Transjugular intracardiac echocardiography-guided transcatheter aortic valve implantation

Extract

An 85-year-old Japanese female presented with New York Heart Association Class II heart failure symptom despite maximum medical therapy. Echocardiography showed severe aortic stenosis (peak velocity of 5.1 m/s, mean pressure gradient 64 mmHg, aortic valve area 0.4 cm²) and computed tomography showed severe calcified leaflets. Patient has been treated with oral corticosteroids for interstitial pneumonia; therefore, heart team decision was to perform transcatheter aortic valve implantation (TAVI) under conscious sedation. AcuNav (Biosense Webster, Irvine, CA, USA) intracardiac echocardiography (ICE) catheter is inserted via 8 Fr sheath from right jugular vein and can be observed under fluoroscopy (Panels A and B). Baseline long-axis views and stiff wire in the left ventricle are shown (Panels C and D and Supplementary material online, Videos S1 and S2). After pre-dilatation, CoreValve Evolut PRO 23 mm (Medtronic Inc., Galway, Ireland) was implanted. At the point of no recapture, ICE showed appropriate depth with minimal paravalvular leakage (PVL) (Panels E and F and Supplementary material online, Video S3), therefore, the valve was fully released. Final angiography and ICE showed trivial PVL (Panels G and H and Supplementary material online, Video S4). Post-procedural echocardiography showed excellent haemodynamics (mean pressure gradient 8.3 mmHg, effective orifice area 1.6 cm²) with trivial PVL. Patient was discharged 3 days after the procedure and clinically remains asymptomatic 1 year after the procedure.