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Published on: December 11, 2017
Coronary protection for the small left coronary sinus during transcatheter aortic valve replacement: a case report
Chen Yang1, Guangyuan Song1, Guannan Niu1
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishilu, Xicheng District, Beijing 100037, China.
Insights
Transcatheter aortic valve replacement (TAVR) carries a risk of coronary obstruction. A four-step assessment involving imaging and pre-emptive stenting successfully prevented this complication in a high-risk patient.
Area of Science:
- Cardiovascular Interventions
- Structural Heart Disease
- Interventional Cardiology
Background:
- Coronary obstruction (CO) is a rare but serious complication during transcatheter aortic valve replacement (TAVR).
- Patients with specific anatomical variations, such as a small left coronary sinus, face elevated risks of CO during TAVR.
Observation:
- A case involving a TAVR patient with a small congenital left coronary sinus and high risk for CO is presented.
- This patient underwent TAVR with a strategy of preliminary coronary protection.
Findings:
- Computed tomography angiography (CTA) and 3D-printing simulation were crucial for risk assessment.
- Pre-emptive chimney stenting, predilation, and advanced imaging successfully prevented CO during the TAVR procedure.
- Follow-up CTA confirmed the patency of the left main coronary artery via chimney stenting.
Implications:
- A novel 'four-step assessment' method is proposed for managing TAVR in patients at high risk of CO.
- This approach enhances procedural safety and outcomes for complex TAVR cases.
Background:
Coronary obstruction (CO) is an infrequent but life-threatening complication during transcatheter aortic valve replacement (TAVR).
Case Summary:
We report the case of a patient who accepted TAVR with high anatomical risks of CO due to the small congenital left coronary sinus, which was treated with preliminary coronary protection. This case highlighted the importance of computed tomography angiography (CTA) evaluation, 3D-printing stimulation, predilation as a reference sign, and pre-emptive chimney stenting technology to successfully anticipate and prevent CO during TAVR. At the 3rd month follow-up, CTA evaluation and 3D-printing simulation identified the chimney stenting of the left main coronary arterial patency.
Discussion:
A 'four-step assessment' method also proposes a new clinical procedure on how to perform TAVR in patients with high risks of CO.
