Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Article types Case report
Language English
Peer review Peer reviewed
Title Unique haemodynamics in a patient with apicoaortic conduit dysfunction who underwent transcatheter aortic valve replacement.
Journal Formal name:European heart journal cardiovascular Imaging
Abbreviation:Eur Heart J Cardiovasc Imaging
ISSN code:20472404/20472412
Domestic / ForeginForegin
Publisher Oxford University Press
Volume, Issue, Page 21(6),pp.652
Author and coauthor DOMOTO Satoru†*, NAGAO Michinobu, ISOMURA Shogo, YAMAGUCHI Junichi, NIINAMI Hiroshi
Publication date 2020/06/01
Summary A 78-year-old woman was admitted with chronic heart failure. She underwent aortic valve bypass using a 23 mm-valved apicoaortic conduit (AAC) for severe aortic stenosis with porcelain aorta 7 years previously (Panel A).

Echocardiography revealed a peak velocity of 4.2 m/s, a mean gradient of 41 mmHg, and no regurgitation within the AAC. Four-dimensional flow magnetic resonance imaging (MRI) revealed that the systematic circulation was mostly ejected from the AAC (Panel B and Supplementary data online, Video S1). AAC dysfunction was diagnosed, and we decided to perform transcatheter aortic valve replacement (TAVR) for the native
aortic valve (NAV).

A 26-mm Medtronic CoreValve Evolut R was implanted from the femoral route using the standard technique (Panel C). Four-dimensional flow MRI revealed that the systematic circulation was ejected from both the NAV and the AAC (Panel D and Supplementary data online, Video S2).

We evaluated the haemodynamics using phase contrast MRI. The stroke volumes (SVs) from the AAC and NAV were 58 mL and 9 mL, respectively. The arch blood flow was retrograde from the descending aorta before TAVR (Panel E, the arrows indicate the flow direction and the numbers indicate the flow volume in millilitres). The SV from the NAV and AAC increased to 41 mL and 45 mL, respectively. The total SV increased, and the arch blood flow became antegrade after TAVR (Panel F).

The haemodynamics after TAVR for AAC dysfunction remain unknown. This case highlights the unique haemodynamics in a patient who underwent TAVR with AAC dysfunction.
DOI 10.1093/ehjci/jez323
PMID 31985782