Peer-review started: December 8, 2017
First decision: December 11, 2017
Revised: December 25, 2017
Accepted: January 16, 2018
Article in press: January 16, 2018
Published online: January 26, 2018
Processing time: 48 Days and 15.7 Hours
Patient with severe calcific aortic stenosis presented with worsening symptom of shortness of breath.
Patient was diagnosed as symptomatic severe aortic stenosis clinically.
Left ventricular outflow tract obstruction, sub-valvular aortic stenosis and supra-valvular aortic stenosis are the differentials.
ECG showed intermittent paced rhythm due to pacemaker and chest x-ray showed sternal wires due to previous coronary artery bypass graft.
Echocardiography and computer tomography showed severe calcific aortic stenosis with perimembranous interventricular septum aneurysm extending into left ventricular outflow tract.
Patient had congenital heart defect which included interventricular septum aneurysm extending into left ventricular outflow tract with acquired severe calcific stenosis of tri-leaflet aortic valve.
The patient was treated with transcatheter aortic valve replacement .This was achieved in our case by implanting the prosthetic valve more distally into the left ventricular outflow tract (LVOT) requiring apposition of the Edwards SAPIEN XT skirt at annulus with most of the valvular metallic frame in supra-annular position.
During transcatheter aortic valve replacement, normally the conventional recommendation is to implant the device with 50% above and 50% below native leaflet insertion .We had 80% aortic and 20% ventricular ratio of the device at the level of leaflet insertion of the native valve.
LVOT denotes left ventricular outflow tract obstruction and TAVR denotes transcatheter aortic valve replacement.
The transcatheter aortic valve replacement can be done in patients having high surgical risk with perimembranous interventricuar septum aneurysm by implanting the device more distally into the LVOT.