Obstructive Hypoattenuated Leaflet Thickening in a Complex Valve-in-Valve TAVR Successfully Treated With Thrombolysis

Figures

• 

  Figure 1. Model of Evolut PRO+ ViV Overlap Over TEE Image With ViV Construct In Situ (A) TEE showing valve orientation in aortic long-axis view, (B) modeling of valve with reference to image from TEE, and (C) a model of the 26-mm Evolut PRO+ valve-in-valve structure to better understand the valve. TEE = transesophageal echocardiography.

• 

  Figure 2. Findings on Baseline TEE Obtained the Day After Hospital Admission (A) TEE showing the turbulent flow across the implanted valve. (B) TEE showing atrioventricular velocity of 5.2 m/s, valve area of 0.5 cm2, and mean pressure gradient of 66 mm Hg. TEE = transesophageal echocardiography.

• 

  Figure 3. Chest CT Angiogram Evaluating the TAVR Prosthesis (A) Coronal section showing well-seated valve-in-valve TAVR prosthesis within the aortic root and ascending aorta. (B) Coronal section showing two 26-mm Evolut valves with HALT (arrows). (C) Axial section demonstrating 2 overlapping transcatheter aortic valve prostheses with HALT. (D) Sagittal section showing valve-in-valve in the ascending aorta across the annulus (arrow). CT = computed tomography; HALT = hypoattenuated leaflet thickening; TAVR = transcatheter aortic valve replacement.

• 

  Figure 4. Timeline of Clinical Events AVA = aortic valve area; BNP = B-type natriuretic peptide; CT = computed tomography; CTA = computed tomography angiography; ECG = electrocardiogram; EF = ejection fraction; HALT = hypoattenuated leaflet thickening; LVH = left ventricular hypertrophy; PVL = paravalvular leak; TEE = transesophageal echocardiography.

• 

  Visual summary. Major Clinical Events With Echocardiographic and Chest CT Findings Showing Overlapping TAVR Valves Mimicking Complex ViV TAVR Configuration AVA = aortic valve area; BNP = B-type natriuretic peptide; CC = chief complaint; CT = computed tomography; CTA = computed tomography angiography; ECG = electrocardiogram; EF = ejection fraction; HALT = hypoattenuated leaflet thickening; LVH = left ventricular hypertrophy; PVL = paravalvular leak; TAVR = transcatheter aortic valve replacement; TEE = transesophageal echocardiography; TTE = transthoracic echocardiography; ViV = valve-in-valve.