2024 年 6 巻 1 号 p. 45-49
Objective: The wire route in the left ventricle (LV) is a key factor for successful transcatheter aortic valve implantation (TAVI). The transapical (TA) approach is the only antegrade approach in which valve crossing is usually easy. In this case, we failed to cross the wire after the transcatheter heart valve (THV) became lodged. However, we bailed out and implanted successfully by confirming the wire route with a dummy valve cross technique.
Case Presentation: A woman in her late 70s presented with symptomatic severe aortic valve stenosis and shaggy descending aorta. As she was frail after bilateral arthroplasty, our heart team decided to perform TA-TAVI under general anesthesia. After apical puncture, the guidewire was passed through the aortic valve under fluoroscopy. Transesophageal echocardiography (TEE) showed the wire running along the septal wall, and the THV was advanced into the LV. However, the THV became lodged below the aortic valve. We reviewed the TEE findings and concluded the wire and delivery system had passed through the chordae tendineae. Therefore, we removed the whole system from the LV and reattempted wire crossing. To confirm the correct wire route, we advanced an aortic valvuloplasty balloon as a dummy valve before inserting the actual THV. The THV passed smoothly through the aortic valve and was implanted successfully. The postoperative course was uneventful, with no bleeding.
Conclusion: In TA-TAVI, the wire route in the LV around the apex is poorly visualized. A dummy valve cross technique might be useful to confirm the wire route.
