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Difficult Cases and Complications from the Catheterization Laboratory: Case 1

  • Neil Ruparelia
  • Azeem Latib
  • Antonio ColomboEmail author
Chapter

Abstract

An 81-year-old lady presented to the Heart Team as an emergency with an episode of acute cardiac decompensation. Three years previously, she had undergone successful cardiac surgery with coronary artery bypass grafting (CABG) (saphenous vein graft – left obtuse marginal branch) with both mitral (25 mm Mosaic valve, Medtronic, Minnesota, USA) and aortic valve replacements (25 mm Epic valve, St. Jude, Minnesota, USA). She made an uneventful recovery from this surgery. Two years later, she presented as an emergency with bacterial endocarditis (Streptococcus sanguinis) affecting the aortic prosthesis that was successfully treated with prolonged ampicillin and gentamicin chemotherapy without the requirement for surgery. However, she was left with residual moderate aortic regurgitation (AR) in the absence of symptoms.

Keywords

Aortic Regurgitation Transcatheter Aortic Valve Implantation Bioprosthetic Valve Minimal Lumen Diameter Embolic Protection Device 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 5.1

Severe aortic regurgitation. Five-chamber apical view, demonstrating severe aortic regurgitation (color Doppler flow) in the presence of preserved left ventricular systolic function (AVI 3007 kb)

Video 5.2

Mobile aortic valve mass. Short-axis view demonstrating appearance of mobile calcified mass on aortic valve leaflet, likely secondary to previously treated endocarditis (AVI 4414 kb)

Video 5.3

Severe aortic regurgitation. Aortography confirmed severe aortic regurgitation, secondary to aortic bioprosthesis dysfunction (AVI 13061 kb)

Video 5.4

Suboptimal positioning of TAVI prosthesis. After partial resheathing of Medtronic Evolut R, aortography demonstrated that the position was suboptimal (too low) and therefore the prosthesis was subsequently resheathed and the reposition to a higher, more ideal position (AVI 18950 kb)

Video 5.5

Final aortography. Final aortography demonstrated excellent position of the TAVI device with no evidence of aortic regurgitation (AVI 19718 kb)

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Neil Ruparelia
    • 1
    • 2
    • 3
  • Azeem Latib
    • 1
    • 2
  • Antonio Colombo
    • 2
    • 3
    Email author
  1. 1.Imperial CollegeLondonUK
  2. 2.San Raffaele Scientific InstituteMilanItaly
  3. 3.EMO-GV Centro Cuore ColumbusMilanItaly

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