TAVI in a Patient with Single Coronary Artery: The Choice of Self-Expandable Valve may be Reasonable

Abstract

Background: Single coronary artery is a rare congenital coronary artery anomaly with the incidence of approximately 0.03%-0.05%. Its coexistence with severe aortic stenosis (AS) is even rarer. Patients who undergo transcatheter aortic valve implantation (TAVI) have a risk of coronary obstruction (1%) which will be more lethal when the origin of the coronary artery is single. Case Report: An 81 year-old female was referred to our institution for severe AS. Her coronary angiography revealed a single coronary artery originating from right sinus of valsalva. Since the patient had a high risk for aortic valve surgery, the cardiac team decided to perform transfemoral TAVI with a self-expandable valve. Conclusion: We presented a successful case of TAVI with Medtronic CoreValve (Medtronic; Minnesota, USA) in a patient with single coronary artery after discussing the base of our strategy for preferring self-expandable valve. To the best of our knowledge, this is the second case of CoreValve implantation in such a patient in the literature. We suggest that the self-expandable valve may be the first choice in these patients because of its recapturable design.

Keywords

• Coronary obstruction, self-expandable valve, single coronary artery, transcatheter aortic valve implantation

References

1. 1. Desmet W, Vanhaecke J, Vrolix M, Van de Werf F, Piessens J, Willems J, et al. Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies. Eur Heart J 1992;13:1637-40.
2. 2. Boissier F, Coolen N, Nataf P, Tchetche D. Sudden death related to an anomalous origin of the right coronary artery. Ann Thorac Surg 2008;85:1077-9. [CrossRef]
3. 3. Corbett M, Powers J, King S, Quinn M, Harris D. Single coronary artery. J Am Coll Cardiol 2009;53:455. [CrossRef]
4. 4. Stajic Z, Mijailovic Z. Single coronary artery associated with severe bicuspid aortic valve stenosis. J Saudi Heart Assoc 2013;25:277-8. [CrossRef]
5. 5. Ribeiro HB, Nombela-Franco L, Urena M, Mok M, Pasian S, Doyle D, et al. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv 2013;6:452-61. [CrossRef]
6. 6. Khatri PJ, Webb JG, Rodes-Cabau J, Fremes SE, Ruel M, Lau K, et al. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med 2013;158:35-46. [CrossRef]
7. 7. Sorbets E, Choby M, Tchetche D. Transcatheter aortic valve implantation with either CoreValve or SAPIEN XT devices in patients with a single coronary artery. J Invasive Cardiol 2012;24:342-4.
8. 8. Stabile E, Sorropago G, Cioppa A, Cota L, Agrusta M, Lucchetti V, et al. Acute left main obstructions following TAVI. EuroIntervention 2010;6:100-5. [CrossRef]

9. 9. Giri J, Szeto WY, Bavaria J, Herrmann HC. Transcatheter aortic valve replacement with coronary artery protection performed in a patient with an anomalous left main coronary artery. J Am Coll Cardiol 2012;7:60. [CrossRef