DOI: 10.25881/BPNMSC.2021.53.55.032

Authors

Vlasenko S.V.1, Biryukov A.V.2, Vil’danov T.R.2, Korepanova A.I.2, Svyatova A.V.2

1 Hospital №40 of Kurortny District, St. Petersburg

2 First Pavlov State Medical University of St. Petersburg

Abstract

Due to the improvement of the technology of transcatheter aortic valve implantation (TAVI), the indications for this operation are extended. Clinical case of left coronary artery obstruction during TAVI, risk factors and prevention are described.

Case description: A 64-year-old female patient with critical aortic stenosis. The risk of surgery with heart lung mashine according to EuroSCORE II — 5%, diabetes mellitus, previous stenting of left anterior descending artery. Severe atherosclerotic lesions of ilio-femoral arterial segments, calcification of the aorta and the angle between the long axis of aortic root and the longitudinal axis of left ventricle (LV) 42°. LVEDV — 74 ml (indexed LVEDV — 37 ml / m2). LV hypertrophy, EFLV — 65%. After transapical implantation of Med-Lab-CT 27 mm aortic valve, narrowing of left mainstem (compressed by calcified left coronary leaflet) occurred. Balloon dilatation and stenting of the left mainstem was performed.

Conclusion: Obstruction of the left mainstem by the leaflet of the native calcified aortic valve occurs at the presence of low height of the orifice of the coronary artery, a narrow aortic root with a height of the Valsalva sinuses in the range from 7 to 12 mm, which creates limited space for the prosthesis, as well as bulky calcified formations on the native left or right valves.

Keywords: transcatheter aortic valve replacement, TAVI, clinical case.

References

1. Hubulava GG, Marchenko SP, Starchik DA, et al. Geometricheskie i morfologicheskie harakteristiki kornya aorty v norme i pri nedostatochnosti aortal’nogo klapana. Hirurgiya. 2018; 57: 4–13. (In Russ).

2. Mack M, Leon M, Thourani V, Makkar R, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019; 380(18): 1695–1705.

3. Vahl TP, Kodali SK, Leon MB. Transcatheter Aortic Valve Replacement 2016: A Modern-Day “through the Looking-Glass” Adventure. J Am Coll Cardiol. 2016; 67(12): 1472–1487.

4. Krasopoulos G, Falconieri F, Benedetto U, et al. European real world trans-catheter aortic valve implantation: Systematic review and meta-analysis of European national registries. J Cardiothorac Surg. 2016; 11(1): 46–51.

5. Belevitin AB, Hubulava GG, Sazonov AB, et al. Hirurgicheskoe lechenie zabolevanij grudnoj aorty. Medicinskij akademicheskij zhurnal. 2010; 10(3): 45–51. (In Russ).

6. Hubulava GG, SHihverdiev NN, Naumov AB, Suvorov VV, Marchenko SP, Averkin II. Patofiziologicheskie mekhanizmy i faktory riska sternal’noj infekcii v kardiohirurgii. Vestnik rossijskoj voenno-medicinskoj akademii. 2013; 41(1): 174–179. (In Russ).

7. Hubulava GG, SHihverdiev NN, Fogt PR, et al. Rezul’taty primeneniya metodiki eliminacii sternal’noj infekcii u kardiohirurgicheskih pacientov. Vestnik hirurgii im II Grekova. 2015; 174(5): 57–60. (In Russ).

8. Eggebrecht H, Vaquerizo B, Moris C, Bossone E, et al. Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): Insights from the e uropean R egistry on e mergent C ardiac S urgery during TAVI (EuRECS-TAVI). Eur Heart J. 2018; 39(8): 676–684.

9. Howard C, Jullian L, Joshi M, et al. TAVI and the future of aortic valve replacement. J Card Surg. 2019; 34(12): 1577–1590.

10. SHihverdiev NN, Hubulava GG, Marchenko SP. Lechenie pacientov kardiologicheskogo profilya. Sovremennye hirurgicheskie vozmozhnosti. SPb, 2011. 206 р. (In Russ).

11. Combaret N, Bouchant M, Motreff P, Souteyrand G. TAVI and coronary revascularization. Ann Cardiol Angeiol (Paris). 2019; 68(6): 423–428.

12. Pfeiffer S, Santarpino G, Fischlein T, Jessl J, Pauschinger M. Coronary obstruction following TAVI valve-in-valve: Could we prevent it? Catheter Cardiovasc Interv. 2013; 81(2): 386.

13. Ribeiro HB, Webb JG, Makkar RR, et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: Insights from a large multicenter registry. J Am Coll Cardiol. 2013; 62(17): 1552–1562.

14. Ribeiro HB, Nombela-Franco L, Urena M, Mok M, Pasian S, Doyle D, et al. Coronary obstruction following transcatheter aortic valve implantation: A systematic review. JACC Cardiovasc Interv. 2013; 6(5): 452–461.

15. Nishimura R.A, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology. American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017; 135(25): 1159–1195.

16. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38(36): 2739–2786.

17. Hubulava GG, SHihverdiev NN, Pajvin AA, Marchenko SP, Naumov AB, et al. Zashchita miokarda pri operaciyah na serdce. SPb: Diton. 143 р. (In Russ).

For citation

Vlasenko S.V., Biryukov A.V., Vil’danov T.R., Korepanova A.I., Svyatova A.V. Left coronary artery obstruction during hybrid aortic valve implantation: anatomy, risk assessment, prevention and stenting. Bulletin of Pirogov National Medical & Surgical Center. 2021;16(1):169-172. (In Russ.) https://doi.org/10.25881/BPNMSC.2021.53.55.032