Successful Transcatheter Aortic Valve Implantation in A Patient With Severe Dilatation of The Ascending Aorta
Keywords:
TAVI, dilated ascending aortaAbstract
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.
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