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Transcatheter Aortic Valve Replacement With Coronary Artery Protection Performed in a Patient With an Anomalous Left Main Coronary Artery
Journal of the American College of Cardiology © 2012 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 60, No. 6, 2012 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2012.01.075
IMAGES IN CARDIOLOGY
Transcatheter Aortic Valve Replacement With Coronary Artery Protection Performed in a Patient With an Anomalous Left Main Coronary Artery Jay Giri, MD, MPH,* Wilson Y. Szeto, MD,† Joseph Bavaria, MD,† Howard C. Herrmann, MD* Philadelphia, Pennsylvania
From the *Divisions of Cardiovascular Medicine and †Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Giri has reported that he has no relationships relevant to the contents of this paper to disclose. Dr. Szeto has relationships with Edwards Lifesciences as a subinvestigator, steering committee member, and a clinical proctor. Dr. Bavaria is a Principal Investigator Clinical Research for the PARTNER Trial by Edwards Lifesciences. Dr. Herrmann received research funding to his institution from Edwards Lifesciences; and speaking honoraria from Edwards Lifesciences. Manuscript received January 6, 2012; accepted January 20, 2012.
A
n 88-year-old woman with critical aortic stenosis was evaluated for transcatheter aortic valve replacement (TAVR) with the Sapien (Edwards Inc., Irvine, California) balloonexpandable aortic bioprosthesis. Pre-operative coronary angiography (A, Online Video 1) revealed a single coronary ostium with an anomalous left main coronary artery (LMCA) arising from the proximal right coronary artery in the right coronary cusp. Cardiac computed tomography confirmed an interarterial course of the anomalous LMCA (B, Online Video 2). A coronary wire was placed in the left anterior descending artery to serve as protection for the LMCA during balloon valvuloplasty and TAVR, with the potential for rapid stenting if necessary (C, red arrow, Online Video 3). During valvuloplasty, aortography confirmed patency of the LMCA (C, blue arrow) with an inflated balloon across the aortic valve (C, black arrow). Post-TAVR angiography revealed continued patency of the LMCA and further elucidated the relationship between the aortic annulus, as demonstrated by the Sapien valve (D, blue arrow, Online Video 4), the right ventricular outflow tract (D, red arrow), and the course of the anomalous LMCA (D, black arrow).
Vol. 60, No. 6, 2012 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2012.01.075
IMAGES IN CARDIOLOGY
Transcatheter Aortic Valve Replacement With Coronary Artery Protection Performed in a Patient With an Anomalous Left Main Coronary Artery Jay Giri, MD, MPH,* Wilson Y. Szeto, MD,† Joseph Bavaria, MD,† Howard C. Herrmann, MD* Philadelphia, Pennsylvania
From the *Divisions of Cardiovascular Medicine and †Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Giri has reported that he has no relationships relevant to the contents of this paper to disclose. Dr. Szeto has relationships with Edwards Lifesciences as a subinvestigator, steering committee member, and a clinical proctor. Dr. Bavaria is a Principal Investigator Clinical Research for the PARTNER Trial by Edwards Lifesciences. Dr. Herrmann received research funding to his institution from Edwards Lifesciences; and speaking honoraria from Edwards Lifesciences. Manuscript received January 6, 2012; accepted January 20, 2012.
A
n 88-year-old woman with critical aortic stenosis was evaluated for transcatheter aortic valve replacement (TAVR) with the Sapien (Edwards Inc., Irvine, California) balloonexpandable aortic bioprosthesis. Pre-operative coronary angiography (A, Online Video 1) revealed a single coronary ostium with an anomalous left main coronary artery (LMCA) arising from the proximal right coronary artery in the right coronary cusp. Cardiac computed tomography confirmed an interarterial course of the anomalous LMCA (B, Online Video 2). A coronary wire was placed in the left anterior descending artery to serve as protection for the LMCA during balloon valvuloplasty and TAVR, with the potential for rapid stenting if necessary (C, red arrow, Online Video 3). During valvuloplasty, aortography confirmed patency of the LMCA (C, blue arrow) with an inflated balloon across the aortic valve (C, black arrow). Post-TAVR angiography revealed continued patency of the LMCA and further elucidated the relationship between the aortic annulus, as demonstrated by the Sapien valve (D, blue arrow, Online Video 4), the right ventricular outflow tract (D, red arrow), and the course of the anomalous LMCA (D, black arrow).