2021 年 3 巻 1 号 p. 1-5
Objective: The embolization of the transcatheter heart valve (THV) is one of the complications of transcatheter aortic valve replacement (TAVR). A migrated THV in the sinus of Valsalva (SOV) needs to be withdrawn to a supra-coronary position. In this case, we successfully pulled the valve with a novel technique using a snare catheter and balloon for coronary intervention.
Case Presentation: A 90-year-old woman with critical aortic stenosis was presented with extremely small aortic valve annulus, heavily calcified left ventricular outflow tract (LVOT), and stenosis in the left anterior descending artery (LAD). Following percutaneous coronary intervention (PCI) to the LAD, a self-expandable THV was deployed. The THV was not fully expanded because of the heavy calcification of the LVOT. The THV was retracted by the nose cone, then migrated to the zero position. Post balloon dilation for the paravalvular leak (PVL) resulted in further migration into the SOV. We could not mobilize the THV by grasping the top frame of the THV. Instead, we grasped the bottom of the stent frame, and we could pull the THV to the supra-coronary position. We passed the previously used coronary balloon through the stent frame and kept pulling the THV with a dilated balloon during the second THV implantation. The second valve was successfully implanted.
Conclusion: We experienced THV embolization and difficulty in withdrawing the THV in the case with the small annulus and heavily calcified LVOT. A combination of snaring the bottom stent frame and balloon retraction technique is a useful alternative method for withdrawing the migrated THV.
