Transcatheter valve implantation into descending aorta due to the insufficient guide wire support

Abstract

Transcatheter aortic valve implantation (TAVI) is an alternative therapy to surgical aortic valve replacement in inoperable patients with severe aortic stenosis. Despite the increasing use of TAVI currently, the potential risk for lifethreatening complications is still regarded to be high. An 86-year-old female patient was admitted to our clinic with angina. On echocardiography, the mean transaortic gradient was 55 mmHg with a calculated aortic valve area of 0.8 cm2. Due to high surgical risk scores (Logistic EuroSCORE= 31.21%), the patient was scheduled for TAVI via transfemoral route. An Amplatz Super Stiff PTFE-coated Guide wire (7 cm Bentson-Type) was positioned correctly into the left ventricle. Predilatation was made into the aortic root by balloon. A 23 mm Edwards SAPIEN XT valve was advanced to the aorta, however, the valve was unable to be placed at the aortic valve level due to the retraction of the guide wire from the left ventricle. The transcatheter aortic valve was withdrawn and implanted to the descending aorta. Subsequently, another transcatheter aortic valve (23 mm Edwards SAPIEN XT) was implanted at the aortic valve level successfully.