Korean Circ J.  2012 Nov;42(11):796-799. 10.4070/kcj.2012.42.11.796.

The First Korean Patient With Severe Aortic Stenosis and Bilateral Iliofemoral Artery Disease Treated With Transcatheter Aortic Valve Implantation by Transsubclavian Approach

• Lee SJ
• Ko YG
• Shim JY
• Lee S
• Chang BC
• Shim JK
• Kwak YR
• Hong MK

• KMID: 2224984
• DOI: http://doi.org/10.4070/kcj.2012.42.11.796

Abstract

Transcatheter aortic valve implantation (TAVI) is indicated as an alternative treatment modality to surgical aortic valve replacement for high risk patients. The standard retrograde approach through the femoral artery is not feasible in the case of unfavorable iliofemoral anatomy or severe peripheral arterial disease (PAD). However, patients with aortic stenosis (AS) have a higher prevalence of for PAD because both diseases are consequences of atherosclerotic degenerative changes. Transsubclavian, transapical, and direct access to the ascending aorta by thoracotomy are alternative routes for the TAVI procedure. In this report, we present the first Korean patient with symptomatic severe AS and bilateral iliofemoral artery disease who was successfully treated with TAVI using a CoreValve (Medtronic, Minneapolis, MN, USA) by transsubclavian approach.

Keyword

Aortic valve stenosis; Catheters; Heart valve prosthesis; Prosthesis implantation

MeSH Terms

Aorta
Aortic Valve
Aortic Valve Stenosis
Arteries
Catheters
Femoral Artery
Heart Valve Prosthesis
Humans
Peripheral Arterial Disease
Prevalence
Prosthesis Implantation
Thoracotomy

Figure

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  Fig. 1 Transthoracic echocardiography showed severely narrowed aortic valve area (0.44 cm2) measured by the continuity equation (A), and color Doppler revealed aliasing due to severe aortic stenosis (B).

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  Fig. 2 Angiography and computed tomography image showed iliofemoral arteries with severe peripheral arterial occlusive disease. Previous stent at Lt. common iliac artery was patent but showed a minimum diameter of 4.5 mm and both common femoral arteries showed a minimum diameter of 4.0 mm. Lt. CIA: left common iliac artery, Rt. CFA: right common femoral artery, Lt. CFA: left common femoral artery.

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  Fig. 3 CoreValve delivery system is advanced through 18 Fr sheath inserted into the Lt. subclavian artery.

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  Fig. 4 CoreValve delivery catheter and bioprosthetic valve deployed across the aortic valve (A) and spontaneously expanded. An aortogram showed good positioning of the CoreValve with mild aortic regurgitation (B).

Reference

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