Authors :
Miguel Maluf; Leonardo Guimaraes; Alfredo Rodrigues; Jairo Pinheiro
Volume/Issue :
Volume 7 - 2022, Issue 12 - December
Google Scholar :
https://bit.ly/3IIfn9N
Scribd :
https://bit.ly/3ZWSY2r
DOI :
https://doi.org/10.5281/zenodo.7547240
Abstract :
Young patients with rheumatic disease almost
invariably develop the multivalvular disease. In general,
patients with multivalvular disease are more severely for
conventional surgical procedures. With the advent of less
invasive transcatheter treatment, patients with more
than one valve disease are part of the Heart Team's
discussion, so that their peculiarities are better
understood.A 32-year-old, female patient refers that
without having performed any physical effort, he
suddenly felt short of breath during walks with a very
fast “pulse” and “gasping” when talking.The patient had
undergone multivalvular surgery 16 years ago:
replacement of the aortic valve with a biological
prosthesis (23 mm), and mitral valve annuloplasty with a
prosthetic ring (26 mm).Clinical examination showed a
pale patient, breathless, and tachycardic. BP: 130 x 55
mmHg, HR: 100 b x min. He had a systolic murmur
++/4+; a diastolic murmur ++/4+, in aortic focus.Doppler
echo images showed significant aortic regurgitation, with
a flap from one of the cusps of the prosthesis, prolapsed
into the cavity of the left ventricle and mild mitral
regurgitation. The final diagnosis was: a rupture of the
biological aortic prosthesis, followed by acute aortic
insufficiency, after the 16th year of follow-up.The patient
underwent aValve in Valve (ViV) - TAVI procedure. A
Sapien 3 ultra valve, measuring 23 mm, was implanted
through a femoral approach inside the dysfunctional
biological prosthesis. The procedure was performed
successfully, and the patient was discharged from the
hospital 2 days later.
Keywords :
ViV-TAVI has become an attractive alternative to redo SAVR in young patients with failed bioprostheses. If there is any limitation to expanding the indications for TAVI or ViV-TAVI procedures for all ages, it is linked to the durability of the prostheses.New expandable synthetic stent valve is already shown in vitro and in vivo tests, greater durability and is free from calcification.
Young patients with rheumatic disease almost
invariably develop the multivalvular disease. In general,
patients with multivalvular disease are more severely for
conventional surgical procedures. With the advent of less
invasive transcatheter treatment, patients with more
than one valve disease are part of the Heart Team's
discussion, so that their peculiarities are better
understood.A 32-year-old, female patient refers that
without having performed any physical effort, he
suddenly felt short of breath during walks with a very
fast “pulse” and “gasping” when talking.The patient had
undergone multivalvular surgery 16 years ago:
replacement of the aortic valve with a biological
prosthesis (23 mm), and mitral valve annuloplasty with a
prosthetic ring (26 mm).Clinical examination showed a
pale patient, breathless, and tachycardic. BP: 130 x 55
mmHg, HR: 100 b x min. He had a systolic murmur
++/4+; a diastolic murmur ++/4+, in aortic focus.Doppler
echo images showed significant aortic regurgitation, with
a flap from one of the cusps of the prosthesis, prolapsed
into the cavity of the left ventricle and mild mitral
regurgitation. The final diagnosis was: a rupture of the
biological aortic prosthesis, followed by acute aortic
insufficiency, after the 16th year of follow-up.The patient
underwent aValve in Valve (ViV) - TAVI procedure. A
Sapien 3 ultra valve, measuring 23 mm, was implanted
through a femoral approach inside the dysfunctional
biological prosthesis. The procedure was performed
successfully, and the patient was discharged from the
hospital 2 days later.
Keywords :
ViV-TAVI has become an attractive alternative to redo SAVR in young patients with failed bioprostheses. If there is any limitation to expanding the indications for TAVI or ViV-TAVI procedures for all ages, it is linked to the durability of the prostheses.New expandable synthetic stent valve is already shown in vitro and in vivo tests, greater durability and is free from calcification.
