Author + information
- Received October 27, 2015
- Revision received November 11, 2015
- Accepted November 19, 2015
- Published online March 14, 2016.
- aDepartment of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
- bDepartment of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- ↵∗Reprint requests and correspondence:
Dr. Yutaka Koyama, Department of Cardiovascular Surgery, Toyohashi Heart Center, 21-1 Gobudori, Oyama-cho Toyohashi, Aichi 441-8530, Japan.
An 88-year-old woman with symptomatic severe aortic stenosis was referred to our center. She was considered to be at high risk for surgical aortic valve replacement due to comorbidities and advanced age. Our heart team opted for transcatheter aortic valve replacement via transapical access because of issues with the peripheral artery. A pair of pledgeted purse-string sutures was placed around the apex via left anterolateral thoracotomy at the sixth intercostal space. A 23-mm SAPIEN-XT prosthesis (Edwards Lifesciences, Irvine, California) was successfully implanted in the target position. However, the recovery of blood pressure was poor, and hypokinetic motion of the apex was noted in the surgical view. Aortography showed trivial aortic regurgitation without obstruction of the left coronary artery orifice (Figure 1A). Additionally, selective angiography of the left coronary artery revealed obstruction of the middle part of left anterior descending artery (LAD) (Figure 1B), whereas previous coronary angiography did not show significant stenosis. The sutures were over 10 mm away from the LAD in direct vision, which was confirmed in post-procedural computed tomography (Figure 1C). After removing 1 of the sutures, which was relatively close to the LAD, the obstruction of the LAD improved slightly but remained significant. Therefore, a vasodilator was repeatedly infused into the LAD, and the flow of the LAD completely recovered (Figure 1D). The obstruction of the LAD in the present case was induced by muscle tension and deformation around the apical sutures. In addition to the removal of the apical suture, selective vasodilator infusion for the obstructed LAD might be effective. The present unique case revealed 1 of the potential etiologies of LAD obstruction after transapical transcatheter aortic valve replacement.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 27, 2015.
- Revision received November 11, 2015.
- Accepted November 19, 2015.
- American College of Cardiology Foundation