Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2019; 11(8): 209-212
Published online Aug 26, 2019. doi: 10.4330/wjc.v11.i8.209
Successful minimal approach transcatheter aortic valve replacement in an allograft heart recipient 19 years post transplantation for severe aortic stenosis: A case report
Sravani Avula, Sudhir Mungee, Marco A Barzallo
Sravani Avula, Sudhir Mungee, Department of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
Marco A Barzallo, Key Clinal Faculty, Department of Cardiovascular Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
Author contributions: Avula S, Mungee S and Barzallo MA contributed equally to this work.
Informed consent statement: Informed consent to publish was obtained from the patient.
Conflict-of-interest statement: All the authors of this article declare that there is no conflict of interest regarding the publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sravani Avula, MD, Cardiology Fellow, Division of Cardiology, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Ave, Peoria, IL 61637, United States. sravani.avula@osfhealthcare.org
Telephone: +1-309-6557257
Received: January 18, 2019
Peer-review started: January 18, 2019
First decision: January 26, 2019
Revised: August 2, 2019
Accepted: August 6, 2019
Article in press: August 7, 2019
Published online: August 26, 2019
Processing time: 217 Days and 4.4 Hours
Abstract
BACKGROUND

Aortic stenosis is one of the rare valvular complications in a transplanted heart. Over the past 8 years, transcatheter approach for aortic valve replacement (TAVR) has been slowly evolving to be the preferred approach in these patient population when compared to the surgical approach. We report a second case in the United States with successful transfemoral minimal approach with minimal sedation for TAVR in a heart transplant recipient 19 years post transplantation for severe symptomatic calcified aortic stenosis.

CASE SUMMARY

We present a case of 73-year-old male who has undergone successful minimal approach transcatheter aortic valve replacement in an allograft heart. Patient had received orthotopic heart transplantation 19 years ago for non-ischemic cardiomyopathy. Follow up transthoracic echocardiograms as per routine protocol did not show any aortic valve disease until 15 years post transplantation. Aortic valve was noted to be mildly sclerotic at that time and gradually progressed to severe symptomatic aortic stenosis over the next 4 years. Patient had complaints of worsening shortness of breath that limited his functional capacity. Overall his post heart transplantation period has been mostly uneventful except for allograft non occlusive vasculopathy and aortic stenosis. His Society of Thoracic Surgery risk score was 12.205% and he was considered to be a high-risk surgical candidate by surgeon. Decision was made to undergo transcatheter aortic valve replacement.

CONCLUSION

With the improved survival of these patients, we think it is time to look into pathophysiology of valvular disease in transplant heart recipients. Some other unanswered questions include, underlying donor and recipient risk factors for valvular diseases in heart transplant recipients.

Keywords: Transcatheter aortic valve replacement; Heart transplant; Minimal approach valve replacement; Severe aortic stenosis; Case report

Core tip: We report a second case in the United States with successful transfemoral minimal approach with minimal sedation for transcatheter approach for aortic valve replacement in a heart transplant recipient. We believe, with the increase of number of reported cases with valvular diseases in heart transplant patients, it is time for further research in valvular disease in allograft heart recipients.