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Images and Case Reports in Interventional Cardiology

Apical Aortic Valve Implantation in a Patient With a Mechanical Valve Prosthesis in Mitral Position

Josep Rodés-Cabau, MD, FESC; Eric Dumont, MD; Santiago Miró, MD; Daniel Doyle, MD; Robert De Larochellière, MD; Marie-Annick Clavel, DVM, MSc; Jacques Villeneuve, MD; Sebastien Bergeron, MD; Mario Senechal, MD and Philippe Pibarot, PhD

From the Quebec Heart Institute/Laval Hospital, Quebec, Canada.

Correspondence to Josep Rodés-Cabau, MD, FESC, Quebec Heart Institute/Laval Hospital, 2725 Chemin Ste-Foy, G1V 4G5 Quebec, Canada. E-mail josep.rodes@crhl.ulaval.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 67-year-old man diagnosed with severe aortic stenosis was admitted to our institution with pulmonary edema. The patient had a history of severe pulmonary fibrosis (total lung capacity, 57% of predicted value; diffusing capacity for carbon monoxide, 33% of predicted value) and had undergone coronary bypass grafting and mitral valve replacement with a St Jude mechanical valve (St Jude Medical, St Paul, Minn) 18 years ago. Doppler echocardiography showed a mean aortic gradient of 36 mm Hg, an aortic valve area of 0.50 cm², and a left ventricular ejection fraction of 45%. Although the mean predicted operative mortality by the Society of Thoracic Surgeons score was 7.5%, the patient was considered at too high risk for surgical aortic valve replacement because of his pulmonary condition, and he was then evaluated for percutaneous aortic valve implantation (PAVI). Transesophageal echocardiography (TEE) showed an aortic annulus of 23 mm as well as proximity between the mitral prosthesis and the aortic annulus (Figure 1A). Contrast computed tomography showed the presence of moderate stenosis and severe calcification of both iliofemoral arteries precluding transfemoral PAVI, and the patient was then proposed for transapical PAVI.

View larger version (81K):   Figure 1. TEE images (long-axis view) showing the relationship between the mechanical valve prosthesis in mitral position and the aortic annulus before aortic valve implantation (A; white arrow indicates the lack of space between the mitral prosthesis and the aortic annulus) and after percutaneous valve implantation (B; white arrows indicate the aortic and ventricular ends of the percutaneously implanted . . . [Full Text of this Article]

 

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