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

Year 2016, Volume: 33 Issue: 3, 357 - 359, 01.05.2016

Hüseyin Dursun Jale Zeynep Gönençer Dayimi Kaya Özalp Karabay Abidin Cenk Erdal

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. 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. 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. Corbett M, Powers J, King S, Quinn M, Harris D. Single coronary artery. J Am Coll Cardiol 2009;53:455. [CrossRef]
• 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. 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. 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. 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. 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. 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