Successful Transcatheter Aortic Valve Implantation in A Patient With Severe Dilatation of The Ascending Aorta


  • Matjaz Bunc Professor of internal medicine and pathophysiology University Medical Center Ljubljana ZaloÅ¡ka c. 007 1000 Ljubljana
  • Jana Ambrožič
  • Blaž Mrevlje
  • Bojan Kontestabile
  • Nikola Lakic
  • Å pela MuÅ¡ič


TAVI, dilated ascending aorta


Background: Transcatheter aortic valve implantation (TAVI) has become a well established method for treating severe symptomatic aortic stenosis (AS) in surgical high-risk patients. Despite increasing use there are certain contraindications for TAVI, one of them being until recently severe dilatation of the ascending aorta.

Case presentation: 86-yr old female patient, with known arterial hypertension, diabetes mellitus type 2 and chronic atrial fibrillation, was admitted due to heart failure.  Echocardiography showed a severe calcified aortic stenosis (aortic valve area 0,5 cm2, mean gradient 47 mmHg). Further investigations showed a severe dilatation of the ascending aorta with a maximum diameter of 52 mm. According to EuroSCORE (19.85%) and STS (12) the patient had a high risk for surgery and was rejected for surgical aortic valve replacement by the Heart Team. Successful TAVI was performed. On 6-month follow up the patient is in good clinical condition and free of symptoms. Control investigations show the bovine aortic valve in proper position with normal  function and no progression of dilatation of the ascending aorta.

Conclusion: In surgical high-risk patients with severe AS and dilatation of the ascending aorta of degenerative etiology (without connective tissue diseases) TAVI can be successfully performed using the Edwards XT valve. Dilatation of ascending aorta should not be an absolute contraindication for TAVI. However, decision for TAVI should be driven by all circumstances of the patient including the 1-2 year prediction  of the possible progression of the aortic dilatation.



Smith CR, Leon MB, Mack MJ et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011 Jun 9;364(23):2187-98.

Leon MB, Smith CR, Mack M et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. N Engl J Med. 2010 Oct 21;363(17):1597-607.

Vahanian A, Alfieri O, Andreotti F et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012 Oct;33(19):2451-96.

van Geldorp MW, Heuvelman HJ, Kappetein AP et al. The effect of aortic valve replacement on quality of life in symptomatic patients with severe aortic stenosis. Neth Heart J. 2013 Jan;21(1):28-35.

Kim TH, Park KH, Yoo JS et al. Does additional aortic procedure carry a higher risk in patients undergoing aortic valve replacement? Korean J Thorac Cardiovasc Surg. 2012 Oct;45(5):295-300.

Andrus BW, O'Rourke DJ, Dacey LJ et al. Stability of ascending aortic dilatation following aortic valve replacement. Circulation. 2003 Sep 9;108 Suppl 1:II295-9.

Joo HC, Chang BC, Youn YN et al. Clinical experience with the Bentall procedure: 28 years. Yonsei Med J. 2012 Sep;53(5):915-23.

Gaudino M, Anselmi A, Morelli M et al. Aortic expansion rate in patients with dilated post-stenotic ascending aorta submitted only to aortic valve replacement long-term follow-up. J Am Coll Cardiol. 2011 Aug 2;58(6):581-4.

Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. Circulation. 2010 Apr 6;121(13):e266-369.

Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012 Oct;42(4):S1-44.




How to Cite

Bunc, M., Ambrožič, J., Mrevlje, B., Kontestabile, B., Lakic, N., & Mušič, Špela. (2013). Successful Transcatheter Aortic Valve Implantation in A Patient With Severe Dilatation of The Ascending Aorta. Asian Journal of Pharmacy, Nursing and Medical Sciences, 1(3). Retrieved from