IMAGE IN CARDIOLOGY

DOI: 10.4244/EIJY15M02_06

Transcatheter Lotus valve implantation in a regurgitant SAPIEN 3 valve

Nicolas M. Van Mieghem1*, MD; Ramon Rodriguez-Olivares1, MD; Arie-Pieter Kappetein2, MD, PhD; Peter P. de Jaegere1, MD, PhD

An 88-year-old male underwent a transcatheter aortic valve implantation with a 26 mm Edwards SAPIEN 3 (S3) valve (Edwards Lifesciences Inc., Irvine, CA, USA) with mild residual paravalvular regurgitation (PAR) after post-dilatation with a 26 mm balloon (Moving image 1). The upper row of Figure 1 illustrates the S3 positioning during expansion (left) with mild PAR by transoesophageal echocardiography (middle) and contrast angiography (right). Transthoracic echocardiography at follow-up (second row) revealed severe PAR (Moving image 2). The pathophysiology of this deterioration to severe PAR is uncertain. S3 sizing and positioning seemed adequate and recoil was excluded. Damage to the S3 integrity by post-dilatation cannot be ruled out. A transcatheter valve-in-S3 implantation with a 27 mm Lotus™ valve (Boston Scientific, Marlborough, MA, USA) followed. The third row displays the Lotus positioning within the S3 (left) and the final result (right) with trivial PAR (middle) (Moving image 3). The bottom row illustrates the mid portion of the frame derived from rotational angiography, confirming identical S3 area at the end of the index procedure and prior to Lotus implantation two months later (no recoil). Note the significant increase in area after Lotus implantation. The Lotus valve is mechanically deployed with high radial force and an adaptive seal. It is completely repositionable and retrievable even after full expansion. These intrinsic features may help optimise transcatheter valve-in-valve procedures.

Figure 1. Fluoroscopy and transoesophageal illustrations as explained in the text. Bottom row displays the cross-sectional view derived from the 3D reconstruction of the rotational angiography using dedicated Siemens software.

Guest Editor

This paper was guest edited by Alec Vahanian, MD; Cardiology Department, Bichat Hospital, Paris, France.

Conflict of interest statement

N. Van Mieghem has received research grants from Edwards Lifesciences, Medtronic and Boston Scientific. P. de Jaegere is a proctor for St. Jude Medical and Boston Scientific. The other authors have no conflicts of interest to declare. The Guest Editor is a consultant for Edwards Lifesciences.

Online data supplement

Moving image 1. Transoesophageal echocardiography after 26 mm S3 implantation shows mild PAR.

Moving image 2. Transthoracic echocardiography in parasternal short-axis view six days after TAVI shows severe PAR.

Moving image 3. Transoesophageal echocardiography after Lotus-in-S3 shows only trivial PAR.

Volume 11 Number 3
Jul 20, 2015
Volume 11 Number 3
View full issue


Key metrics

Suggested by Cory

IMAGE IN CARDIOLOGY

10.4244/EIJV11I11A255 Feb 12, 2016
Edwards SAPIEN 3 implanted in a failing aortic bioprosthesis: first report
Molina-Martin de Nicolas J et al
free

CLINICAL RESEARCH

10.4244/EIJ-D-18-00005 May 20, 2018
Novel predictors of mild paravalvular aortic regurgitation in SAPIEN 3 transcatheter aortic valve implantation
Tang GH et al
free

10.4244/EIJV11I10A220 Feb 19, 2016
Accurate procedural assessment of AR – critical for successful TAVI
Kapadia S and Tuzcu ME
free
Trending articles
151.43

State-of-the-Art

10.4244/EIJ-D-22-00776 Apr 3, 2023
Computed tomographic angiography in coronary artery disease
Serruys PW et al
free
55.9

Clinical research

10.4244/EIJ-D-22-00621 Feb 20, 2023
Long-term changes in coronary physiology after aortic valve replacement
Sabbah M et al
free
54.9

Expert review

10.4244/EIJ-D-21-01010 Jun 24, 2022
Device-related thrombus following left atrial appendage occlusion
Simard T et al
free
43.75

Clinical Research

10.4244/EIJ-D-21-01091 Aug 5, 2022
Lifetime management of patients with symptomatic severe aortic stenosis: a computed tomography simulation study
Medranda G et al
free
39.95

Clinical research

10.4244/EIJ-D-22-00558 Feb 6, 2023
Permanent pacemaker implantation and left bundle branch block with self-expanding valves – a SCOPE 2 subanalysis
Pellegrini C et al
free
X

The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

EuroPCR EAPCI
PCR ESC
Impact factor: 7.6
2023 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2024)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2024 Europa Group - All rights reserved