Images of an Ectopic Balloon Expandable Valve Deployed at the Aortic Arch Level Following Valve Embolization

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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00062. Epub March 19, 2024.

An 83-year-old man with severe aortic stenosis underwent implantation of a 29-mm SAPIEN-3 (Edwards Lifesciences) transcatheter aortic valve (TAV) appropriately sized for an aortic annulus area of 543.6 mm². Immediately post-implantation, due to loss of capture of the rapid pacing sequence (pacing failure) during deployment (Figure 1A), the TAV lost contact with the aortic annulus and migrated to the ascending aorta (Video 1). After a brief period of rocking motion within the ascending aorta (Figure 1B), the TAV was finally embolized at the distal part of the aortic arch (Figure 1C; Videos 2 & 3). Due to a significant residual aortic valve regurgitation, an additional 29-mm balloon-expandable TAV was successfully advanced through the first TAV and deployed in the native valve (Figure 2A).  Having assessed that the embolized TAV was positioned distally to the ostia of the left common carotid and the left subclavian artery with ample patency of possibly jeopardized vessels (Figure 2B), post-dilation with a 29-mm balloon was performed to secure the valve against the aortic wall (Figure 2C). 

The patient was discharged uneventfully on the fifth day post-procedure. Clinical and imaging assessment of the patient upon discharge did not reveal any significant sequalae of the complication since ankle-brachial index was normal and continuous-wave doppler on descending aorta did not reveal any signs of stenosis (coarctation-equivalent), whereas color-doppler assessment of the left carotid showed normal flow. The 1-year follow up was uneventful with no cardiovascular adverse events reported. Computed tomographic aortography at the 1-year follow up showed that the ectopic deployed valve remained well expanded (Figure 3).

Affiliations and Disclosures

From the ¹Department of Cardiology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; ²Radiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Address for correspondence: Dimitrios Tziakas, MD,PhD, FESC, SCAI, FACC, Department of Cardiology, Medical School, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece.  Email: dtziakas@med.duth.gr