Transfemoral transcatheter aortic valve replacement for severe aortic stenosis with concomitant left ventricular diverticulum: a case report

BACKGROUND: Left ventricular diverticulum (LVD) is a rare cardiac malformation in patients with severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) is not recommended due to the risk of diverticulum injury. However, for patients considered inoperable or at high surgical risk, TAVR might be the only treatment option. The safety and feasibility of TAVR for severe AS with concomitant LVD are still unclear. CASE SUMMARY: An 80-year-old Asian woman complaining of shortness of breath was admitted to our hospital, whose echocardiogram showed calcified severe AS and a diverticulum in the left ventricular apex. A transfemoral 26 mm Venus-A prosthetic aortic valve was successfully implanted. Pre- and post-procedural cardiac magnetic resonance imaging revealed a remarkable volume reduction of LVD. DISCUSSION: Transfemoral TAVR was not preferred because the straight-tip hydrophilic wire and catheter tip could injure the fragile diverticulum wall. If we could avoid the injury of the diverticulum, TAVR would be a good option for patients at high surgical risk.