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Transcatheter Aortic Valve Implantation for Native Aortic Regurgitation After Healed Infective Endocarditis
Tsz Ho Chan1, Samuel Rustem Panday2, Rupert Simpson1
1Kings College Hospital, London, UK.
Background:
Severe native aortic regurgitation due to cusp perforation after healed infective endocarditis presents challenges for transcatheter aortic valve implantation (TAVI), particularly without annular calcification.
Case Summary:
A 46-year-old patient with healed infective endocarditis presented with severe eccentric aortic regurgitation due to perforation of the left coronary cusp. Given prohibitive surgical risk, transfemoral TAVI using the JenaValve Trilogy system was performed. Controlled deflection and rotational repositioning enabled coaxial alignment of the valve above the native cusps prior to deployment, resulting in no paravalvular leak and excellent hemodynamic outcome.
Discussion:
This case highlights the technical challenges of TAVI in aortic regurgitation with cusp perforation and demonstrates how leaflet-locator anchoring, delivery system deflection, and multimodality imaging enable safe and effective valve positioning.
Take-Home Message:
Cusp perforation may cause locator misengagement during TAVI; controlled deflection and repositioning are critical to achieve safe, stable deployment.
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