TAVR - Complex TAVR
Wongsaput Boonyakiatwattana1, Anuruck Jeamanukoolkit2, Prayuth Rasmeehirun1, Worawut Tassanawiwat3, Tanyarat Aramsareewong4, Piyanart Preeyanont5
Chulabhorn Hospital, Thailand1, Chulabhorn Hospital , Thailand2, Sunpasitthiprasong, Thailand3, Phramongkutklao Hospital, Thailand4, Cardiac center, Thailand5
Relevant Clinical History and Physical Exam
Relevant Test Results Prior to Catheterization
ECG revealed LVH with strain pattern. CAG revealed insignificant CAD. Pre-TAVI CT presented; moderately calcified symmetrical tricuspid valve with annular perimeter of 70.1 mm, derived-diameter 22.3 mm (Fig. 2A), average diameter of sinuses of valsalva (SOV) 29.9 mm, coronary ostia height 12.5 mm (left) & 13.4 mm (right), minimum femoral diameter 5.3 mm (right), 5.3 mm (left) and high bifurcation on both femorals (Fig. 2B). TAVI was planned under general anesthesia with Accurate Neo2 size S.
Relevant Catheterization Findings
We describe a case of severe intravalvular leak due to an immobile cusp. Post-deployment leaflet injury accelerated the need for investigating to seek intrinsic leaflets problem. We need to consider the device issue not only complications in straightforward procedure but also repeating fault in same lot of device.The Acurate Neo2 size S in this lot was sent to analysis for hydrodynamics, leaflet mechanics, calcification susceptibility, crimping and deployment stability. Although this lot had a new manual suture design with qualified by in vitro ISO guideline, this design, specificly size S, may increased leaflet tension caused incompletely mechanical valve closing.