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Transcatheter aortic valve replacement for bicuspid aortic valve regurgitation in a 17-year-old patient with congenitally corrected transposition of great arteries: a case report.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-6.EH

Abstract

Background

Limited research has been conducted on the surgical management of the aortic valve in congenitally corrected transposition of great arteries (ccTGA) and to our knowledge there have been no reports on the treatment of bicuspid aortic regurgitation (AR) in ccTGA. We report on a ccTGA patient with bicuspid AR and systemic right ventricule (SRV) dysfunction who underwent transcatheter aortic valve replacement (TAVR).

Case summary

A 17-year-old male with a history of ccTGA and cerebral palsy diagnosed at birth presented with heart failure. During childhood, he did not experience any heart failure symptoms, however, secondary to progressive bicuspid AR he experienced worsening SRV dysfunction beginning at 15-year-old. Echocardiography showed reduced SRV ejection fraction and severe bicuspid AR. The heart team, including a cardiac surgeon and paediatric cardiologist, discussed the treatment strategies and decided to proceed with TAVR as surgical aortic valve replacement was deemed high risk. TAVR was performed with the 34 mm Evolut R (Medtronic, Minneapolis, MN, USA). Post-operative echocardiography showed severe paravalvular leak (PVL). Therefore, valve-in-valve TAVR using a 29 mm Edwards SAPIEN 3 (Edwards Lifesciences, Irvine, CA, USA) was performed on post-operative Day 2 for PVL reduction. Following second procedure, PVL was significantly improved. The patient was discharged in stable condition.

Discussion

This is the first case wherein TAVR was performed for bicuspid AR in a patient with ccTGA. With appropriate preparation and planning and a collaborative multi-disciplinary team approach, TAVR can be a treatment option for severe AR in patients with ccTGA at high risk for surgery.

Authors+Show Affiliations

Smidt Heart Institute, Cedars Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor, Suite A3600, Los Angeles, CA 90048, USA.Smidt Heart Institute, Cedars Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor, Suite A3600, Los Angeles, CA 90048, USA.Department of Pediatrics, Smidt Heart Institute, Cedars Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor, Suite A3600, Los Angeles, CA 90048, USA.Smidt Heart Institute, Cedars Sinai Medical Center, 127 S. San Vicente Blvd, Third Floor, Suite A3600, Los Angeles, CA 90048, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617485

Citation

Nomura, Takahiro, et al. "Transcatheter Aortic Valve Replacement for Bicuspid Aortic Valve Regurgitation in a 17-year-old Patient With Congenitally Corrected Transposition of Great Arteries: a Case Report." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-6.
Nomura T, Miyasaka M, Zahn EM, et al. Transcatheter aortic valve replacement for bicuspid aortic valve regurgitation in a 17-year-old patient with congenitally corrected transposition of great arteries: a case report. Eur Heart J Case Rep. 2020;4(3):1-6.
Nomura, T., Miyasaka, M., Zahn, E. M., & Makkar, R. R. (2020). Transcatheter aortic valve replacement for bicuspid aortic valve regurgitation in a 17-year-old patient with congenitally corrected transposition of great arteries: a case report. European Heart Journal. Case Reports, 4(3), 1-6. https://doi.org/10.1093/ehjcr/ytaa102
Nomura T, et al. Transcatheter Aortic Valve Replacement for Bicuspid Aortic Valve Regurgitation in a 17-year-old Patient With Congenitally Corrected Transposition of Great Arteries: a Case Report. Eur Heart J Case Rep. 2020;4(3):1-6. PubMed PMID: 32617485.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcatheter aortic valve replacement for bicuspid aortic valve regurgitation in a 17-year-old patient with congenitally corrected transposition of great arteries: a case report. AU - Nomura,Takahiro, AU - Miyasaka,Masaki, AU - Zahn,Evan M, AU - Makkar,Raj R, Y1 - 2020/05/08/ PY - 2019/01/18/received PY - 2019/02/20/revised PY - 2020/04/09/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Aortic regurgitation KW - Bicuspid aortic valve KW - Case report KW - Congenitally corrected transposition of great arteries KW - Transcatheter aortic valve replacement SP - 1 EP - 6 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - Background: Limited research has been conducted on the surgical management of the aortic valve in congenitally corrected transposition of great arteries (ccTGA) and to our knowledge there have been no reports on the treatment of bicuspid aortic regurgitation (AR) in ccTGA. We report on a ccTGA patient with bicuspid AR and systemic right ventricule (SRV) dysfunction who underwent transcatheter aortic valve replacement (TAVR). Case summary: A 17-year-old male with a history of ccTGA and cerebral palsy diagnosed at birth presented with heart failure. During childhood, he did not experience any heart failure symptoms, however, secondary to progressive bicuspid AR he experienced worsening SRV dysfunction beginning at 15-year-old. Echocardiography showed reduced SRV ejection fraction and severe bicuspid AR. The heart team, including a cardiac surgeon and paediatric cardiologist, discussed the treatment strategies and decided to proceed with TAVR as surgical aortic valve replacement was deemed high risk. TAVR was performed with the 34 mm Evolut R (Medtronic, Minneapolis, MN, USA). Post-operative echocardiography showed severe paravalvular leak (PVL). Therefore, valve-in-valve TAVR using a 29 mm Edwards SAPIEN 3 (Edwards Lifesciences, Irvine, CA, USA) was performed on post-operative Day 2 for PVL reduction. Following second procedure, PVL was significantly improved. The patient was discharged in stable condition. Discussion: This is the first case wherein TAVR was performed for bicuspid AR in a patient with ccTGA. With appropriate preparation and planning and a collaborative multi-disciplinary team approach, TAVR can be a treatment option for severe AR in patients with ccTGA at high risk for surgery. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617485/Transcatheter_aortic_valve_replacement_for_bicuspid_aortic_valve_regurgitation_in_a_17-year-old_patient_with_congenitally_corrected_transposition_of_great_arteries:_a_case_report DB - PRIME DP - Unbound Medicine ER -
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