Banga S, Barzallo MA, Nighswonger CL, Mungee S. Transcatheter aortic valve replacement in membranous interventricular septum aneurysm with left ventricular outflow tract extension. World J Cardiol 2018; 10(1): 1-5 [PMID: 29391929 DOI: 10.4330/wjc.v10.i1.1]
Corresponding Author of This Article
Sandeep Banga, MD, Doctor, 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. drsbanga@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Cardiol. Jan 26, 2018; 10(1): 1-5 Published online Jan 26, 2018. doi: 10.4330/wjc.v10.i1.1
Transcatheter aortic valve replacement in membranous interventricular septum aneurysm with left ventricular outflow tract extension
Sandeep Banga, Marco A Barzallo, Casey L Nighswonger, Sudhir Mungee
Sandeep Banga, Marco A Barzallo, Sudhir Mungee, Division of Cardiology, Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL 61637, United States
Sandeep Banga, Marco A Barzallo, Casey L Nighswonger, Sudhir Mungee, Osf St. Francis Medical Center, Peoria, IL 61637, United States
Author contributions: Banga S reviewed the literature and wrote the manuscript; Barzallo MA and Mungee S operated the patient and revised the manuscript; Nighswonger CL helped in getting consent from the patient and image collection.
Informed consent statement: All patients identifiable information has been anonymized in this case report. The patient provided informed written consent for their case to be written up.
Conflict-of-interest statement: All the authors have nothing to report.
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/
Correspondence to: Sandeep Banga, MD, Doctor, 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. drsbanga@gmail.com
Telephone: +1-309-5506820 Fax: +1-309-6557732
Received: December 7, 2017 Peer-review started: December 8, 2017 First decision: December 11, 2017 Revised: December 25, 2017 Accepted: January 16, 2018 Article in press: January 16, 2018 Published online: January 26, 2018
ARTICLE HIGHLIGHTS
Case characteristics
Patient with severe calcific aortic stenosis presented with worsening symptom of shortness of breath.
Clinical diagnosis
Patient was diagnosed as symptomatic severe aortic stenosis clinically.
Differential diagnosis
Left ventricular outflow tract obstruction, sub-valvular aortic stenosis and supra-valvular aortic stenosis are the differentials.
Laboratory diagnosis
ECG showed intermittent paced rhythm due to pacemaker and chest x-ray showed sternal wires due to previous coronary artery bypass graft.
Imaging diagnosis
Echocardiography and computer tomography showed severe calcific aortic stenosis with perimembranous interventricular septum aneurysm extending into left ventricular outflow tract.
Pathological diagnosis
Patient had congenital heart defect which included interventricular septum aneurysm extending into left ventricular outflow tract with acquired severe calcific stenosis of tri-leaflet aortic valve.
Treatment
The patient was treated with transcatheter aortic valve replacement .This was achieved in our case by implanting the prosthetic valve more distally into the left ventricular outflow tract (LVOT) requiring apposition of the Edwards SAPIEN XT skirt at annulus with most of the valvular metallic frame in supra-annular position.
Related reports
During transcatheter aortic valve replacement, normally the conventional recommendation is to implant the device with 50% above and 50% below native leaflet insertion .We had 80% aortic and 20% ventricular ratio of the device at the level of leaflet insertion of the native valve.
Term explanation
LVOT denotes left ventricular outflow tract obstruction and TAVR denotes transcatheter aortic valve replacement.
Experiences and lessons
The transcatheter aortic valve replacement can be done in patients having high surgical risk with perimembranous interventricuar septum aneurysm by implanting the device more distally into the LVOT.
