Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2015;68:893 - Vol. 68 Num.10 DOI: 10.1016/j.rec.2014.11.020

Coronary Thromboembolism During Transcatheter Aortic Valve Replacement

Ricardo Mori Junco a,, Francisco Domínguez Melcon b, Mar Moreno Yangüela b

a Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
b Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain

Refers to

Coronary Obstruction During Transcatheter Aortic Valve Replacement: Related to Calcification or Thrombus?
Cengiz Ozturk, Ali Osman Yildirim, Mustafa Demir, Sevket Balta
Rev Esp Cardiol. 2016;69:456-7
Full text - PDF

Article

A 74-year-old male with hypertension, type 2 diabetes mellitus, diabetic nephropathy and chronic alcoholic liver disease, presented with severe, symptomatic aortic stenosis. Aortic valve replacement surgery was ruled out due to the high risk and we opted for transcatheter aortic valve implantation (TAVI). A previous coronary angiography showed a severe obstructive lesion in the proximal segment of the left anterior descending artery, which was revascularised with two drug-eluting stents. The patient was admitted to hospital for a scheduled TAVI. During the procedure, while we were implanting a 27 mm LOTUS (Boston Scientific, Natick, Massachusetts, United States) aortic prosthesis transfemorally, the transoesophageal echocardiography showed the appearance of a mobile, thick structure with irregular and broad movements in the ascending aorta, compatible with a thrombus (Figure 1 and video 1A of the supplementary material). This structure was attached to the left main coronary artery (Figure 1 and video 1B of the supplementary material). The patient simultaneously suffered ST-segment elevation on the cardiac monitor and severe hypotension (systolic pressure 50 mmHg), which required inotropic support. Transoesophageal echocardiography showed dilatation of the left ventricle with anteroapical akinesia and severe systolic dysfunction (Figure 2 and video 2A of the supplementary material), therefore we proceeded with an emergency coronary angiography. The left main coronary artery was selectively probed with a guide catheter, revealing thrombotic occlusion of the distal left main coronary artery (Figure 2 and video 2B of the supplementary material). Thrombus aspiration and dilatation were performed with a balloon, achieving a notable improvement in flow. Final flow was TIMI 3 (Figure 3 and video 3A of the supplementary material). In the final transoesophageal echocardiography, the left ventricle was visualised with global systolic and segmental functions preserved (Figure 3 and video 3B of the supplementary material).

Figure 1.

Figure 2.

Figure 3.

Appendix A. SUPPLEMENTARY MATERIAL

Supplementary material associated with this article can be found in the online version available at doi:10.1016/j.rec.2014.11.020.

Appendix A. SUPPLEMENTARY MATERIAL

Video 1A

Video 1A

Video 2B

Video 2B

Video 3A

Video 3B

Corresponding author: ricardomori22@gmail.com

1885-5857/© 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

Cookies
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
Cookies policy
x
To improve our services and products, we use cookies (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.