RESUMEN
Rotational atherectomy (RA) is an important interventional technique to facilitate effective percutaneous coronary intervention of severely calcified lesions. Despite the improved probability of better procedural outcomes during angioplasty, the use of RA is associated with an inherent risk of complications. Here, we present a case of a woman in her mid-90s with severe aortic stenosis (AS) who underwent RA facilitated angioplasty of the right coronary artery (RCA), with the procedure complicated by the Kokeshi phenomenon. Manual traction to retrieve the burr resulted in dehiscence of an aortic plaque near the ostium of the RCA. Unfortunately, the patient's risk profile precluded surgery. After a multidisciplinary discussion, a self-expanding Core Valve Evolut R prosthesis (Medtronic, Minneapolis, Minnesota, USA) was successfully implanted, with improvement in the AS and stabilisation of the aortic plaque. This is the first reported case of successful non-operative management of a mobile-aortic plaque caused by RA with a transcatheter prosthesis.
Asunto(s)
Estenosis de la Válvula Aórtica , Aterectomía Coronaria , Intervención Coronaria Percutánea , Reemplazo de la Válvula Aórtica Transcatéter , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/cirugía , Aterectomía Coronaria/métodos , Vasos Coronarios/cirugía , Femenino , Humanos , Intervención Coronaria Percutánea/métodosAsunto(s)
Insuficiencia de la Válvula Aórtica/terapia , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Valvuloplastia con Balón , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Anciano , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Hemodinámica , Humanos , Masculino , Diseño de Prótesis , Recuperación de la Función , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
We describe the case of a 69-year-old man with a history of bioprosthetic aortic valve replacement who presented with Corynebacterium striatum prosthetic valve endocarditis (PVE) complicated by severe aortic insufficiency with refractory cardiogenic shock despite antibiotic therapy. He was considered a prohibitive-risk surgical candidate due to co-morbid conditions and off-label valve-in-valve transcatheter aortic valve replacement (TAVR) was performed after detailed multidisciplinary evaluation. He recovered well without recurrent infection following completion of antibiotics and transthoracic echocardiogram at 12 months showed a normal functioning prosthetic valve. To our knowledge, this is the first reported case of native or PVE treated with TAVR.
