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Case Reports
. 2017 Aug 1;44(4):274-278.
doi: 10.14503/THIJ-16-5958. eCollection 2017 Aug.

Balloon Repositioning of Transcatheter Aortic Valve after Migration into the Left Ventricular Outflow Tract, Followed by Valve-in-Valve Procedure

Masaki Ito, Norio Tada, Masaki Hata
Case Reports

Balloon Repositioning of Transcatheter Aortic Valve after Migration into the Left Ventricular Outflow Tract, Followed by Valve-in-Valve Procedure

Masaki Ito et al. Tex Heart Inst J. .

Abstract

Transcatheter aortic valve replacement is an established option for treating patients with symptomatic aortic stenosis; however, severe, life-threatening complications, such as valve migration, are possible. We report the case of an 82-year-old woman whose Edwards Sapien XT valve migrated into the left ventricular outflow tract one day after transcatheter aortic valve replacement. We used an inflated balloon to adjust the position of the migrated valve before performing a valve-in-valve procedure via a transapical approach, which resulted in a good valve implantation.

Keywords: Aortic valve stenosis/therapy; balloon valvuloplasty; foreign-body migration/etiology/prevention & control/therapy; heart valve prosthesis implantation/adverse effects/instrumentation/methods; treatment outcome.

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Figures

Fig. 1.
Fig. 1.
Multidetector computed tomogram shows the aortic annulus (calculated area, 3.82 cm2; dimensions, 19.5 × 25.1 mm).
Fig. 2.
Fig. 2.
Transesophageal echocardiograms show A) good expansion of the implanted valve, and B) in color-Doppler mode, several mild paravalvular leaks that were not associated with annular calcification.
Fig. 3.
Fig. 3.
Aortogram obtained through optimal positioning of the C-arm shows the transcatheter aortic valve slightly below the native right coronary cusp (arrow).
Fig. 4.
Fig. 4.
Multidetector computed tomogram shows the transcatheter heart valve within the left ventricular outflow tract. The valve was 7.1 mm lower than the aortic annulus at the right coronary cusp, and it was just below the annulus at the left coronary and noncoronary cusps.
Fig. 5.
Fig. 5.
Fluoroscopic images. A) A 0.035-in spring-coil wire was passed in antegrade fashion through the migrated transcatheter heart valve and native aortic valve via a transapical approach. B) A 25-mm Z-Med II balloon catheter was inflated and pushed forward to move the transcatheter heart valve up to the aortic annulus. C) The valve-in-valve procedure was performed with a 26-mm Edwards Sapien XT valve. D) Aortogram shows the implanted transcatheter valve covering the native aortic and migrated valves, with mild aortic regurgitation.
See this image and copyright information in PMC

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