BACKGROUND: An 80-year-old man with symptomatic severe aortic valve stenosis, haemodynamic instability, important comorbidities and a high surgical risk. Following bridgeballoon aortic valvuloplasty to recover from the unstable haemodynamics he was deemed suitable for transcatheter aortic valve implantation (TAVI) via the femoral access route. INVESTIGATION: Fluoroscopy. DIAGNOSIS: During TAVI, while the operators were preparing for prosthesis deployment (Edwards SAPIEN 3), the extra-stiff guidewire was accidentally withdrawn from the left ventricle (LV) to the ascending aorta. MANAGEMENT: Valve orifice was re-crossed from the contralateral access, a snare was introduced through the AL1 catheter and pushed anterogradely through the valve. The extra-stiff wire was then captured in the ascending aorta and pulled back into the LV to complete the procedure.

How should i treat an unexpected deadlock at the time of transcatheter aortic valve prosthesis implantation?

Dall'Ara, Gianni;Moretti, Carolina;Taglieri, Nevio;Marzocchi, Antonio;
2017

Abstract

BACKGROUND: An 80-year-old man with symptomatic severe aortic valve stenosis, haemodynamic instability, important comorbidities and a high surgical risk. Following bridgeballoon aortic valvuloplasty to recover from the unstable haemodynamics he was deemed suitable for transcatheter aortic valve implantation (TAVI) via the femoral access route. INVESTIGATION: Fluoroscopy. DIAGNOSIS: During TAVI, while the operators were preparing for prosthesis deployment (Edwards SAPIEN 3), the extra-stiff guidewire was accidentally withdrawn from the left ventricle (LV) to the ascending aorta. MANAGEMENT: Valve orifice was re-crossed from the contralateral access, a snare was introduced through the AL1 catheter and pushed anterogradely through the valve. The extra-stiff wire was then captured in the ascending aorta and pulled back into the LV to complete the procedure.
Dall'Ara, Gianni; Moretti, Carolina; Marrozzini, Cinzia; Taglieri, Nevio; Saia, Francesco; Marzocchi, Antonio; Witkowski, Adam; Kahlert, Philipp; Hildebrandt, Heike A.; Lind, Alexander Y.; Jã¡nosi, Rolf Alexander; Rassaf, Tienush
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/616807
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