JACC. Case reports · 2026
Real-Time Hemodynamic Guidance During Valve-in-Valve TAVI.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Konami Yutaka, Sakamoto Tomohiro, Suzuyama Hiroto, Horio Eiji, Sato Tomohide, Maeda Mika, Yamada Masahiro, Ideta Ichiro, Koyama Jyunjiro
Аннотация
OBJECTIVES: To describe hemodynamic guidance during valve-in-valve transcatheter aortic valve implantation using simultaneous aortic and left ventricular pressure monitoring.
KEY STEPS: A 90-year-old woman with a failed 19-mm surgical bioprosthesis and severe transvalvular regurgitation underwent valve-in-valve implantation with a self-expanding valve guided by a SavvyWire. During the first deployment, the aortic waveform remained completely flat after pacing was discontinued, whereas left ventricular pulsatility persisted; the valve was recaptured. During the second deployment, aortic pulsatility recovered after pacing cessation; final release was performed. Postdilatation reduced the invasive mean transvalvular gradient from 23 to 11 mm Hg.
POTENTIAL PITFALLS: A flat aortic waveform with preserved left ventricular pulsatility is a warning sign warranting system confirmation and multimodality reassessment, not a specific diagnosis of leaflet dysfunction.
TAKE-HOME MESSAGE: Simultaneous pressure monitoring can complement fluoroscopy when valve function is uncertain during deployment and may support timely recapture when abnormal hemodynamics persist.
KEY STEPS: A 90-year-old woman with a failed 19-mm surgical bioprosthesis and severe transvalvular regurgitation underwent valve-in-valve implantation with a self-expanding valve guided by a SavvyWire. During the first deployment, the aortic waveform remained completely flat after pacing was discontinued, whereas left ventricular pulsatility persisted; the valve was recaptured. During the second deployment, aortic pulsatility recovered after pacing cessation; final release was performed. Postdilatation reduced the invasive mean transvalvular gradient from 23 to 11 mm Hg.
POTENTIAL PITFALLS: A flat aortic waveform with preserved left ventricular pulsatility is a warning sign warranting system confirmation and multimodality reassessment, not a specific diagnosis of leaflet dysfunction.
TAKE-HOME MESSAGE: Simultaneous pressure monitoring can complement fluoroscopy when valve function is uncertain during deployment and may support timely recapture when abnormal hemodynamics persist.