European Journal of Cardio-Thoracic Surgery 47 (2015) 195–196 doi:10.1093/ejcts/ezu139 Advance Access publication 30 March 2014
IMAGES IN CARDIO-THORACIC SURGERY
Cite this article as: Pasic M, Buz S, Drews T, Unbehaun A. Distortion of a transcatheter aortic valve after external chest compression. Eur J Cardiothorac Surg 2015;47:195–6.
Distortion of a transcatheter aortic valve after external chest compression Miralem Pasic*, Semih Buz, Thorsten Drews and Axel Unbehaun Deutsches Herzzentrum Berlin, Berlin, Germany * Corresponding author. Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Tel: +49-30-45932108; fax: +49-30-45932018; e-mail: [email protected] (M. Pasic). Received 29 December 2013; received in revised form 26 February 2014; accepted 27 February 2014
Keyword: Transcatheter aortic valve implantation
after external chest compression performed 6 days after primary TAVI (Figs 1 and 2). Suspected leaflet thrombus precluded balloon redilatation. Valve distortion—an adverse event
IMAGES IN CARDIOTHORACIC SURGERY
Four years after previous transcatheter aortic valve implantation (TAVI), transapical ‘TAVI-valve-in-TAVI-valve’ procedure eliminated aortic regurgitation and reshaped the old valve distorted
Figure 1: (A and B) Lateral and antero-posterior chest X-rays showing a distorted balloon-expandable valve (blue circles) after previous manual chest compression during cardiopulmonary resuscitation. The oval instead of circular shape of the distorted valve is clearly recognizable only on the lateral chest X-ray and not on the antero-posterior chest X-ray. (C) Regular position of the valve with no aortic regurgitation after the first transcatheter valve implantation (transfemoral). (D) A computed tomogram of the chest showing the distorted valve (arrow) anchored in the outflow tract of the left ventricle (LV). (E and F) Transoesophageal echocardiography (mid-oesophageal long-axis view) showing the distorted valve and two regurgitant jets (in green); the upper jet is paravalvular and the lower is transvalvular. A large bracket (in red) marks the distorted valve. RA: right atrium; LA: left atrium; LV: left ventricle; Ao: ascending aorta.
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
196
M. Pasic et al. / European Journal of Cardio-Thoracic Surgery
Figure 2: (A) Transoesophageal echocardiography (mid-oesophageal aortic valve short-axis view) showing restoration of the circular shape of the valve (yellow circle) after the second transcatheter aortic valve implantation (transapical valve-in-valve). (B) The oval shape of the distorted valve seen during angiography before the second procedure. Blue arrow indicates the tip of the angiographic catheter placed in the ostium of the left coronary artery with an adequate distance between the ostium and the distorted valve. (C–F) Transapical implantation of a new balloon-expandable valve into the distorted old valve eliminating existing aortic valve regurgitation.
of TAVI—should be taken into account before expanding indications of TAVI.
Conflict of interest: All authors have been proctors to Edwards Lifesciences since July 2009. There are no other disclosures.
IMAGES IN CARDIO-THORACIC SURGERY
Cite this article as: Pasic M, Buz S, Drews T, Unbehaun A. Distortion of a transcatheter aortic valve after external chest compression. Eur J Cardiothorac Surg 2015;47:195–6.
Distortion of a transcatheter aortic valve after external chest compression Miralem Pasic*, Semih Buz, Thorsten Drews and Axel Unbehaun Deutsches Herzzentrum Berlin, Berlin, Germany * Corresponding author. Deutsches Herzzentrum Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Tel: +49-30-45932108; fax: +49-30-45932018; e-mail: [email protected] (M. Pasic). Received 29 December 2013; received in revised form 26 February 2014; accepted 27 February 2014
Keyword: Transcatheter aortic valve implantation
after external chest compression performed 6 days after primary TAVI (Figs 1 and 2). Suspected leaflet thrombus precluded balloon redilatation. Valve distortion—an adverse event
IMAGES IN CARDIOTHORACIC SURGERY
Four years after previous transcatheter aortic valve implantation (TAVI), transapical ‘TAVI-valve-in-TAVI-valve’ procedure eliminated aortic regurgitation and reshaped the old valve distorted
Figure 1: (A and B) Lateral and antero-posterior chest X-rays showing a distorted balloon-expandable valve (blue circles) after previous manual chest compression during cardiopulmonary resuscitation. The oval instead of circular shape of the distorted valve is clearly recognizable only on the lateral chest X-ray and not on the antero-posterior chest X-ray. (C) Regular position of the valve with no aortic regurgitation after the first transcatheter valve implantation (transfemoral). (D) A computed tomogram of the chest showing the distorted valve (arrow) anchored in the outflow tract of the left ventricle (LV). (E and F) Transoesophageal echocardiography (mid-oesophageal long-axis view) showing the distorted valve and two regurgitant jets (in green); the upper jet is paravalvular and the lower is transvalvular. A large bracket (in red) marks the distorted valve. RA: right atrium; LA: left atrium; LV: left ventricle; Ao: ascending aorta.
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
196
M. Pasic et al. / European Journal of Cardio-Thoracic Surgery
Figure 2: (A) Transoesophageal echocardiography (mid-oesophageal aortic valve short-axis view) showing restoration of the circular shape of the valve (yellow circle) after the second transcatheter aortic valve implantation (transapical valve-in-valve). (B) The oval shape of the distorted valve seen during angiography before the second procedure. Blue arrow indicates the tip of the angiographic catheter placed in the ostium of the left coronary artery with an adequate distance between the ostium and the distorted valve. (C–F) Transapical implantation of a new balloon-expandable valve into the distorted old valve eliminating existing aortic valve regurgitation.
of TAVI—should be taken into account before expanding indications of TAVI.
Conflict of interest: All authors have been proctors to Edwards Lifesciences since July 2009. There are no other disclosures.
