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Case Reports
. 2022 Aug 3;4(15):934-940.
doi: 10.1016/j.jaccas.2022.06.006.

Transcatheter Aortic Valve Replacement in a Patient With Criss-Cross Heart

Daniel Lewin  1   2 , Karel M Van Praet  1   3 , Gaik Nersesian  1   3 , Marcus Kelm  2   4   5 , Markus Kofler  1   3 , Martin Baumgartner  6 , Jörg Kempfert  1   3 , Volkmar Falk  1   3   5   7   8 , Christoph Klein  9 , Axel Unbehaun  1   3
Affiliations
Case Reports

Transcatheter Aortic Valve Replacement in a Patient With Criss-Cross Heart

Daniel Lewin et al. JACC Case Rep. .

Abstract

This paper presents the first transcatheter management of severe aortic regurgitation in a 77-year-old woman with a criss-cross heart-an extremely rare and complex congenital heart disease. The procedure achieved an elimination of aortic regurgitation and resulted in a remarkable improvement of the patient's physical condition. (Level of Difficulty: Advanced.).

Keywords: AR, aortic regurgitation; CCH, criss-cross heart; CMR, cardiac magnetic resonance; CT, computed tomography; NAVR, native aortic valve regurgitation; NYHA, New York Heart Association; SAVR, surgical aortic valve replacement; TAVI; TAVR; TAVR, transcatheter aortic valve replacement; TTE, transthoracic echocardiography; VSD, ventricular septal defect; aortic valve regurgitation; criss-cross heart.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Criss-Cross Heart Anatomy Magnetic resonance imaging (A, C) and computed tomography (B, D) showing left and right ventricular relationships and connections as well as the tricuspid (yellow ring in B) and mitral valve (red ring in D). (E) Three-dimensional volume rendering of the criss-cross heart. Created with BioRender.com. Ao = aorta (blue); LA = left atrium (pink); LV = left ventricle (green); PA = pulmonary artery/trunk (yellow); RA = right atrium (grey); RV = right ventricle (red).
Figure 2
Figure 2
Preprocedural Transthoracic Echocardiography of the Aortic Valve Transthoracic echocardiography revealing a severe aortic valve regurgitation (A) and showing the flow profile through the aortic valve (B). Created with BioRender.com.
Figure 3
Figure 3
Preprocedural Computed Tomography of the Aortic Valve, Sinus of Valsalva, and Left Ventricular Outflow Tract Three-dimensional computed tomography reconstruction of the aortic valve from different views (A); the aortic valve is asymmetric, tricuspid, and slightly thickened with negligible minor calcification. Computed tomography and respective dimensions of the aortic annulus (B), sinus of Valsalva (C), and left ventricular outflow tract (D). Created with BioRender.com.
Figure 4
Figure 4
Sequence of the Transthoracic Aortic Valve Replacement Sizing with a 25-mm balloon (A), stepwise delivery of the prosthetic valve (B, C), implantation during rapid-pacing (D), final aortic valve angiography (E). Close proximity of the ventricular septal defect occluder (arrow) and prosthetic valve is noticeable. Created with BioRender.com.
Figure 5
Figure 5
Postprocedural Transthoracic Echocardiography Postprocedural flow through the aortic valve (A) and mitral valve (B). Both valves show a remaining minor regurgitation with significantly improved flow profiles compared to the preprocedural imaging. A paravalvular leakage (arrow) is also noticeable. Created with BioRender.com.
Figure 6
Figure 6
Preprocedural and Postprocedural Volume Flow Rates Based on 4-dimensional cardiac magnetic resonance imaging, preprocedural (A, top) and postprocedural (A, bottom) volume flow rates through the ascending aorta (red) and descending aorta (blue), as well as preprocedural (B, top) and postprocedural (B, bottom) flow velocities through the aorta were estimated. Created with BioRender.com. TAVI = transcatheter aortic valve implantation.
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References

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