TAVI Between a Rock and a Hard Place in a Transplanted Heart

Area of Science:

• Cardiology
• Cardiac Imaging
• Interventional Cardiology

Background:

• Transcatheter aortic valve intervention (TAVI) is a treatment option for aortic stenosis.
• Patient selection for TAVI requires careful assessment of cardiac anatomy.
• Large aortic annuli present unique challenges for device implantation.

Observation:

• A 61-year-old male patient presented for TAVI evaluation.
• Gated cardiac computed tomography revealed extensive eccentric calcification of the left ventricular outflow tract (LVOT).
• The patient had a large aortic annulus (33 mm; 854 mm²).

Findings:

• The patient's aortic annulus size exceeded recommended manufacturer limits for TAVI devices.
• Extensive LVOT calcification extended into the mitral valve leaflet.
• Observational data indicate potential use of Edwards Sapien 3 and Medtronic Evolut R devices in large annuli.

Implications:

• This case highlights the importance of advanced imaging in complex TAVI cases.
• Careful consideration of patient-specific anatomy is crucial for successful TAVI.
• Further research may clarify optimal device selection for patients with large aortic annuli and LVOT calcification.