Role of transseptal approach during TAVI in a patient with uncrossable severe bicuspid aortic stenosis. Case resolution

Abstract

CASE RESOLUTION Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly since it affects approximately 1% of the population. Transcatheter aortic valve implantation (TAVI) has become the treatment of choice of aortic stenosis in high to moderate risk surgical patients.1 Initially, the presence of BAV was considered as an exclusion criterion for TAVI. However, with the development of new generation devices, TAVI for BAV has become a feasible treatment strategy given its good clinical outcomes.2 Nevertheless, BAV still represents a challenging clinical scenario the scientific community is still learning about. Therefore, heart team evaluation is key to decide the most suitable valve replacement strategy in patients with BAV. To solve the challenge previously described a second procedure was scheduled with general endotracheal anesthesia. The patients’ informed consent was obtained. Under biplanar fluoroscopic and transesophageal guidance, transseptal puncture was performed using a 7-Fr Mullins Sheath (Medtronic, Inc., United States). A long stiff J-tip guidewire (Terumo, Japan) and a 5-Fr Judkins Right JR 4 catheter (Boston Scientific, United States) were advanced towards the left atrium, left ventricle, and stenotic aortic valve. The antegrade approach was used to access the descending thoracic aorta. The Terumo guidewire was snared using a 35 mm Gooseneck snare...