Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 13, Number 4, April 2022, pages 172-177

Valve-in-Valve Transcatheter Aortic Valve Implantation With Acute Left and Right Coronary Artery Occlusion: A Case Report

Figures

Figure 1.
Figure 1. Transthoracic echocardiography of the bioprosthetic aortic valve: 2D picture showing thickened left ventricular septum and severely calcified aortic cusps (left); continuous doppler through the bioprosthetic aortic valve showing severe stenosis (maximal velocity 4.3 m/s, mean gradient 43 mm Hg) (right).
Figure 2.
Figure 2. CT aortogram measurements: aortic annulus (up left); sinus of Valsalva (up right); left coronary ostia height (bottom left); right coronary ostia height (bottom right). CT: computed tomography.
Figure 3.
Figure 3. (a) Balloon aortic valvuloplasty with a 22 × 40 mm balloon and a BMW wire placed in the distal LAD. Flow is present in both coronary arteries. (b) Drug-eluted stent placed in the middle segment of the LAD (red arrow). (c) Implantation of a 26-mm balloon-expandable Sapien 3 valve in the annular position. (d) Left main stenting up to the ascending aorta using the “chimney technique”; post-dilatation balloon (green arrow). (e) Aortography showing an occlusion of the RCA (blue arrow). (f) Flow restoration in the RCA after administration of unfractionated heparin and eptifibatide (yellow arrow). LAD: left anterior descending; RCA: right coronary artery.
Figure 4.
Figure 4. TTE Doppler gradient through the Sapien 3 valve before discharge showing mildly elevated velocity and gradients. TTE: transthoracic echocardiography.