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Case Reports
. 2022 Apr;13(4):172-177.
doi: 10.14740/jmc3868. Epub 2022 Mar 25.

Valve-in-Valve Transcatheter Aortic Valve Implantation With Acute Left and Right Coronary Artery Occlusion: A Case Report

Matjaz Bunc  1 , Luka Vitez  1 , Gian Paolo Ussia  2
Affiliations
Case Reports

Valve-in-Valve Transcatheter Aortic Valve Implantation With Acute Left and Right Coronary Artery Occlusion: A Case Report

Matjaz Bunc et al. J Med Cases. 2022 Apr.

Abstract

Acute coronary artery occlusion is a relatively rare procedural adverse event in valve-in-valve transcatheter aortic valve implantation. Here we present a case of a 26-mm Sapien 3 prosthetic valve implantation in a degenerated 23-mm Freedom Solo bioprosthetic surgical valve with subsequent left and right coronary occlusion. Left coronary artery occlusion was managed immediately with the use of an upfront coronary artery protection technique and drug-eluting stent placement. Right coronary artery occlusion presented with right-sided heart failure and cardiac arrest that required resuscitation and additional hemodynamic support. As the artery could not be engaged with a catheter, a combination of intravenous antithrombotic and anticoagulant therapy was used as a successful bailout step to restore adequate coronary flow.

Keywords: Coronary artery embolization; Coronary artery occlusion; Transcatheter aortic valve implantation; Valve-in-valve.

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Conflict of interest statement

Authors declare no conflict of interest regarding the publication of this article.

Figures

Figure 1
Figure 1
Transthoracic echocardiography of the bioprosthetic aortic valve: 2D picture showing thickened left ventricular septum and severely calcified aortic cusps (left); continuous doppler through the bioprosthetic aortic valve showing severe stenosis (maximal velocity 4.3 m/s, mean gradient 43 mm Hg) (right).
Figure 2
Figure 2
CT aortogram measurements: aortic annulus (up left); sinus of Valsalva (up right); left coronary ostia height (bottom left); right coronary ostia height (bottom right). CT: computed tomography.
Figure 3
Figure 3
(a) Balloon aortic valvuloplasty with a 22 × 40 mm balloon and a BMW wire placed in the distal LAD. Flow is present in both coronary arteries. (b) Drug-eluted stent placed in the middle segment of the LAD (red arrow). (c) Implantation of a 26-mm balloon-expandable Sapien 3 valve in the annular position. (d) Left main stenting up to the ascending aorta using the “chimney technique”; post-dilatation balloon (green arrow). (e) Aortography showing an occlusion of the RCA (blue arrow). (f) Flow restoration in the RCA after administration of unfractionated heparin and eptifibatide (yellow arrow). LAD: left anterior descending; RCA: right coronary artery.
Figure 4
Figure 4
TTE Doppler gradient through the Sapien 3 valve before discharge showing mildly elevated velocity and gradients. TTE: transthoracic echocardiography.
See this image and copyright information in PMC

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