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Complex valve in valve TAVI in a 60 yrs old patient with degenerated tissue valve operated 10 yrs back

A 60-year-old lady presented with recurrent heart failure hospitalizations. She underwent an aortic valve replacement with a bio-prosthetic valve in 2012 for severe aortic stenosis and now developed restenosis with moderate aortic regurgitation of the aortic valve due to degeneration of the prosthetic aortic valve. She was in severe heart failure and was transferred via air ambulance. A re-do surgery was deemed very high risk and hence option of valve-in-valve TAVI was considered. During the evaluation of TAVI, her CT showed very low aortic annulus to coronary height (a predictor of coronary occlusion due to prosthetic valve). After a multidisciplinary Heart-team meeting, it was decided to go ahead with TAVI. She underwent TAVI using a self-expandable 23mm Medtronic Evolut valve on the 1st day of the new year as the 1st case in our cath lab.

The low coronary height was a big challenge in this case and to prevent the risk of coronary occlusion, RCA was pre-emptively wired and a stent was positioned in the mid-segment ready for deployment in case of occlusion of the RCA with valve tissue. The procedure went uneventful with no compromise to coronary flow and the gradient across aorta was completely abolished with minimal aortic regurgitation. The patient recovered well from the procedure and could be ambulated within 24 hours.

Dr. P C Rath
MBBS; MD; DM (Cardiology); FICC; FACC
Cardiologist
Apollo Hospitals, Jubilee Hills, Hyderabad, India

Dr. Manoj Agrawal
MBBS; MD; DM; FACC; FACAI
Cardiologist
Apollo Hospitals, Jubilee Hills, Hyderabad, India

Dr.Varsha Kiron
MD,DM(Cardiology), DNB(Cardiology)
Cardiologist
Apollo Hospitals, Jubilee Hills, Hyderabad, India

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