First-in-man: successful interventional closure of severe paravalvular leakage after surgical rapid deployment aortic valve replacement

First-in-man: successful interventional closure of severe paravalvular leakage after surgical... Cardiovascular flashlight 1655 doi:10.1093/eurheartj/ehy091 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 5 March 2018 .................................................................................................................................................... First-in-man: successful interventional closure of severe paravalvular leakage after surgical rapid deployment aortic valve replacement Shazia Afzal, Laura Kleinebrecht, Katharina Hellhammer*, and Verena Veulemans Division of Cardiology, Pulmunology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Du¨sseldorf, Germany * Corresponding author. Tel: 149 211 8118800, Fax: 149 211 8118812, Email: Katharina.Hellhammer@med.uni-duesseldorf.de We present the case of an 80-year-old patient suffering from haemolysis due to a paravalvular leakage (PVL) after Intuity valve (21 mm) im- plantation in 2016. Only limited data exists regarding possible therapy strategies of relevant PVL after rapid deployment aortic valve replace- ment (RDAVR) using the novel Edwards Intuity Elite valve system (Edwards Lifesciences, USA). A delivery and a balloon positioning system are used to facilitate the deployment of the innovative valve after the native, calcified valve has been surgically resected. To prohibit PVL a textured sealing cloth is attached to the stent frame. Given the patient’s critical clinical condition an interventional approach for PVL closure was chosen. To facilitate the procedure, we applied the latest generation of fusion imaging [Anatomical Intelligence, Philips, Netherlands (Panels A and B)]. A 10  5mm Amplatzer Vascular Plug III Occluder (Abbott, USA) was implanted (Panels C and D) with excellent short- and long-term result. This first-in-man report describes that interventional closure of a PVL in new RDAVR devices like the Intuity valve is feasible and represents a reliable therapeutic option. (Panel A) A 3D model is generated based on 3D imaging during transoesophageal echocardiography. (Panel B)The 3D model is superim- posed on the live fluoroscopic image. (Panel C) Two markers are placed in the echo image and automatically fused with fluoroscopy showing the borders of the PVL. Hence, the wire is guided through the PVL. (Panel D) The Amplatzer occluder is positioned in the PVL. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/18/1655/4920929 by Ed 'DeepDyve' Gillespie user on 21 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal Oxford University Press

First-in-man: successful interventional closure of severe paravalvular leakage after surgical rapid deployment aortic valve replacement

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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0195-668X
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1522-9645
D.O.I.
10.1093/eurheartj/ehy091
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Abstract

Cardiovascular flashlight 1655 doi:10.1093/eurheartj/ehy091 CARDIOVASCULAR FLASHLIGHT Online publish-ahead-of-print 5 March 2018 .................................................................................................................................................... First-in-man: successful interventional closure of severe paravalvular leakage after surgical rapid deployment aortic valve replacement Shazia Afzal, Laura Kleinebrecht, Katharina Hellhammer*, and Verena Veulemans Division of Cardiology, Pulmunology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Du¨sseldorf, Germany * Corresponding author. Tel: 149 211 8118800, Fax: 149 211 8118812, Email: Katharina.Hellhammer@med.uni-duesseldorf.de We present the case of an 80-year-old patient suffering from haemolysis due to a paravalvular leakage (PVL) after Intuity valve (21 mm) im- plantation in 2016. Only limited data exists regarding possible therapy strategies of relevant PVL after rapid deployment aortic valve replace- ment (RDAVR) using the novel Edwards Intuity Elite valve system (Edwards Lifesciences, USA). A delivery and a balloon positioning system are used to facilitate the deployment of the innovative valve after the native, calcified valve has been surgically resected. To prohibit PVL a textured sealing cloth is attached to the stent frame. Given the patient’s critical clinical condition an interventional approach for PVL closure was chosen. To facilitate the procedure, we applied the latest generation of fusion imaging [Anatomical Intelligence, Philips, Netherlands (Panels A and B)]. A 10  5mm Amplatzer Vascular Plug III Occluder (Abbott, USA) was implanted (Panels C and D) with excellent short- and long-term result. This first-in-man report describes that interventional closure of a PVL in new RDAVR devices like the Intuity valve is feasible and represents a reliable therapeutic option. (Panel A) A 3D model is generated based on 3D imaging during transoesophageal echocardiography. (Panel B)The 3D model is superim- posed on the live fluoroscopic image. (Panel C) Two markers are placed in the echo image and automatically fused with fluoroscopy showing the borders of the PVL. Hence, the wire is guided through the PVL. (Panel D) The Amplatzer occluder is positioned in the PVL. Published on behalf of the European Society of Cardiology. All rights reserved. V The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/eurheartj/article-abstract/39/18/1655/4920929 by Ed 'DeepDyve' Gillespie user on 21 June 2018

Journal

European Heart JournalOxford University Press

Published: Mar 5, 2018

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