Abstract
A 50-year-old man presented in cardiogenic shock. Echocardiogram showed ejection fraction
(EF) 22%, apical thrombus, and severe bicuspid aortic stenosis. Transcatheter aortic
valve replacement (TAVR) was recommended, given his high surgical risk. Urgent TAVR
was performed without complication, using transcatheter cerebral embolic protection
and intracardiac echocardiography (ICE) for left-ventricular wire placement. The patient
was discharged on warfarin, and follow-up echocardiogram showed no apical thrombus,
EF 55%, and well-functioning bioprosthesis. This case shows a good TAVR outcome in
bicuspid aortic stenosis despite apical thrombus and poor EF. Cerebral embolic protection
and ICE can minimize risk of stroke.
Résumé
Un homme de 50 ans s'est présenté en choc cardiogénique. L'échocardiographie a révélé
une fraction d'éjection (FE) de 22 %, un thrombus apical et une sténose aortique bicuspide
grave. Un remplacement valvulaire aortique par cathéter (RVAC) a été recommandé, compte
tenu du risque chirurgical élevé. Le RVAC a été réalisé en urgence, sans complication,
en utilisant un dispositif transcathéter de protection d'embolie cérébrale et une
échocardiographie intracardiaque (EIC) pour le placement de la sonde dans le ventricule
gauche. Le patient est sorti de l'hôpital sous warfarine et l'échocardiographie de
suivi n'a révélé aucun thrombus apical, une FE de 55 % et une bioprothèse qui fonctionne
bien. Ce cas démontre un succès de RVAC dans le cas d'une sténose aortique bicuspide,
malgré un thrombus apical et une faible FE. La protection contre l'embolie cérébrale
et l'EIC peuvent minimiser le risque d'accident vasculaire cérébral.
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References
- Left ventricular thrombus: contemporary etiologies, treatment strategies, and outcomes.J Am Coll Cardiol. 2019; 73: 2007-2009
- Antithrombotic therapy for patients with left ventricular mural thrombus.J Am Coll Cardiol. 2020; 75: 1676-1685
- Debris heterogeneity across different valve types captured by a cerebral protection system during transcatheter aortic valve replacement.JACC Cardiovasc Interv. 2018; 11: 1262-1273
- Embolic protection device in a patient with large left ventricular thrombus undergoing transcatheter aortic valve replacement.Int J Cardiol. 2016; 222: 703-704
- Balloon versus self-expandable valve for the treatment of bicuspid aortic valve stenosis.Circ Cardiovasc Interv. 2020; 13e008714
Article info
Publication history
Published online: June 14, 2021
Accepted:
June 1,
2021
Received:
April 20,
2021
Footnotes
See page 1670 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
