Anesthetic management of concurrent Amplatzer atrial septal occlusion and transcatheter aortic valve implantation with percutaneous cardiopulmonary support in a patient with severe left ventricular dysfunction

Abstract

　We report a case in which transcatheter closure of an atrial septal defect with an Amplatzer septal occluder device (ASO) and transapical transcatheter aortic valve implantation (TAVI) were performed sequentially under the same anesthesia. A patient was diagnosed with severe aortic valve stenosis and severely depressed left ventricular function. The patient had undergone balloon aortic valvuloplasty in the past, and a left to right shunt remained.

　We inserted an outflow and an inflow catheter into the right axillary artery and the right femoral vein, respectively. ASO was performed without percutaneous cardiopulmonary support (PCPS), which was on standby. TAVI was performed with low flow PCPS.

　We used a pulmonary artery catheter and transesophageal echocardiography for monitoring and to avoid circulatory collapse.