Percutaneous closure of an atrial septal defect and transcatheter aortic valve implantation in a patient with diffuse coronary artery disease
Abstract
This is the case report of use of modern interventional, fully percutaneous treatment of a clinically significant, and moderately hemodynamically significant ostium secundum atrial septal defect and (also significant) degenerative calcified aortic stenosis in a 76-year-old patient with diffuse coronary artery disease and at high risk of cardiac surgery (14.4% risk using the logistic EuroSCORE). The atrial septal defect and aortic stenosis were successfully managed using a combination of two separate percutaneous interventions, implantation of a 12 mm Occlutech Figulla ("stretched" diameter, 9-10 mm) and transcatheter aortic valve implantation (TAVI) using the CoreValve Revalving 26 mm prosthesis.
The procedures were uneventful, with complete left bundle branch block (LBBB), and intermittent right bundle branch block developing postprocedurally. Considering the pre-existing degree I AV block and persisting LBBB and, subsequently, the high risk of complete bundle branch block, the patient was implanted a DDDR pacemaker.
Follow-up at 4 months postprocedurally documented a good effect of interventional therapy with good valve function as demonstrated by transthoracic heart ultrasound, showing no signs of a shunt at the level of atria. The patient reported appreciable improvement of his quality of life.
New methods of interventional cardiology can be used to treat safely and effectively also patients at a surgical risk not acceptable to cardiac surgeons