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Related Concept Videos

Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Transapical TAVI in Left Ventricular Apical Aneurysm.

Ayman Helal1, Lok Yuh Ing2, Joanna Bilak1

  • 1Department of Cardiology, Derriford Hospital, University Hospitals Plymouth, Plymouth, UK.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 22, 2026
PubMed
Summary

Transcatheter aortic valve implantation (TAVI) via the transapical route is feasible even with a left ventricular apical aneurysm. This approach offers a viable option when transfemoral access fails for severe aortic stenosis patients.

Keywords:
bicuspid aortic valveleft ventricular aneurysmsevere aortic stenosistransapical accesstranscatheter aortic valve implantation (TAVI)

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve implantation (TAVI) is standard for severe aortic stenosis, with transfemoral (TF) access preferred.
  • Transapical (TA) TAVI is typically avoided in left ventricular (LV) apical aneurysms due to rupture risk.
  • Complex patient profiles often necessitate alternative TAVI access strategies.

Purpose of the Study:

  • To report the first case of transapical TAVI performed from an LV apical aneurysm.
  • To demonstrate the feasibility of TA TAVI in challenging anatomical conditions.
  • To challenge the contraindication of TA TAVI in LV apical aneurysms.

Main Methods:

  • A patient with severe bicuspid aortic stenosis and failed TF access underwent TA TAVI.
  • The procedure involved accessing the LV apex through an aneurysm sac despite fibrosed myocardium.
  • A 29mm Edwards Sapien S3 Ultra valve was successfully deployed.

Main Results:

  • Successful implantation of the TAVI valve with trivial paravalvular regurgitation.
  • Stable postoperative recovery was achieved.
  • The procedure demonstrated TA TAVI feasibility in an LV apical aneurysm.

Conclusions:

  • Transapical TAVI can be safely performed in patients with LV apical aneurysms.
  • LV apical aneurysms should not be an absolute contraindication for TA TAVI.
  • This case expands TAVI access options for complex aortic stenosis patients.