JACC. Case reports · 2026
IVUS-Guided UNICORN Leaflet Modification During Redo TAVR to Prevent Coronary Obstruction.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Hailan Ahmed, Ali Montasir H, Khurana Ayush, Premawardhana Amila, Sabra Ahmed, Hassan Mazin, Ionescu Adrian, Obaid Daniel, Dorman Stephen, Chase Alexander
Аннотация
BACKGROUND: Coronary obstruction is a rare but potentially fatal complication of transcatheter aortic valve replacement (TAVR), particularly during valve-in-valve and TAVR-in-TAVR procedures. Leaflet modification techniques have emerged to reduce this risk.
CASE SUMMARY: A 67-year-old woman with severe degeneration of a 26-mm SAPIEN 3 transcatheter heart valve presented with acute heart failure. Computed tomography demonstrated severe prosthetic stenosis and a high risk of left coronary obstruction (virtual valve-to-coronary distance 3.4 mm). Redo TAVR was performed using intravascular ultrasound (IVUS)-guided UNICORN (Undermining Iatrogenic Coronary Obstruction with Radiofrequency Needle) leaflet modification, followed by implantation of a 23-mm RESILIA valve. IVUS enabled precise leaflet traversal and real-time assessment of the relationship between the modified leaflet, valve frame, and left main coronary artery, resulting in an excellent procedural and hemodynamic outcome.
CONCLUSIONS: This is the first reported IVUS-guided UNICORN leaflet modification during TAVR-in-TAVR, highlighting its potential to improve procedural precision and safety in patients at high risk of coronary obstruction.
CASE SUMMARY: A 67-year-old woman with severe degeneration of a 26-mm SAPIEN 3 transcatheter heart valve presented with acute heart failure. Computed tomography demonstrated severe prosthetic stenosis and a high risk of left coronary obstruction (virtual valve-to-coronary distance 3.4 mm). Redo TAVR was performed using intravascular ultrasound (IVUS)-guided UNICORN (Undermining Iatrogenic Coronary Obstruction with Radiofrequency Needle) leaflet modification, followed by implantation of a 23-mm RESILIA valve. IVUS enabled precise leaflet traversal and real-time assessment of the relationship between the modified leaflet, valve frame, and left main coronary artery, resulting in an excellent procedural and hemodynamic outcome.
CONCLUSIONS: This is the first reported IVUS-guided UNICORN leaflet modification during TAVR-in-TAVR, highlighting its potential to improve procedural precision and safety in patients at high risk of coronary obstruction.