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Management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report
BACKGROUND: Left ventricular outflow track (LVOT) obstruction (LVOTO) is a severe complication of transcatheter mitral valve replacement (TMVR) procedures, with an uncertain prognosis and only few strategies available to prevent its occurrence. TMVR is thus contraindicated in some patients because o...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883726/ https://www.ncbi.nlm.nih.gov/pubmed/36727134 http://dx.doi.org/10.1093/ehjcr/ytad027 |
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author | Cavalerie, Hugo Casassus, Frederic Dubourg, Benjamin Darremont, Olivier |
author_facet | Cavalerie, Hugo Casassus, Frederic Dubourg, Benjamin Darremont, Olivier |
author_sort | Cavalerie, Hugo |
collection | PubMed |
description | BACKGROUND: Left ventricular outflow track (LVOT) obstruction (LVOTO) is a severe complication of transcatheter mitral valve replacement (TMVR) procedures, with an uncertain prognosis and only few strategies available to prevent its occurrence. TMVR is thus contraindicated in some patients because of a high risk of LVOTO onset. We demonstrate how LVOTO can be managed with a balloon inflation in the LVOT and a D-shaped deformation of the bioprosthetic valve. CASE SUMMARY: A 64-year-old female presented with acute pulmonary oedema 2 weeks following aortic valve replacement and aorto-coronary bypass surgeries. A concomitant mitral stenosis, secondary to significant calcifications of the mitral annulus, was not treated during the procedure. After surgery, the mitral valvulopathy caused an acute heart failure and TMVR was performed by the heart team. The procedure was complicated by a cardiac arrest secondary to the onset of LVOTO which was managed by a balloon inflation in the LVOT and an alcohol septal ablation. Two-year follow-up shows a favourable outcome of the patient and good function of the prosthetic valve despite its deformation. DISCUSSION: This case highlights the successful management of a LVOTO following valve-in-mitral annular calcification TMVR by balloon inflation in the LVOT. It is strongly recommended to place a ‘rescue’ guidewire in transaortic position during TMVR in order to manage the potential onset of acute LVOTO. |
format | Online Article Text |
id | pubmed-9883726 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-98837262023-01-31 Management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report Cavalerie, Hugo Casassus, Frederic Dubourg, Benjamin Darremont, Olivier Eur Heart J Case Rep Case Report BACKGROUND: Left ventricular outflow track (LVOT) obstruction (LVOTO) is a severe complication of transcatheter mitral valve replacement (TMVR) procedures, with an uncertain prognosis and only few strategies available to prevent its occurrence. TMVR is thus contraindicated in some patients because of a high risk of LVOTO onset. We demonstrate how LVOTO can be managed with a balloon inflation in the LVOT and a D-shaped deformation of the bioprosthetic valve. CASE SUMMARY: A 64-year-old female presented with acute pulmonary oedema 2 weeks following aortic valve replacement and aorto-coronary bypass surgeries. A concomitant mitral stenosis, secondary to significant calcifications of the mitral annulus, was not treated during the procedure. After surgery, the mitral valvulopathy caused an acute heart failure and TMVR was performed by the heart team. The procedure was complicated by a cardiac arrest secondary to the onset of LVOTO which was managed by a balloon inflation in the LVOT and an alcohol septal ablation. Two-year follow-up shows a favourable outcome of the patient and good function of the prosthetic valve despite its deformation. DISCUSSION: This case highlights the successful management of a LVOTO following valve-in-mitral annular calcification TMVR by balloon inflation in the LVOT. It is strongly recommended to place a ‘rescue’ guidewire in transaortic position during TMVR in order to manage the potential onset of acute LVOTO. Oxford University Press 2023-01-17 /pmc/articles/PMC9883726/ /pubmed/36727134 http://dx.doi.org/10.1093/ehjcr/ytad027 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Case Report Cavalerie, Hugo Casassus, Frederic Dubourg, Benjamin Darremont, Olivier Management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report |
title | Management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report |
title_full | Management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report |
title_fullStr | Management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report |
title_full_unstemmed | Management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report |
title_short | Management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report |
title_sort | management of life-threatening deformation of obstructive transcatheter mitral valve replacement bioprosthesis with balloon inflation in left ventricular outflow tract: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9883726/ https://www.ncbi.nlm.nih.gov/pubmed/36727134 http://dx.doi.org/10.1093/ehjcr/ytad027 |
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