CASE20240524_002
Transcatheter Aortic Valve Implantation During Asystole
By Alexey Sozykin, Emelianov Pavel, Alexandr Shlykov, Liudmila Ulyanova, Natalya Novikova
Presenter
Alexey Sozykin
Authors
Alexey Sozykin1, Emelianov Pavel2, Alexandr Shlykov1, Liudmila Ulyanova2, Natalya Novikova1
Affiliation
Central Clinical Hospital of the Russian Academy of Sciences, Russian Federation1, Scientific Clinical Center 2 Petrovsky National Research Center of Surgery NRCS, Russian Federation2,
View Study Report
CASE20240524_002
TAVR - Complex TAVR
Transcatheter Aortic Valve Implantation During Asystole
Alexey Sozykin1, Emelianov Pavel2, Alexandr Shlykov1, Liudmila Ulyanova2, Natalya Novikova1
Central Clinical Hospital of the Russian Academy of Sciences, Russian Federation1, Scientific Clinical Center 2 Petrovsky National Research Center of Surgery NRCS, Russian Federation2,
Clinical Information
Relevant Clinical History and Physical Exam
An 89-year-old patient with a burdened cardiovascular history, marked cognitive decline, decreased memory for current and past events. The anamnesis is collected partly from words, partly from the data provided by the medical documentation. Hypertension has been diagnosed for a long time, but it is difficult to clarify the maximum indicators, does not accept any post-treatment, if necessary uses nitrospray, herbal cardiospore.
Relevant Test Results Prior to Catheterization
Biochemistry (Blood (venous)):Date: 05/22Temperature - 36,000 (36.4 - 37) degrees. C; FiO2 - 30,000 () %; pH - 7,310 (); pCO2 - 51,400 (42-55) mmHg; pO2 - 35,800 () mmHg; SO2 – 69 500 (95 – 99) %; HCO3 - 25,600 (22 - 31) mmol/l; SBK - 23,100 (21.8 - 26.2) mmol/L; tCO2 - 24,000 (18.9 - 24.9) mmol/L; tO2 - 4800 (7.1 - 8.9) mmol/L; SBE - -0,100 (-3 - 2) mmol/l; p50 - 28,370 (25 - 29) mmHg; FO2Hb – 67 300 (94 – 98) %; FCOHb - 1.60
Relevant Catheterization Findings
After successive dilation of 20x40 mm and 25x40 mm cylinders, total aortic valve insufficiency occurred, followed by ventricular fibrillation and asystole; during asystole, an Abbott Portico aortic prosthesis with a diameter of 29 mm was implanted.
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MOVIE-0001.mp4 MOVIE-0002.mp4 MOVIE-0003.mp4Interventional Management
Procedural Step
The right common femoral artery was punctured and two intravascular Proglide sutures were applied. The rigid Confida conductor is located in the cavity of the left ventricle. Next, a balloon catheter 20.0x40mm was wound up with great difficulties, valvuloplasty was performed, then valvuloplasty was performed with a balloon catheter 25.0x40mm. after dilation, total regurgitation of the aortic valve occurred, ventricular fibrillation occurred, successful defebrillation was performed, asystole was registered on the ECG, indirect heart massage was initiated, during which the Portico 29mm aortic valve prosthesis was positioned and implanted. After implantation of the prosthesis and indirect heart massage and vasopressor support, the sinus rhythm was restored with a heart rate of 95, and blood pressure of 140 and 70 mmHg.
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MOVIE-0001.mp4 MOVIE-0002.mp4 MOVIE-0003.mp4Case Summary
Complex patients should be operated on by experienced surgeons in a well-equipped surgery room. It is always necessary to take into account the presence of initial regurgitation on the aortic valve. Always be ready to perform the implantation of an aortic prosthesis, even during asystole.