Transcatheter aortic valve replacement in membranous interventricular septum aneurysm with left ventricular outflow tract extension

Abstract

We report a challenging case of a 81-year-old male with history of severe calcific aortic valve stenosis and aneurysmal membranous interventricular septum. The presence of anomalies in the sub-annular area can lead to valve malpositioning and its consequences. Transcatheter aortic valve implantation (TAVR) in patients with aneurysm of the perimembranous interventricular septum extending into the left ventricular outflow tract has not been previously reported. This case describes a successful transfemoral TAVR with an Edwards SAPIEN XT valve (Edwards Lifesciences, Irvine, CA, United States) with such anomaly.

Keywords: Transcatheter aortic valve replacement; Aneurysmal membranous interventricular septum

Core tip: Congenital perimembranous ventricular septal aneurysm is reported to be rare and its co-occurrence with severe calcific aortic stenosis is even rarest. This unique case establishes that the transcatheter aortic valve replacement can be done in patients with aneurysmal perimembranous interventricular septum. This was achieved in our case by implanting the prosthetic valve more distally into the left ventricular outflow tract requiring apposition of the Edwards SAPIEN XT skirt at annulus with most of the valvular metallic frame in supra-annular position.