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Avoiding Pacemaker Implantation by Using Intracardiac Echocardiography During Self-Expanding Valve TAVR
Satoki Oka1, Syunsuke Matsushita1, Akihiro Ikuta1
1Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
Background:
Intracardiac echocardiography during transcatheter aortic valve replacement (TAVR) clarifies the relationship between the bioprosthetic valve and membranous septum (MS), reducing atrioventricular conduction disturbances.
Case Summary:
An 82-year-old man with severe aortic stenosis underwent transfemoral TAVR owing to annular calcification; we used a self-expanding 29-mm Evolut FX valve (Medtronic) for the procedure. Computed tomography showed a short MS length, indicating high risk for conduction disturbance. Intracardiac echocardiography revealed that although the valve extended beyond the MS, calcifications at the noncoronary cusp (NCC) and right coronary cusp (RCC) would prevent contact with the muscular septum, avoiding the need for permanent pacemaker implantation (PPI).
Discussion:
The conduction pathway and the MS are located between the NCC and RCC. Severe calcification at these sites may reduce the risk of PPI.
Take-Home Message:
Significant valve calcification at the NCC and RCC may allow deep implantation during TAVR without PPI.
