Simultaneous Transcatheter Intervention for Coarctation of the Aorta and Bicuspid Aortic Valve

J Heart Valve Dis. 2017 Jul;26(4):481-484.

Abstract

Coarctation of the aorta (CoA) is a relatively common congenital heart anomaly, and bicuspid aortic valve (BAV) is a common congenital heart disease that coexists with CoA. In larger children and adults with CoA, transcatheter intervention has gained acceptance, but for surgical high-risk patients with aortic stenosis, the use of transcatheter aortic valve implantation (TAVI) has been established. Recently, although favorable data have been reported for TAVI when treating BAV, simultaneous transcatheter intervention for CoA and BAV will prove to be a challenge because of the unique anatomy involved requires multiple procedural steps and also has problems of site access. Herein is reported a successful case of simultaneous thoracic endovascular repair (TEVAR) for CoA and transfemoral TAVI for congenital BAV dysfunction. A 62-year-old male with CoA and congenital BAV with severe aortic stenosis and aortic regurgitation had NYHA class IV heart failure symptoms. Because of the patient's extremely poor left ventricular function, the authors' heart team decided to perform simultaneous TEVAR for CoA and transfemoral TAVI. After deployment of a 32 mm stent graft, a 29 mm SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) was successfully deployed through the stent graft. This resulted in no significant pressure gradient within the aorta, and no aortic regurgitation. Video 1: Cineradiography showing delivery of the Edwards Commander delivery system through the stent graft. Video 2: Final aortography showing no residual aortic regurgitation.

Publication types

  • Case Reports

MeSH terms

  • Aortic Coarctation / diagnostic imaging
  • Aortic Coarctation / physiopathology
  • Aortic Coarctation / surgery*
  • Aortic Valve / abnormalities*
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery
  • Aortic Valve Insufficiency / diagnostic imaging
  • Aortic Valve Insufficiency / physiopathology
  • Aortic Valve Insufficiency / surgery*
  • Aortography / methods
  • Bicuspid Aortic Valve Disease
  • Blood Vessel Prosthesis Implantation / methods*
  • Cardiac Catheterization*
  • Computed Tomography Angiography
  • Echocardiography, Doppler, Color
  • Endovascular Procedures / methods*
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / physiopathology
  • Heart Valve Diseases / surgery*
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Recovery of Function
  • Transcatheter Aortic Valve Replacement / methods*
  • Treatment Outcome
  • Ventricular Function, Left