Key result
TAVI reduces mean aortic valve gradient by ~49 mmHg in repaired double outlet right ventricle.
Why the study?
Management of severe aortic stenosis in patients with surgically repaired double outlet right ventricle and comorbidities poses clinical challenges.
Case Report (n=1)
No
May offer alternative for high-risk repaired DORV with severe AS; leaves open need for larger studies before wider use.
A 52-year-old male patient, with a medical history of surgically repaired double outlet right ventricle presented with severe aortic stenosis (AS) and hepatitis C with cirrhosis, presented with New York Heart Association Class IV heart failure. During evaluation for a liver transplant, he was deemed a poor surgical candidate due to his aortic valve disease and cirrhosis with model for end-stage liver disease score of 14. Transthoracic echocardiogram showed severe AS with a mean gradient of 62 mm Hg and calculated aortic valve area of 0.74 cm(2) with a normal ejection fraction of 65%. The patient underwent transfemoral implantation of a 23-mm Edwards Sapien commercial heart valve with significant mean gradient reduction across the aortic valve from 62 to 13 mm Hg. The patient was observed in the coronary care unit and discharged home 2 days postprocedure with his clinical symptoms greatly improved.
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Keswani et al. (2013) conducted a case report in Severe aortic stenosis with surgically repaired double outlet right ventricle and cirrhosis (n=1). Transcatheter aortic valve implantation (23-mm Edwards Sapien valve) was evaluated on Mean gradient across the aortic valve. Transcatheter aortic valve implantation in a patient with a surgically repaired double outlet right ventricle reduced the mean aortic valve gradient from 62 to 13 mm Hg with clinical improvement.
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