Management of severe aortic regurgitation in a patient with cardiogenic shock using a percutaneous left ventricular assist device and transcatheter occlusion of the failed aortic valve homograft as a bridge to surgical valve replacement

Catheter Cardiovasc Interv. 2014 Jan 1;83(1):E141-5. doi: 10.1002/ccd.24993. Epub 2013 Jul 1.

Abstract

Acute hemodynamic compromise due to severe aortic regurgitation remains a difficult problem. The optimal management strategy and timing of surgery continues to evolve as new technologies become available. Here, we report the case of a young woman presenting with severe regurgitation of an aortic homograft who developed precipitous cardiogenic shock and multi-organ dysfunction. Her mortality risk with emergent surgery was prohibitive, and no percutaneous valve-in-valve device was available. We stabilized her condition by placing an Amplatz-type Atrial Septal Defect (ASD) occluder across her aortic valve in conjunction with a percutaneous left ventricular assist device as a bridge to surgical valve replacement. She went on to a successful surgery and recovered well.

Keywords: cardiopulmonary support; valvular heart disease; ventricular support devices.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Allografts
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Aortic Valve Insufficiency / diagnosis
  • Aortic Valve Insufficiency / etiology
  • Aortic Valve Insufficiency / physiopathology
  • Aortic Valve Insufficiency / therapy*
  • Bioprosthesis*
  • Cardiac Catheterization* / instrumentation
  • Echocardiography, Doppler, Color
  • Female
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / instrumentation
  • Heart Valve Prosthesis*
  • Heart-Assist Devices*
  • Hemodynamics
  • Humans
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / therapy
  • Prosthesis Failure*
  • Reoperation
  • Septal Occluder Device
  • Severity of Illness Index
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / physiopathology
  • Shock, Cardiogenic / therapy*
  • Treatment Outcome
  • Ventricular Function, Left