Skip to main content

Advertisement

ADVERTISEMENT

Clinical Images

Images of an Ectopic Balloon Expandable Valve Deployed at the Aortic Arch Level Following Valve Embolization

Georgios Chalikias, MD, PhD1; Soultana Foutzitzi, MD2; Dimitrios Stakos, MD, PhD1; Dimitrios Tziakas, MD, PhD1

August 2024
1557-2501
J INVASIVE CARDIOL 2024;36(8). doi:10.25270/jic/24.00062. Epub March 19, 2024.

© 2024 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of the Journal of Invasive Cardiology or HMP Global, their employees, and affiliates. 


An 83-year-old man with severe aortic stenosis underwent implantation of a 29-mm SAPIEN-3 (Edwards Lifesciences) transcatheter aortic valve (TAV) appropriately sized for an aortic annulus area of 543.6 mm2. Immediately post-implantation, due to loss of capture of the rapid pacing sequence (pacing failure) during deployment (Figure 1A), the TAV lost contact with the aortic annulus and migrated to the ascending aorta (Video 1). After a brief period of rocking motion within the ascending aorta (Figure 1B), the TAV was finally embolized at the distal part of the aortic arch (Figure 1C; Videos 2 and 3). Due to a significant residual aortic valve regurgitation, an additional 29-mm balloon-expandable TAV was successfully advanced through the first TAV and deployed in the native valve (Figure 2A).  Having assessed that the embolized TAV was positioned distally to the ostia of the left common carotid and the left subclavian artery with ample patency of possibly jeopardized vessels (Figure 2B), post-dilation with a 29-mm balloon was performed to secure the valve against the aortic wall (Figure 2C). 

 

Figure 1
Figure 1. Transcatheter aortic balloon-expandable valve embolization at the aortic arch. (A) Pacing failure during transcatheter aortic valve deployment led to valve embolization to the ascending aorta. (B) Brief period of rocking motion of the transcatheter aortic valve within ascending aorta. (C) Embolization of the transcatheter aortic valve at the distal part of the aortic arch.

 

Figure 2
Figure 2. Bail-out strategy. (A) Assessment of possibly jeopardized vessels (left common carotid and subclavian artery). (B) Securing the embolized transcatheter aortic valve to the aortic wall at the level of the distal aortic arch. (C) Deployment of a second 29-mm transcatheter aortic valve at the aortic annulus.

 

The patient was discharged uneventfully on the fifth day post-procedure. Clinical and imaging assessment of the patient upon discharge did not reveal any significant sequalae of the complication as the ankle-brachial index was normal and continuous-wave doppler on the descending aorta did not reveal any signs of stenosis (coarctation equivalent), whereas color-Doppler assessment of the left carotid showed normal flow. The 1-year follow up was uneventful with no cardiovascular adverse events reported. Computed tomographic aortography at the 1-year follow-up showed that the ectopic deployed valve remained well expanded (Figure 3).

 

Figure 3
Figure 3. One-year follow-up computed tomographic aortography.

 

Affiliations and Disclosures

From the 1Department of Cardiology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; 2Radiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Address for correspondence: Dimitrios Tziakas, MD,PhD, FESC, SCAI, FACC, Department of Cardiology, Medical School, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece.  Email: dtziakas@med.duth.gr

 


Back to August 2024 Table of Contents


Advertisement

Advertisement

Advertisement