Journal of Transcatheter Valve Therapies
Online ISSN : 2434-4532
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Displaying 1-2 of 2 articles from this issue
Case Report
  • Kentaro Honda, Teruaki Wada, Hideki Kunimoto, Yoshiharu Nishimura
    2025 Volume 7 Issue 1 Pages 9-13
    Published: 2025
    Released on J-STAGE: February 01, 2025
    JOURNAL OPEN ACCESS
    Supplementary material

    Objective: Balloon rupture during transcatheter aortic valve implantation (TAVI) can be a challenging complication to manage, especially with alternative access routes. We report a case of a successful bailout after a balloon rupture during trans-subclavian TAVI.

    Case Presentation: An 83-year-old woman was scheduled to receive TAVI. Peripheral access was poor, so we planned for a trans-subclavian approach. The patient has low left ventricular function, and an arterial cannula for percutaneous cardio-pulmonary support was inserted from the left subclavian artery (SCA), and then, it was decided to perform TAVI through the right SCA. However, during the valve alignment process, the axis of the sheath and the axis of the valve did not align properly, and the balloon ruptured, making both deployment and retrieval impossible. Under median sternotomy, we successfully retrieved the valve under a simple clamp of the brachiocephalic artery. Trans-aortic TAVI was followed successfully and the patient is still in good condition.

    Conclusion: Balloon rupture during TAVI via trans-subclavian access can be successfully managed. This case highlights the importance of having bailout strategies for complications during TAVI procedures.

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  • Daisuke Sunohara, Tatsuya Saigusa, Tadashi Itagaki, Yukari Okuma, Yosh ...
    2025 Volume 7 Issue 1 Pages 1-7
    Published: 2025
    Released on J-STAGE: January 21, 2025
    JOURNAL OPEN ACCESS
    Supplementary material

    Objective: We report a case of microscopic pulmonary arteriovenous malformations (PAVMs) diagnosed by selective microbubble testing from the pulmonary artery.

    Case Presentations: A 56-year-old woman simultaneously experienced multiple cerebral infarctions, acute right pulmonary artery thromboembolism, and deep vein thrombosis at 44 years old. Conventional, non-selective microbubble testing using transesophageal echocardiography (TEE) was positive. She began warfarin administration, which was discontinued after 6 months due to no thrombosis recurrence and no congenital thrombosis predisposition. Later, preoperative TEE did not confirm patency of the foramen ovale, but non-selective microbubble testing was again positive. Although a clear patent foramen ovale (PFO) could not be identified, the possibility of a PFO with an extremely small shunt tract could not be ruled out and required further examination. Attempts to pass the foramen ovale with a multipurpose catheter under TEE guidance were unsuccessful. Next, we inserted a catheter into the pulmonary artery for selective microbubble testing. We observed bubble inflow from the right pulmonary artery to the right upper pulmonary vein, which enabled a diagnosis of microscopic PAVMs. Although these might constitute a contributing factor to paradoxical embolism, the shunt volume was thought to be small. We opted against shunt embolization, instead prescribing edoxaban to prevent thrombosis.

    Conclusion: Selective microbubble testing from the pulmonary artery could detect microscopic PAVMs and was effective for differentiation from a PFO.

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