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Editorial
10. Kappetein AP, Head SJ, Genereux P, Piazza N, Van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, Van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodes-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB. Updated standardized endpoint definitions for transcatheter aortic valve implantation. Eur Heart J 2012;33:2403 – 2418. 11. Latib A, Naim C, De Bonis M, Sinning JM, Maisano F, Barbanti M, Parolari A, Lorusso R, Testa L, Actis Dato G, Miceli A, Sponga S, Rosato F, De Vincentiis C, Werner N, Fiorina C, Bartorelli A, Di Gregorio O, Casilli F, Muratori M, Alamanni F, Glauber M, Livi U, Nickenig G, Tamburino C, Alfieri O, Colombo A. Transcatheter aortic valve implantation—associated prosthetic valve infective endocarditis—results of a large multicenter registry. J Am Coll Cardiol 2014;64: 2176– 2178. 12. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/
ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2438 –88. 13. Hammerstingl C, Nickenig G, Grube E. Treatment of a degenerative stenosed CoreValve aortic bioprosthesis by transcatheter valve-in-valve insertion. Catheter Cardiovasc Interv 2011;79:748 –755. 14. Sinning JM, Vasa-Nicotera M, Werner N, Zimmer S, Mellert F, Welz A, Grube E, Nickenig G, Hammerstingl C. CoreValve degeneration with severe transvalvular aortic regurgitation treated with valve-in-valve implantation. JACC Cardiovasc Interv 2014;7: e71–2. 15. Sinning JM, Vasa-Nicotera M, Chin D, Hammerstingl C, Ghanem A, Bence J, Kovac J, Grube E, Nickenig G, Werner N. Evaluation and management of paravalvular aortic regurgitation after transcatheter aortic valve replacement. J Am Coll Cardiol 2013;62: 11 – 20.
CARDIOVASCULAR FLASHLIGHT
doi:10.1093/eurheartj/ehu524 Online publish-ahead-of-print 30 January 2015
.............................................................................................................................................................................
How to re-shape a transcatheter heart valve 1 Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany; and 2Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
* Corresponding author. Email: [email protected] †
These authors contributed equally to this work.
A 82-year-old female patient suffering from severe aortic stenosis presented with progressive dyspnoea NYHA class III after syncope. Due to severe calcifications of the ilio-femoral arteries, she underwent uneventful transapical transcatheter aortic valve implantation with a balloon-expandable Edwards SAPIEN 3 (23 mm) prosthesis. Three hours postoperatively, the patient had a sudden cardiac arrest due to ventricular fibrillation (VF). After 4 min of cardiopulmonary resuscitation (CPR) normal sinus rhythm was restored. Since neither signs of cardiac ischaemia (no ST-segment alterations in the electrocardiogram) nor troponin elevation were seen myocardial ischaemia could be ruled out as reason for VF. TEE after CPR confirmed a correct intra-annular position of the transcatheter heart valve (THV) but revealed a severe prosthesis deformation with consecutive paravalvular leakage (Panels A and B). To overcome this THV-specific failure mode, which has been described recently for balloon-expandable THVs, we decided to re-dilate the SAPIEN 3 prosthesis via transfemoral access (Supplementary material online, Video S1), using a 9-French 20 mm Tyshak II Balloon Dilatation Catheter (NuMED Inc., Hopkinton, NY, USA). After the first inflation of the balloon (Supplementary material online, Video S2), the prosthesis appeared reshaped in fluoroscopy without any signs of migration or any remaining transvalvular gradient. Furthermore, the significant paravalvular leakage had completely disappeared after re-dilation of the prosthesis stent frame, which now appeared round-shaped again (Panels C and D). The further clinical course of the patient was uneventful. Long-term follow-up has to show whether re-dilation might impact stability of the stent frame or durability of the valve itself but this case demonstrates how to address successfully THV compression. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on November 13, 2015
Wilhelm Roell1†, Jan Malte Sinning2†, Nikos Werner2, and Fritz Mellert1*
Editorial
10. Kappetein AP, Head SJ, Genereux P, Piazza N, Van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, Van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodes-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB. Updated standardized endpoint definitions for transcatheter aortic valve implantation. Eur Heart J 2012;33:2403 – 2418. 11. Latib A, Naim C, De Bonis M, Sinning JM, Maisano F, Barbanti M, Parolari A, Lorusso R, Testa L, Actis Dato G, Miceli A, Sponga S, Rosato F, De Vincentiis C, Werner N, Fiorina C, Bartorelli A, Di Gregorio O, Casilli F, Muratori M, Alamanni F, Glauber M, Livi U, Nickenig G, Tamburino C, Alfieri O, Colombo A. Transcatheter aortic valve implantation—associated prosthetic valve infective endocarditis—results of a large multicenter registry. J Am Coll Cardiol 2014;64: 2176– 2178. 12. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM III, Thomas JD. 2014 AHA/
ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2438 –88. 13. Hammerstingl C, Nickenig G, Grube E. Treatment of a degenerative stenosed CoreValve aortic bioprosthesis by transcatheter valve-in-valve insertion. Catheter Cardiovasc Interv 2011;79:748 –755. 14. Sinning JM, Vasa-Nicotera M, Werner N, Zimmer S, Mellert F, Welz A, Grube E, Nickenig G, Hammerstingl C. CoreValve degeneration with severe transvalvular aortic regurgitation treated with valve-in-valve implantation. JACC Cardiovasc Interv 2014;7: e71–2. 15. Sinning JM, Vasa-Nicotera M, Chin D, Hammerstingl C, Ghanem A, Bence J, Kovac J, Grube E, Nickenig G, Werner N. Evaluation and management of paravalvular aortic regurgitation after transcatheter aortic valve replacement. J Am Coll Cardiol 2013;62: 11 – 20.
CARDIOVASCULAR FLASHLIGHT
doi:10.1093/eurheartj/ehu524 Online publish-ahead-of-print 30 January 2015
.............................................................................................................................................................................
How to re-shape a transcatheter heart valve 1 Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany; and 2Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
* Corresponding author. Email: [email protected] †
These authors contributed equally to this work.
A 82-year-old female patient suffering from severe aortic stenosis presented with progressive dyspnoea NYHA class III after syncope. Due to severe calcifications of the ilio-femoral arteries, she underwent uneventful transapical transcatheter aortic valve implantation with a balloon-expandable Edwards SAPIEN 3 (23 mm) prosthesis. Three hours postoperatively, the patient had a sudden cardiac arrest due to ventricular fibrillation (VF). After 4 min of cardiopulmonary resuscitation (CPR) normal sinus rhythm was restored. Since neither signs of cardiac ischaemia (no ST-segment alterations in the electrocardiogram) nor troponin elevation were seen myocardial ischaemia could be ruled out as reason for VF. TEE after CPR confirmed a correct intra-annular position of the transcatheter heart valve (THV) but revealed a severe prosthesis deformation with consecutive paravalvular leakage (Panels A and B). To overcome this THV-specific failure mode, which has been described recently for balloon-expandable THVs, we decided to re-dilate the SAPIEN 3 prosthesis via transfemoral access (Supplementary material online, Video S1), using a 9-French 20 mm Tyshak II Balloon Dilatation Catheter (NuMED Inc., Hopkinton, NY, USA). After the first inflation of the balloon (Supplementary material online, Video S2), the prosthesis appeared reshaped in fluoroscopy without any signs of migration or any remaining transvalvular gradient. Furthermore, the significant paravalvular leakage had completely disappeared after re-dilation of the prosthesis stent frame, which now appeared round-shaped again (Panels C and D). The further clinical course of the patient was uneventful. Long-term follow-up has to show whether re-dilation might impact stability of the stent frame or durability of the valve itself but this case demonstrates how to address successfully THV compression. Supplementary material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
Downloaded from http://eurheartj.oxfordjournals.org/ by guest on November 13, 2015
Wilhelm Roell1†, Jan Malte Sinning2†, Nikos Werner2, and Fritz Mellert1*
