1. 5th Meeting on Acute Cardiac Care and Emergency Medicine, 2016 Vilnius
Transcatheter aortic valve implantation (TAVI) complicated by acute bronchial bleeding
I. Norkienė1, R. Samalavičius1, K. Ručinskas2, P. Šerpytis 2
1.Vilnius University, Faculty of medicine, Vilnius, Lithuania 2. Clinic of Cardiovascular Diseases, Vilnius University Hospital Santariškiu Klinikos. Vilnius, Lithuania
5th Meeting on Acute Cardiac Care and Emergency Medicine, 2016 Vilnius
Introduction:
Transcatheter aortic valve implantation (TAVI) has been increasingly used as a preferred treatment for severe symptomatic aortic stenosis in inoperable and high surgical risk patients. The role of TAVI is expanding – newer indications for its use are under research. There is growing interest for the application of TAVI in lower surgical risk patients or in patients with anatomical difficulties.
Post – procedural course:
2 hours after procedure - massive hemoptysis.
Endobronchial obturation of left main bronchus.
No contrast extravasation or signs of pulmonary embolization in angio CT.
Foam obturator to occlude upper left bronchus for 2 days.
Obturator removed, with no more signs of obvious bleeding and no indication to other treatments.
Patient was discharged from hospital NYHA II
Case report:
A 73-year-old woman
Symptomatic aortic valve stenosis. 0,7 cm2
Aortic coarctation interposition graft 50 years ago (1964).
Valvuloplasty successfully done 1 year ago.
NYHA functional class was III.
EuroSCORE II was 2,64 %
STS predicted mortality was 2.3 %.
The patient rejected conventional surgery. After multidisciplinary evaluation TAVI as an alternative strategy was suggested and risks explained to the patient. The patient consented and accepted the risks of intervention.
TAVI:
26 mm Core Valve nitinolporcine prosthesis.
Right femoral artery and an 18 Fr (6 mm)
Malpositioning of the valve and attempts to correct it ended up with valve stuck in aorta below subclavian artery.
After procedure valve left in descending aorta.
Figure 3. Obturation of lef main bronchus and complete collapse of the left lung
Figure 4. Three-dimensional reconstruction for the CT angiography showing CoreValve position in the aortic arch
Figure 1. Two-dimensional echocardiographic evaluation
Gradient through aortic valve 27.5 mmHg
Aortic valve area 0.7 cm2
Aortic insufficiency I degree.
Figure 4 . Chest xray before the discharge
Figure 2. Cardiac catheterization angiography showing the misplacement of TAVI
Conclusion:
Multidisciplinary heart valve team should determine the choice of the treatment for aortic valve stenosis in high surgical risk patient. Operators should pay thorough attention and be prepared for challenging anatomic characteristics of the individual patient.
Refferences:
DR Holmes, MJ Mack, S Kaul, et al ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59:1200.
O’Sullivan, P Wenaweser. Optimizing clinical outcomes of transcatheter aortic valve implantation patients with comorbidities Expert Rev Cardiovasc Ther Dec;13(12):