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J Thorac Cardiovasc Surg 2009;138:1022-1024
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

Feasibility of transapical aortic valve implantation fully guided by transesophageal echocardiography

Eric Dumont, MD, Jerôme Lemieux, MD, Daniel Doyle, MD, Josep Rodés-Cabau, MD, FESC*

Quebec Heart Institute, Laval Hospital, Québec, Canada

Received for publication January 23, 2009; revisions received March 15, 2009; accepted for publication March 20, 2009.

* Address for reprints: Josep Rodés-Cabau, MD, FESC, Québec Heart Institute, Laval Hospital, 2725 Chemin Ste-Foy, G1V 4G5 Québec, Canada. (Email: josep.rodes@crhl.ulaval.ca).

The first 20% of the full text of this article appears below.


   Introduction
 
Transapical aortic valve implantation (TAVI) is emerging as an alternative to surgical aortic valve replacement for the treatment of patients with severe aortic stenosis considered to be at very high or prohibitive surgical risk.1Go In this report we present, for the first time, a case of TAVI fully guided by transesophageal echocardiography (TEE), with no angiography, and we also discuss the usefulness of echocardiography for guiding TAVI procedures.


   Clinical Summary
 
A 73-year-old woman with severe aortic stenosis was admitted to our hospital with a diagnosis of pulmonary edema. She had a history of bypass grafting, stroke, peripheral vascular disease, severe calcification of the ascending aorta, and chronic renal failure. Doppler echocardiography showed a mean aortic gradient of 33 mm Hg, an aortic valve area of 0.65 cm2, and a left ventricular ejection fraction of 30%. Coronary angiography showed patency of all grafts. The patient was refused for conventional surgical aortic valve replacement (Society of Thoracic Surgeons score 14.5%) and she was then evaluated for transcatheter valve implantation. Contrast-enhanced computed tomography showed complete occlusion of both iliac arteries precluding a retrograde approach through the femoral artery, and TAVI was then proposed. The procedure . . . [Full Text of this Article]




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