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Published on: August 14, 2017
Strategic Reintervention With Marked Oversizing and Overexpansion in TAV-in-SAV for Hemolytic Paravalvular Leak
Makoto Saigan1, Masaki Miyasaka2, Keita Yoshiyama1
1Department of Cardiology, Sendai Kousei Hospital, Sendai, Miyagi, Japan.
Background:
Paravalvular leak (PVL) is a common complication of surgical aortic valve replacement and may recur even after transcatheter plug closure.
Case Summary:
A 71-year-old man developed recurrent PVL with hemolytic anemia 4 years after plug closure after redo surgical aortic valve replacement with a 25-mm Carpentier-Edwards Perimount Magna Ease valve. Valve-in-valve transcatheter aortic valve replacement was performed using a 29-mm Sapien 3 Ultra Resilia valve (Edwards Lifesciences). To achieve sufficient oversizing and annular apposition, a deliberately oversized valve was selected and deployed using balloon overfilling.
Discussion:
We report the intentional use of an oversized Sapien 3 valve with deliberate overexpansion beyond the standard size recommended for a 25-mm Magna Ease valve. This strategy led to effective PVL sealing and the complete resolution of hemolysis.
Take-Home Messages:
Anatomy-guided valve oversizing, combined with intentional overexpansion, is pivotal to procedural success. This approach may be a viable treatment option for high-risk patients with recurrent PVL.
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