2022 年 4 巻 1 号 p. 67-70
Objective: We present a case of successful transcatheter aortic valve implantation (TAVI) via cusp-overlap technique performed with fluoroscopy and transesophageal echocardiography (TEE) guidance without any contrast agent in a patient with severe aortic stenosis (AS) and chronic kidney disease.
Case Presentation: An 83-year-old female with severe AS was admitted to our hospital undergoing TAVI. Contrastenhanced CT was not performed due to her severe renal dysfunction. Therefore, we planned a non-contrast transfemoral TAVI. Under general anesthesia, we performed a 3D measurement of TEE before the TAVI procedure for choosing an appropriate transcatheter heart valve (THV) size. Using two pigtail catheters as landmarks, we adjusted the perpendicular view and the cusp-overlap view. After pre-dilation, a THV was deployed and implanted using the cusp-overlap view and the left anterior oblique view without using any contrast agent, and TEE demonstrated that the THV was implanted at an optimal implantation depth. She was transferred to another hospital for rehabilitation on postoperative day 6 without any complications including any conduction delay.
Conclusion: We first described a successful non-contrast TAVI with the cusp-overlap technique, which could be performed using two pigtail catheters as a landmark without a contrast agent. An appropriately sized THV was selected and deployed at an optimal position guided by TEE. We believe that this technique is feasible, and the permanent pacemaker implantation rate could be decreased in patients with severe AS and severe chronic kidney disease.
