A, Brand A, Knebel F, Laule M, et al. Valve embolization during transcatheter aortic valve implantation: Incidence, risk factors and follow-up by computed tomography. Front Cardiovasc Med. 2022;9:928740.
- Makkar RR, Jilaihawi H, Chakravarty T, Fontana GP, Kapadia S, Babaliaros V, et al. Determinants and outcomes of acute transcatheter valve-in-valve therapy or embolization: a study of multiple valve implants in the U.S. PARTNER trial (Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve). J Am Coll Cardiol. 2013;62(5):418-30.
- Cuttone F, Ivascau C, Grollier G, Massetti M. Distal embolization of Edwards SAPIEN prosthesis during transcatheter aortic valve implantation. G Chir. 2013;34(9-10):275-7.
- Gul M, Erkanli K, Erol MK, Bakir I. Ventricular embolization of Edwards SAPIEN prosthesis following transcatheter aortic valve implantation. J Invasive Cardiol. 2012;24(10):537-8.
- Masson JB, Kovac J, Schuler G, Ye J, Cheung A, Kapadia S, et al. Transcatheter aortic valve implantation: review of the nature, management, and avoidance of procedural complications. JACC Cardiovasc Interv. 2009;2(9):811-20.
- Tiroch K, Schleiting H, Karpettas N, Schmitz E, Vetter HO, Seyfarth M, et al. How should I treat dislocation of a TAVI SAPIEN prosthesis into the left ventricle? EuroIntervention. 2015;10(11):1370-2.
- Otalvaro L, Damluji A, Alfonso CE, Williams DB, Heldman AW. Management of transcatheter aortic valve embolization into the left ventricle. J Card Surg. 2015;30(4):360-3.
- Astarci P, Desiron Q, Glineur D, El Khoury G. Transapical explantation of an embolized transcatheter valve. Interact Cardiovasc Thorac Surg. 2011;13(1):1-2.
- Seecheran N, Ittleman F, Dauerman H. Left ventricular outflow tract embolization and balloon assisted recapture of a SAPIEN XT prosthesis during transcatheter aortic valve replacement. Catheter Cardiovasc Interv. 2016;88(3):E89-92.
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiovascular Surgery |
| Journal Section | Case Report |
| Authors | |
| Early Pub Date | February 12, 2025 |
| Publication Date | April 30, 2025 |
| Submission Date | August 16, 2024 |
| Acceptance Date | January 16, 2025 |
| Published in Issue | Year 2025 Volume: 27 Issue: 1 |
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