Urgent endovascular aortic dissection repair in a Marfan patient during COVID‐19 pandemic

Yuan, Xun; Verdes, Mireya Castro; Capoccia, Massimo; Rosendahl, Ulrich; Nienaber, Christoph

doi:10.1002/ccr3.4634

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…Second, the presence of an aortic dissection spanning the entire aortic arch required a non-traumatic approach that would lower the risk of rupture. For this, a mounted pigtail catheter was used to safely cross the dissected segment using a technique used for thoracic endovascular aortic repair (TEVAR) of dissection ( 9 ). The case also highlights the strengths and advantages of using a balloon-expandable valve-in-valve TAVI.…”

Section: Discussionmentioning

confidence: 99%

Case report: A complex case of valve-in-valve TAVI and left bundle branch pacing for severe aortic regurgitation with partially corrected type A aortic dissection and low ejection fraction

Mihailovič,

Žižek,

Vitez

et al. 2023

Front. Cardiovasc. Med.

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BackgroundAortic regurgitation is a major concern following transcatheter aortic valve implantation (TAVI), as even low-grade regurgitation is associated with increased mortality. This is of particular concern to patients with pre-existing aortic disease who are at increased risk of TAVI valve slippage. Furthermore, conduction system disturbances after TAVI, namely left bundle branch block (LBBB), may have an additional detrimental effect on cardiac function.Case presentationThis report documents a successful treatment strategy in a frail patient with a bicuspid aortic valve and aortic disease after valve-sparing surgical repair in 1998, who subsequently developed aortic stenosis and underwent TAVI with an Evolut R self-expanding aortic valve. The progression of aortic disease, aortic root dilatation, and leaflet degeneration over the following years caused aortic regurgitation of the self-expanding aortic valve, resulting in left ventricular dilatation and heart failure along with LBBB and left ventricular (LV) mechanical dyssynchrony. Diagnostic workup of the patient showed persistence of the aneurysm distal to the graft with a dissection spanning the ascending aorta, arch, and terminating proximal to the aortic isthmus. After consideration by the cardiac team, a balloon-expandable valve was chosen for a valve-in-valve (ViV) procedure to provide sufficient radial force to expand the existing valve and correct the regurgitation. Due to the anatomy, a J-wire and pigtail catheter were successfully used for a safe approach and placement of the valve. Following the procedure, intermittent complete atrioventricular block was observed in addition to the pre-existing left bundle branch block, necessitating resynchronization pacing. Due to anatomical considerations, ease of placement, and the expected good level of resynchronization due to the proximal block, we opted for left bundle branch pacing, which showed improvement in left ventricular dyssynchrony and LV function at follow-up.ConclusionValve-in-valve implantation of a balloon-expandable Myval TAVI device to treat aortic regurgitation caused by slippage and right leaflet disfunction of slef valve is feasible in challenging anatomical scenarios. Left bundle branch pacing is a viable alternative to correct mechanical dyssynchrony in complex patients with LBBB and anatomical challenges necessitating resynchronization.

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Section: Discussionmentioning

confidence: 99%

Case report: A complex case of valve-in-valve TAVI and left bundle branch pacing for severe aortic regurgitation with partially corrected type A aortic dissection and low ejection fraction

Mihailovič,

Žižek,

Vitez

et al. 2023

Front. Cardiovasc. Med.

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“…Furthermore, the use of TEVAR still remains uncertain in patients with connective tissue disorders [ 37 , 95 ]. However, in an emergency setting, TEVAR may be considered in patients with connective tissue diseases [ 96 , 97 ]. The group of patients with retrograde extension from the entry tear in the descending aorta to the ascending aorta with a completely or partially thrombosed false lumen in the ascending aorta can initially be managed medically [ 98 ].…”

Section: Managementmentioning

confidence: 99%

Current Understanding of Aortic Dissection

Yuan

Mitsis

Nienaber

2022

Life

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The aorta is the largest artery in the body, delivering oxygenated blood from the left ventricle to all organs. Dissection of the aorta is a lethal condition caused by a tear in the intimal layer of the aorta, followed by blood loss within the aortic wall and separation of the layers to full dissection. The aorta can be affected by a wide range of causes including acute conditions such as trauma and mechanical damage; and genetic conditions such as arterial hypertension, dyslipidaemia, and connective tissue disorders; all increasing the risk of dissection. Both rapid diagnostic recognition and advanced multidisciplinary treatment are critical in managing aortic dissection patients. The treatment depends on the severity and location of the dissection. Open surgical repair is the gold standard of treatment for dissections located to the proximal part of the aorta and the arch, while endovascular interventions are recommended for most distal or type B aortic dissections. In this review article, we examine the epidemiology, pathophysiology, contemporary diagnoses, and management of aortic dissection.

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Urgent endovascular aortic dissection repair in a Marfan patient during COVID‐19 pandemic

Abstract: Although Thoracic Endovascular Aortic Repair is usually applied to patients without connective tissue disorders, our case shows its potential for complicated type B aortic dissection in a Marfan patient as a feasible alternative to open redo surgery with good short‐term outcomes.

Cited by 2 publications

References 9 publications

Case report: A complex case of valve-in-valve TAVI and left bundle branch pacing for severe aortic regurgitation with partially corrected type A aortic dissection and low ejection fraction

Case report: A complex case of valve-in-valve TAVI and left bundle branch pacing for severe aortic regurgitation with partially corrected type A aortic dissection and low ejection fraction

Current Understanding of Aortic Dissection

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