Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2019; 7(21): 3549-3552
Published online Nov 6, 2019. doi: 10.12998/wjcc.v7.i21.3549
Transfemoral aortic valve implantation in the case of pre-existing mitral prosthesis and pure aortic regurgitation: A case report
Aysun Erdem, Aycan Esen Zencirci, Kivilcim Ozden, Sait Terzi
Aysun Erdem, Aycan Esen Zencirci, Kivilcim Ozden, Sait Terzi, Department of Cardiology, Dr Siyami Ersek Thoracic and Heart Surgery Education and Research Hospital, Istanbul 34710, Turkey
Author contributions: Erdem A drafted the first manuscript; Esen Zencirci A, Ozden K, and Terzi S contributed to the histological diagnosis.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: 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: Aysun Erdem, MD, Doctor, Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tibbiye cad, No 13, Istanbul 34710, Turkey. erdemaysun@yahoo.com
Telephone: +90-533-3252733 Fax: +90-216-3106578
Received: May 14, 2019
Peer-review started: May 21, 2019
First decision: August 1, 2019
Revised: September 20, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: November 6, 2019
Processing time: 182 Days and 10.8 Hours
Abstract
BACKGROUND

Transcatheter aortic valve replacement (TAVR) is recommended in patients with severe aortic stenosis who have high surgical risk. However, in the pre-existing mechanical mitral valve prosthesis and natural pure aortic regurgitation, TAVR is relatively contraindicated. In this report, we described one case of TAVR with native aortic regurgitation in the presence of mechanical mitral valve prosthesis.

CASE SUMMARY

A 64-year-old man with a medical history of mitral valve replacement had severe dyspnea and was symptomatic even at rest for 3 mo. His echocardiography showed severe native pure aortic regurgitation. His euroscore was 15. A TAVR procedure with an evolut R was planned. A 34 mm evolut R was placed by transesophageal echocardiography. The mitral prosthesis was functioning normally, and mild-moderate paravalvular leakage was evident by transesophageal echocardiography. The patient recovered without any complication. At 1 mo follow up, the patient was well, and no paravalvular leakage was noted.

CONCLUSION

TAVR for pure aortic regurgitation in the presence of prosthetic mitral valve can be a safe procedure.

Keywords: Transcatheter aortic valve replacement; Prosthetic; Mitral stenosis; Aortic regurgitation; Case report

Core tip: Transcatheter aortic valve replacement (TAVR) is recommended in the treatment of severe aortic stenosis in patients who are at high or prohibitive surgical risk. Several patients with previous mitral valve surgery were reported to have been treated with TAVR. However, TAVR has been performed off-label to treat patients with pure aortic regurgitation due to the absence of calcium for device anchoring. There are few data showing that transfemoral TAVR is feasible and safe for the treatment aortic regurgitation in selected patients. Here, we report one case of transfemoral TAVR for native aortic regurgitation in the setting of a pre-existing mitral prosthesis.