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      A Case of Acute Left Main Coronary Obstruction Following Transcatheter Aortic Valve Implantation

      case-report
      1 , , 1 , 1
      ,
      Cureus
      Cureus
      coronary obstruction, transcatheter aortic valve implantation

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          Abstract

          Transcatheter aortic valve implantation (TAVI) is a highly effective procedure in selected patients with severe degenerative aortic valve stenosis at high risk for conventional surgery. Coronary occlusion is a periprocedural life-threatening complication that despite its low frequency (˂1%) is poorly predictable and requires immediate diagnosis and treatment. Herein, we report a coronary obstruction after transcatheter implantation of valve prosthesis, followed by coronary intervention with successful recanalization.

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          Most cited references6

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          Percutaneous aortic valve implantation retrograde from the femoral artery.

          Percutaneous aortic valve implantation by an antegrade transvenous approach has been described but is problematic. Retrograde prosthetic aortic valve implantation via the femoral artery has potential advantages. Percutaneous prosthetic aortic valve implantation via the femoral arterial approach is described and the initial experience reported. The valve prosthesis is constructed from a stainless steel stent with an attached trileaflet equine pericardial valve and a fabric cuff. After routine aortic balloon valvuloplasty, a 22F or 24F sheath is advanced from the femoral artery to the aorta. A steerable, deflectable catheter facilitates manipulation of the prosthesis around the aortic arch and through the stenotic valve. Rapid ventricular pacing is used to reduce cardiac output while the delivery balloon is inflated to deploy the prosthesis within the annulus. Percutaneous aortic prosthetic valve implantation was attempted in 18 patients (aged 81+/-6 years) in whom surgical risk was deemed excessive because of comorbidities. Iliac arterial injury, seen in the first 2 patients, did not recur after improvement in screening and access site management. Implantation was successful in 14 patients. After successful implantation, the aortic valve area increased from 0.6+/-0.2 to 1.6+/-0.4 cm2. There were no intraprocedural deaths. At follow-up of 75+/-55 days, 16 patients (89%) remained alive. This initial experience suggests that percutaneous transarterial aortic valve implantation is feasible in selected high-risk patients with satisfactory short-term outcomes.
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            Coronary obstruction following transcatheter aortic valve implantation: a systematic review.

            This study sought to evaluate, through a systematic review of the published data, the main baseline characteristics, management, and clinical outcomes of patients suffering coronary obstruction as a complication of transcatheter aortic valve implantation (TAVI).
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              Avoiding Coronary Occlusion and Root Rupture in TAVI – The Role of Pre-procedural Imaging and Prosthesis Selection

              Coronary occlusion and rupture of the aortic root or annulus remain two major concerns of transcatheter aortic valve implantation technique. Despite their relatively low frequency they raised the interest of the scientific community as they carry an extremely poor prognosis. Prosthesis type and size selection is part of the patient selection process that allows the operator to prevent these complications. In this article, the techniques used either during pre-TAVI screening or during the procedure itself to avoid coronary occlusion and aortic rupture will be discussed.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                14 December 2017
                December 2017
                : 9
                : 12
                : e1951
                Affiliations
                [1 ] Department of Cardiology, University Hospital St. Ekaterina, Medical University of Sofia, Bulgaria
                Author notes
                Article
                10.7759/cureus.1951
                5812537
                29468106
                32f68a73-5143-4d09-9790-a57e92aa63b4
                Copyright © 2017, Dimitrova et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 7 December 2017
                : 14 December 2017
                Categories
                Cardiology
                Emergency Medicine
                Radiology

                coronary obstruction,transcatheter aortic valve implantation

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