Management of Prosthesis Embolization into Left Ventricle after Transcatheter Aortic Valve Implantation: A Case Report

Abstract

Transcatheter aortic valve implantation is recommended in advanced aortic stenosis, in elderly patients who are not suitable for surgery. Valve embolization is one of the most important complications that is life-threatening. A 61-year-old male patient was being followed up with a complaint of shortness of breath. He had a history of coronary artery bypass graft operation. Transthoracic echocardiography revealed severe aortic stenosis. Transfemoral transcatheter aortic valve implantation was performed, but while the balloon passed through the valve, the valve embolized the ventricle. The patient was then taken into operation. The native aortic valve was resected, the valve embolized into the ventricle was cut and removed, and surgical aortic valve replacement was performed. Endovascular methods can be preferred in suitable patients, but in cases where they fail, urgent open-heart surgery is required. One of the most important points is that the guidewire should not be removed when embolization.

Keywords

• Transcatheter aortic valve implantation
• aortic stenosis
• prosthesis embolization

Transkateter Aort Kapak İmplantasyonu Sonrası Sol Ventriküle Protez Embolizasyonunun Yönetimi: Bir Olgu Sunumu

Abstract

İleri aort darlığında, cerrahiye uygun olmayan yaşlı hastalarda transkateter aort kapak implantasyonu önerilmektedir. Kapak embolizasyonu hayatı tehdit eden en önemli komplikasyonlardan biridir. 61 yaşında erkek hasta nefes darlığı şikayetiyle takip ediliyordu. Koroner arter baypas greft operasyonu öyküsü vardı. Transtorasik ekokardiyografide ciddi aort darlığı saptandı. Hastaya transfemoral transkateter aort kapak implantasyonu yapıldı, ancak balon kapaktan geçerken kapak ventrikülü embolize oldu. Hasta daha sonra operasyona alındı. Doğal aort kapağı rezeke edildi, ventriküle embolize olan kapak kesilerek çıkarıldı ve cerrahi aort kapak replasmanı yapıldı. Uygun hastalarda endovasküler yöntemler tercih edilebilir ancak başarısız olunduğu durumlarda acil açık kalp ameliyatı gerekir. En önemli noktalardan biri embolizasyon sırasında kılavuz telin çıkarılmamasıdır.

Keywords

• Transkateter aort kapak implantasyonu
• aort stenozu
• protez embolizasyonu

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