Treatment of Acute Aortic Insufficiency With a Dedicated Device

Abstract

A 66-year-old man with refractory multiple myeloma presented with acute severe aortic insufficiency leading to cardiogenic shock and multiorgan failure. After comprehensive heart team evaluation, he underwent successful JenaValve transcatheter aortic valve (JenaValve Technology, Inc., Irvine, California) implantation resulting in resolution of his aortic insufficiency and improvement in his clinical status. (Level of Difficulty: Advanced.).

Keywords: AI, aortic insufficiency; AS, aortic stenosis; TAVR, transcatheter aortic valve replacement; TEE, transesophageal echocardiography; TTE, transthoracic echocardiography; aortic valve; endocarditis; valve replacement.

Conflict of interest statement

Dr. Khalique is director of the core laboratory that has a contract with JenaValve; however, he does not receive direct compensation. Dr. Vahl has received institutional funding to Columbia University Irving Medical Center from JenaValve, Boston Scientific, Edwards Lifesciences, and Medtronic; and has personally received consulting fees from Abbott Vascular, Boston Scientific, and Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

© 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.

Figures

Graphical abstract

Figure 1

Pre-Procedural Imaging (A) Transthoracic echocardiographic imaging demonstrating severe aortic insufficiency. (B) Diastolic flow reversal in the aorta. (C) Transesophageal echocardiographic short-axis imaging of native aortic valve demonstrating perforated noncoronary cusp leaflet. (D) Transesophageal echocardiography with color-flow Doppler demonstrating flow through the perforated noncoronary cusp leaflet.

Figure 2

JenaValve Design JenaValve (JenaValve Technology, Inc., Irvine, California). THV = transcatheter heart valve.

Figure 3

Intraprocedural Imaging (A) Intraprocedural transesophageal echocardiographic localization of JenaValve (JenaValve Technology, Inc., Irvine, California) locators (arrowhead) in each coronary cusp using short-axis imaging. (B) Intraprocedural transesophageal echocardiographic localization of JenaValve locators (arrowhead) in each coronary cusp using long-axis imaging. (C) Final intraprocedural transesophageal echocardiographic imaging of deployed JenaValve in short axis. (D) Final intraprocedural transesophageal echocardiographic imaging of deployed JenaValve in long axis.

Figure 4

JenaValve Deployment (A) Sheath and valve are positioned in the ascending aorta. (B) Locators are exposed by retracting the sheath. (C) Locators are aligned with the left coronary cusp. (D) Locators in right and left coronary cusps. (E) Deployment of sealing ring. (F) Fully deployed JenaValve (JenaValve Technology, Inc., Irvine, California).