Severe paravalvular leakage caused by delayed dislocation of valve prosthesis after transcatheter aortic valve replacement for rheumatic aortic valve disease

Figures

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  Figure 1.. Preoperative 3-dimensional computed tomography (CT) evaluation of aortic root structure, virtual valve annulus angulation, cross-valve, valve release position, and transcatheter aortic valve replacement (TAVR) surgery path. The inner diameters of the aortic valve virtual annulus (A), sinus (B), sinus junction (C), and ascending aorta (D) were 29.8, 38.8, 34.0, and 39.9 mm, respectively. The inner diameters of the left ventricular outflow tract 2.5 and 5 mm below the plane of the virtual annulus (E and F) were 30.4 and 32.5 mm, respectively. The maximum inner diameters of supravalvular structures 2 (G), 4 (H), 6 (I), and 8 mm (J) above the plane of the virtual annulus were 27.2, 27.8, 27.2, and 28.0 mm, respectively. The height of the left coronary artery was 10.6 mm (K). The height of the right coronary artery was 18.8 mm (L). The results showed that the angle of the virtual valve ring was 54°, close to the standard of the transverse position (M). Middle position of the right coronary sinus (cross-valve position): left anterior oblique 12°, foot position 13° (N). Left and right coronary sinus overlapping position (valve release position): right anterior oblique 11°, foot position…

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  Figure 2.. Digital subtraction angiography (DSA), transesophageal echocardiography (TEE), and transthoracic echocardiography (TTE) evaluation during the 1st transcatheter aortic valve replacement (TAVR) operation. The solid white line shows the plane of the valve ring, and the white dotted line shows the plane of the bottom of the valve prosthesis (A). Preoperative TTE evaluation showing severe aortic stenosis and regurgitation (B). The postoperative TEE evaluation results showed mild and moderate perivalvular leakage (PVL) (C) in the long-axis plane and 2 mm reflux beam (D) in the 1 and 5 o’clock directions in the short-axis plane.

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  Figure 3.. Bedside transthoracic echocardiography (TTE) evaluation and the relationship between the aortic root complications and the position of the bottom edge of the valve prosthesis and the virtual valve ring evaluated by 3-dimensional computed tomography (CT) before the 2nd transcatheter aortic valve replacement (TAVR) operation. The evaluation results of the long axis (A) and short axis (B) of the bedside TTE showed moderate and severe central regurgitation of the aortic valve and severe perivalvular leakage (PVL). At the tangent position of the valve, CT was used to measure the distance from the bottom of the valve prosthesis to the plane of the valve ring; the results showed 10 to 11 mm (C and D) on the side of the non-coronary sinus and 13 to 14 mm (E and F) on the opposite side.

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  Figure 4.. Postoperative digital subtraction angiography (DSA) and transesophageal echocardiography (TEE) evaluation. Digital subtraction angiography (DSA) and transesophageal echocardiography (TEE) evaluation. (A) The solid red line shows the plane of the valve ring, and the red dotted line shows the plane of the bottom of the 2nd valve prosthesis. (B and C) The TEE evaluation results after the 2nd TAVR operation showed that there was no PVL and central reflux in the long-axis plane and no reflux beam in the short-axis plane. PVL = paravalvular leakage, TAVR = transcatheter aortic valve replacement.