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Case Reports
. 2018 Dec 2:2018:5026190.
doi: 10.1155/2018/5026190. eCollection 2018.

Recurrence of Left Ventricular Outflow Tract Obstruction Requiring Alcohol Septal Ablation after Transcatheter Aortic Valve Implantation

Hideki Kitahara  1 , Kaoru Mastuura  2 , Atsushi Sugiura  1 , Akiko Yoshimura  3 , Takahiro Muramatsu  3 , Yusaku Tamura  2 , Takashi Nakayama  1 , Yoshihide Fujimoto  1 , Goro Matsumiya  2 , Yoshio Kobayashi  1
Affiliations
Case Reports

Recurrence of Left Ventricular Outflow Tract Obstruction Requiring Alcohol Septal Ablation after Transcatheter Aortic Valve Implantation

Hideki Kitahara et al. Case Rep Cardiol. .

Abstract

Left ventricular outflow tract (LVOT) obstruction is sometimes observed in patients with severe aortic stenosis (AS). It is still controversial how to manage the remaining severe AS, when LVOT obstruction is well-controlled by medical therapy. We report a case with acute recurrence of LVOT obstruction requiring emergent alcohol septal ablation (ASA) after transcatheter aortic valve implantation (TAVI), even in a stable state on beta-blockers. For the ASA procedure, transesophageal echocardiography was useful to clearly observe the perfusion area of the target septal branch by injecting microbubble contrast. Since it took some time to cause the recurrence of LVOT obstruction in this case, careful evaluation should be done after TAVI in high-risk patients for LVOT obstruction before terminating the TAVI procedure.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(a) The first septal branch was confirmed beforehand. (b) Tip injection into the septal branch using a 2 mm balloon. (c) Total occlusion of the septal branch was confirmed after alcohol injection. (d) Transesophageal echocardiography confirmed the perfusion area of the septal branch as a bright area by contrast injection. (e) Alcohol was administered into the septal branch. (f) Finally, pressure gradient at the left ventricular outflow tract was decreased.
Figure 2
Figure 2
(a–c) No systolic anterior motion (SAM) was observed before transcatheter aortic valve implantation (TAVI). (d–f) Five minutes after TAVI, there was no SAM or pressure gradient. (g) Fifteen minutes later, SAM clearly emerged. (h) Transthoracic echocardiography showed severe mitral regurgitation. (i) Pressure gradient was >50 mmHg at the left ventricular outflow tract.
See this image and copyright information in PMC

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