A Tandem Valve, a unique complication of TAVR

CASE STUDY, February 2016, VOL IV ISSUE I, ISSN 2042-4884
10.5083/ejcm.20424884.146 , Cite or Link Using DOI
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Srinivasan Sattiraju MD, Sanjay Mehta MD, Mathew Gibb MD, Scott Cook MD Michael Colla MD, Emil Missov MD PhD

ABSTRACT

We report a unique complication of transcatheter aortic valve replacement (TAVR) in which there is mechanical entrapment of two Edward Sapien valves. The tandem valve configuration created a high gradient across the valves stuck in tandem. The images and videos in this case capture findings that underscore the complexity of interaction between two prosthetic valves. We believe this case serves a high teaching value for physicians taking care of patients with aortic stenosis managed with TAVR approach.

INTRODUCTION

A 78-year-old man with ischemic cardiomyopathy, two prior sternotomies, stage 3 chronic kidney disease and oxygen-dependent chronic obstructive pulmonary disease was considered for transcatheter aortic valve replacement (TAVR) due to severe valvular aortic stenosis. Operative risk was deemed unacceptably high (Society of Thoracic Surgeons predicted risk of mortality 11.4%, EuroScore II 13%). The left ventricular ejection fraction was 20% at baseline. The peak velocity and mean pressure gradient across the aortic valve measured 440 cm/s and 39 mmHg, respectively following dobutamine challenge, consistent with preserved contractile reserve of the left ventricle and true severe valvular aortic stenosis (valve area 0.7 cm²). The aortic annular size measured 439 mm2 (average diameter, 23-24 mm). A transaortic approach was planned due to small luminal diameter of the peripheral vessels.