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[Transprosthetic catheterization of a Björk-Shiley aortic prosthesis with fatal outcome]
Insights
Transprosthetic catheterization of Björk-Shiley aortic prostheses can cause fatal complications due to disc sticking. The transseptal approach is recommended for left ventricular catheterization after aortic valve replacement to ensure patient safety.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Aortic valve replacement with mechanical prostheses like the Björk-Shiley prosthesis is a common procedure.
- Catheterization is often required for diagnostic and therapeutic interventions post-surgery.
- Transprosthetic catheterization has been considered a viable approach for accessing the left ventricle.
Observation:
- A retrograde transprosthetic catheterization using a Sones catheter on a Björk-Shiley aortic prosthesis (ABP) led to the tilting disc becoming stuck.
- Attempts to retrieve the catheter were unsuccessful, resulting in a fatal outcome before emergency reoperation could be performed.
Findings:
- Retrograde transprosthetic catheterization of tilting or bileaflet prostheses carries a significant risk of mechanical complications.
- The procedure, previously reported as low-risk, can lead to irreversible catheter entrapment and adverse events.
Implications:
- Transprosthetic catheterization of mechanical aortic valves, particularly those with tilting discs or bileaflet designs, should be avoided.
- The transseptal approach is the recommended alternative for left ventricular catheterization post-aortic valve replacement.
- This safer approach allows for accurate assessment of prosthesis function and co-existing mitral valve pathology.
Abstract:
Retrograde transprosthetic catheterization of a Björk-Shiley aortic prosthesis (type ABP) using a Sones catheter resulted in sticking of the tilting disc. Every attempt to withdraw the catheter failed and the patient died before he could be transferred for emergency reoperation. We advise against transprosthetic catheterization of tilting or bileaflet prostheses, which has been reported to be easily to perform without apparent risk. If left ventricular catheterization is mandatory after aortic valve replacement, the transseptal approach should be used. This is the only procedure which permits accurate evaluation of the functioning of the prosthesis or a concomitant mitral valve disease.