Repeat transcatheter aortic valve replacement using a 23 mm Evolut R in a small patient with a failed 20 mm SAPIEN XT
Images in Cardiovascular Intervention
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An 85-year-old small woman (body surface area of 1.0 m 2) presented with acute heart failure requiring non-invasive positive pressure ventilation. Her past medical history included rheumatic arthritis with immunosuppression therapy. She previously had a successful transfemoral transcatheter aortic valve replacement (TAVR) with the 20 mm SAPIEN XT (Edwards Lifesciences) in 2011 without complication. Her symptom was improved. However, follow-up transthoracic echocardiography (TTE) demonstrated maximal aortic valve velocity of 2.9 m/s at discharge, although the leaflets were fully opened. In emergent admission 6 years after the first TAVR, TTE demonstrated maximal aortic valve velocity of 6.2 m/s with calcified leaflets of the 20 mm SAPIEN XT which resulted in decompensated heart failure (Fig. 1a), and salvage intervention was required. Transfemoral Valve-in-Valve TAVR using the 23 mm Evolut R (Medtronic) was urgently planned based on the computed tomography (Fig. 1b). Severely calcified...
© Japanese Association of Cardiovascular Intervention and Therapeutics 2018