Interventions for valvular disease and heart failure

Double chimney stenting without contrast during transcatheter aortic valve-in-valve implantation

EuroIntervention 2023;18:999-1000. DOI: 10.4244/EIJ-D-22-00385

Xavier Armario
Xavier Armario1,2, MD; Mattia Lunardi1,3, MD, MSc; Liesbeth Rosseel1, MD; Masafumi Ono3,4, MD; Yoshinobu Onuma1,3, MD, PhD; Darren Mylotte1,3, MBBCh, MD, PhD
1. Department of Cardiology, Galway University Hospital, Galway, Ireland; 2. Universitat Autònoma de Barcelona, Barcelona, Spain; 3. National University of Ireland Galway, Galway, Ireland; 4. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
A frail 88-year-old female, who 9 years earlier underwent surgical aortic valve replacement (21 mm Trifecta valve; Abbott) and coronary artery bypass graft (left internal mammary artery [LIMA] to left anterior descending artery), presented with heart failure due to severe intraprosthetic regurgitation and a dysfunctional LIMA. The patient suffered a severe anaphylactic reaction to contrast media after coronary angiography and, somewhat unexpectedly, had a second near-fatal anaphylactic reaction during multislice computed tomography (MSCT), despite steroid and antihistamine premedication. MSCT identified a high risk of bilateral coronary artery obstruction accompanying transcatheter aortic valve-in-valve implantation (ViV-TAVI) (Figure 1A).

In this challenging scenario, a ...

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