Catheterization and Cardiovascular Interventions

Volume 97, Issue 5 pp. 955-958

CASE REPORT

A novel technique to manage transcatheter aortic valve embolization

Kunal K. Chawla MD,

Kunal K. Chawla MD

orcid.org/0000-0002-3229-7895

Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts

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Xiangke Huang MD,

Xiangke Huang MD

Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts

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Neal Hadro MD,

Neal Hadro MD

Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts

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Ashequl M. Islam MD,

Corresponding Author

Ashequl M. Islam MD

[email protected]

orcid.org/0000-0002-7563-2059

Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts

Correspondence

Ashequl M. Islam, MD, Professor of Medicine, University of Massachusetts School of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.

Email: [email protected]

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Kunal K. Chawla MD,

Kunal K. Chawla MD

orcid.org/0000-0002-3229-7895

Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts

Search for more papers by this author

Xiangke Huang MD,

Xiangke Huang MD

Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts

Search for more papers by this author

Neal Hadro MD,

Neal Hadro MD

Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts

Search for more papers by this author

Ashequl M. Islam MD,

Corresponding Author

Ashequl M. Islam MD

[email protected]

orcid.org/0000-0002-7563-2059

Baystate Medical Center, University of Massachusetts School of Medicine, Springfield, Massachusetts

Correspondence

Ashequl M. Islam, MD, Professor of Medicine, University of Massachusetts School of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.

Email: [email protected]

Search for more papers by this author

First published: 10 October 2020

https://doi.org/10.1002/ccd.29279

Citations: 2

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Abstract

We report a case of a 69-year-old male who was planned for a transcatheter aortic valve replacement (TAVR) with a 26 mm Sapien 3 Valve (Edwards Lifesciences, Irvine, California) for the treatment of symptomatic severe aortic stenosis. During rapid ventricular pacing and implantation of the TAVR valve, there was a loss of pacing capture and subsequent embolization of the valve into the aortic arch. Retrieval of the embolized valve was attempted unsuccessfully using several techniques. Finally, by using a 34 mm Evolut R Valve (Medtronic, Minneapolis, Minnesota), we were able to secure the embolized valve in the transverse segment of the aortic arch without compromising the branch vessels. To our knowledge, this is the first reported case of using a valve-in-valve approach to fixate an embolized valve in the transverse aorta.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.

Open Research

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Supporting Information

Filename	Description
ccd29279-sup-0001-VideoS1.movQuickTime video, 4 MB	Video S1 Unsuccessful retrieval of valve due to calcium: Attempts to pull the embolized Sapien 3 Valve into the descending thoracic aorta using the delivery balloon were unsuccessful due to a calcified plaque on the inferior surface of the transverse aortic arch and tortuosity of the aorta.
ccd29279-sup-0002-VideoS2.movQuickTime video, 5.7 MB	Video S2 Attempts to overexpand valve in transverse aorta: Attempts to overexpand the Sapien 3 Valve with balloons were unsuccessful in securing the embolized valve in place.
ccd29279-sup-0003-VideoS3.movQuickTime video, 5.3 MB	Video S3 Deployment of transcatheter aortic valve replacement (TAVR) valve in the aortic position: Given that the valve was not obstructing any of the great vessels, we proceeded with treating the patient's aortic stenosis with a larger 29 mm Sapien 3 Bioprosthetic Valve. The delivery catheter of the 29 mm Sapien 3 Valve was threaded carefully through the embolized valve and successfully implanted in the aortic annulus.
ccd29279-sup-0004-VideoS4.movQuickTime video, 5.7 MB	Video S4 Evolut TAVR valve deployment with embolized sapien valve: Delivery of a 34 mm Medtronic Evolut R Valve within the embolized Sapien 3 Valve in order to secure it in place.
ccd29279-sup-0005-VideoS5.avivideo/avi, 525.5 KB	Video S5 Final aortic arch angiogram: Aortic arch angiogram showing Medtronic Evolut R Valve anchoring embolized Sapien 3 Valve in place between innominate and left subclavian arteries.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Volume97, Issue5

April 1, 2021

Pages 955-958

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A novel technique to manage transcatheter aortic valve embolization

Abstract

CONFLICT OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

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A novel technique to manage transcatheter aortic valve embolization

Abstract

CONFLICT OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

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