Transcatheter Aortic Valve Implantation In A Patient With Systemic Senile Transthyretin Type Amyloidosis

Authors

  • Matjaz Bunc Professor of internal medicine and pathophysiology University Medical Center Ljubljana ZaloÅ¡ka c. 007 1000 Ljubljana
  • Jerca Blazina
  • Nina Zidar
  • Blaz Mrevlje

Keywords:

TAVI, CoreValve, atrioventricular block, amyloidosis

Abstract

Trancatheter aortic valve implantation with CoreValve or Edwards-Sapien prosthesis is becoming the method of choice for treating severe, symptomatic aortic stenosis in surgical high risk patients. CoreValve implantation may worsen atrioventricular conduction with possible development of atrioventricular block. However, in patients with infiltrative cardiomyopathy, such as amyloidosis, conduction disturbances can be the result of the underlying disease alone.

88-yr old female patient with severe, symptomatic aortic stenosis, after was scheduled for transcatheter aortic valve implantation. The procedure itself was successfully performed however, after the procedure transient complete atrioventricular block developed and a temporary pacemaker electrode was inserted. One day after the procedure the atrioventricular block resolved into her basic heart rhythm which was chronic atrial fibrillation with slow ventricular response. Due to development of systemic signs of infection of unknown origin the temporary electrode was removed and implantation of permanent VVI-type pacemaker was indicated. While waiting for implantation the patient died of sudden cardiac death.

Results of autopsy showed a CoreValve in the proper aortic valve position without blocking the ostia of coronary arteries, mildly enlarged and moderately thickened left and right ventricles on macroscopic level. Histopathological examination showed that the patient had an underlying systemic senile amyloidosis of the transthyretin type with predominant involvement of the heart.

Our patient, who has undergone a transcatheter aortic valve implantation due to severe, symptomatic aortic stenosis, after two balloon valvuloplasties, was also suffering from systemic senile amyloidosis of transthyretin type. This was discovered only postmortem on autopsy.

Transcatheter aortic valve implantation may cause iatrogenic transient or permanent conduction disturbances with possible development of atrioventricular block and present the need for transient or permanent pacemaker implantation. However, her underlying infiltrative cardiomyopathy, could also lead to the same conduction system abnormalities. It is hard to conclude whether conduction disturbances in this case that lead to sudden cardiac death were entirely iatrogenic or entirely due to amyloidosis. In terms of complete atrioventricular block developing just after the procedure and ending in sudden cardiac death, conduction disturbances may have been due to her underlying infiltrative cardiomyopathy and exacerbated by the CoreValve implantation.

 

References

Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation 2002;106:3006-8.

Webb JG, Pasupati S, Humphries K, Thompson C, Altwegg L, Moss R, Sinhal A, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation 2007;116:755-763.

Grube E, Shuler G, Buellersfeld L, Gerckens U, Linke A, Wenaweser P, Sauren B, et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and third- generation self expanding CoreValve prosthesis: Device success and 30-day clinical outcome. J Am CollCardiol 2007;50:69-76.

Cribier A, Eltchaninof H, Tron C, Bauer F, Agatiello C, Nercolini D, Tapiero S, et al. Treatment of calcific aortic stenosis with the percutaneous heart valve: Mid-term follow-up from the initial feasibility studies: The French experience. J Am CollCardiol 2006;47:1214-23.

Rubin JM, Avanzas P, Del Valle R, Renilla A, Ríos E, Calvo D, Lozano I, et al. Atrioventricular conduction disturbance characterization in transcatheter aortic valve implantation with CoreValve prosthesis. CircCardiovascInterv 2011;Epub ahead of print.

Ferreira ND, Caeiro D, Adao L, Oliveira M, Gonçalves H, Ribeiro J, Teixeira M, et al. Incidence and predictors of permanent pacemaker requirement after transcatheter aortic valve implantation with a self-expanding bioprosthesis. Pacing Clin Electrophysiol. 2010;33(11):1364-72.

Rapezzi C, Quarta CC, Riva L, Longhi S, Gallelli I, Lorenzini M, Ciliberti P, et al. Transthyretin-related amyloidosis and the heart: a clinical overview. Nat Rev Cardiol 2010;7:398-408.

Baan JJ, Yong Z, Koch K, Henriques JP, Bouma BJ, Vis MM, Cocchieri R, et al. Factors associated with cardiac conduction disorders and permanent pacemaker implantation after percutaneous aortic valve implantation with the CoreValve prosthesis. Am Heart J 2010;159:497-503.

Leon M, Smith C, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010;363:1597-1607.

Koos R, Mahnken AH, Aktug O, Dohmen G, Autschbach R, Marx N, Hoffmann R. Electrocardiographic and imaging predictors for permanent pacemaker requirement after transcatheter aortic valve implantation. J Heart Valve Dis 2011;20(1):83-90.

Rutger-Jan N, Van Mieghem NM, Schultz CJ, Schultz CJ, Tzikas A, Van der Boon RM, Maugenest AM, et al. Timing and potential mechanisms of new conduction abnormalities during implantation of the Medtronic CoreValve System in petients with aortic stenosis. Eur Heart J 2011; Aug;32(16):2067-74.

Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. CirccardiovascInterv 2008;1:74-81.

Godino C, Maisano F, Montorfano M, Latib A, Chieffo A, Michev I, Al-Lamee R et al. Outcomes after transcatheter aortic valve implantation with both Edwards-Sapien and CoreValve devices in a single center: the Milan experience. JACC CardiovascInterv 2010;3:1110-1121.

Bleiziffer S, Ruge H, Horer J, Hutter A, Geisbüsch S, Brockmann G, Mazzitelli D et al. Predictors for new-onset complete heart block after transcatheter aortic valve implantation. JACC CardiovascInterv 2010;1:310-316.

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Published

2013-10-14

How to Cite

Bunc, M., Blazina, J., Zidar, N., & Mrevlje, B. (2013). Transcatheter Aortic Valve Implantation In A Patient With Systemic Senile Transthyretin Type Amyloidosis. Asian Journal of Pharmacy, Nursing and Medical Sciences, 1(3). Retrieved from https://ajouronline.com/index.php/AJPNMS/article/view/241