Abstract/Description
Background:
Paravalvular leak (PVL) is a recognized complication following transcatheter aortic valve replacement (TAVR), associated with increased mortality, heart failure symptoms, and hemolytic anemia. Standard percutaneous PVL closure relies on crossing the defect with a 0.035-inch hydrophilic guidewire, followed by exchange for a stiffer wire to enable device delivery. However, traversing the defect can be technically challenging due to decreased maneuverability of the guidewire. We report a case of PVL repair using a modified 0.014-inch polymer-jacketed coronary guidewire and aspiration guidewire strategy that facilitated stable device deployment and complete leak closure.
Case Presentation and Management:
An 86-year-old woman with prior transfemoral TAVR presented with hemolytic anemia (haptoglobin < 10 mg/dL, LDH 640 U/L) and recurrent transfusion needs. Transesophageal echocardiography revealed moderate anterior PVL between the left and right coronary cusps. CT confirmed suitability for closure. Under intracardiac and transesophageal echocardiographic guidance, right femoral venous and arterial access was obtained. The defect was crossed using a Sion Black wire, a 0.014-inch polymer jacket (PJ), non-tapered coronary guidewire. This was followed by a CatRX Aspiration Catheter to utilize Dual 0.014” and 0.038” lumens. This ensured secure wire access and confirmed that the wire tracked through the true regurgitant pathway rather than becoming trapped between the prosthetic valve and stent frame. This enabled formation of an outlet for delivery of an Amplatzer Vascular Plug 4. Post-deployment imaging confirmed complete occlusion and device stability, with improved aortic diastolic pressure and AR index.
Conclusion:
This case illustrates a successful, novel use of a 0.014-inch polymer-jacketed, non-tapered-tip coronary guidewire and outlines its future consideration in treatment of PVL from a prior TAVR.
Faculty Advisor/Mentor
Matthew R Summers, MD, FACC
Faculty Advisor/Mentor Department
Complex Coronary and Interventional Cardiology, Sentara Cardiology Specialists
College/School/Affiliation
Sentara
Included in
Novel Guidewire Technique for Paravalvular Leak Repair Following TAVR: A Case Report
Background:
Paravalvular leak (PVL) is a recognized complication following transcatheter aortic valve replacement (TAVR), associated with increased mortality, heart failure symptoms, and hemolytic anemia. Standard percutaneous PVL closure relies on crossing the defect with a 0.035-inch hydrophilic guidewire, followed by exchange for a stiffer wire to enable device delivery. However, traversing the defect can be technically challenging due to decreased maneuverability of the guidewire. We report a case of PVL repair using a modified 0.014-inch polymer-jacketed coronary guidewire and aspiration guidewire strategy that facilitated stable device deployment and complete leak closure.
Case Presentation and Management:
An 86-year-old woman with prior transfemoral TAVR presented with hemolytic anemia (haptoglobin < 10 mg/dL, LDH 640 U/L) and recurrent transfusion needs. Transesophageal echocardiography revealed moderate anterior PVL between the left and right coronary cusps. CT confirmed suitability for closure. Under intracardiac and transesophageal echocardiographic guidance, right femoral venous and arterial access was obtained. The defect was crossed using a Sion Black wire, a 0.014-inch polymer jacket (PJ), non-tapered coronary guidewire. This was followed by a CatRX Aspiration Catheter to utilize Dual 0.014” and 0.038” lumens. This ensured secure wire access and confirmed that the wire tracked through the true regurgitant pathway rather than becoming trapped between the prosthetic valve and stent frame. This enabled formation of an outlet for delivery of an Amplatzer Vascular Plug 4. Post-deployment imaging confirmed complete occlusion and device stability, with improved aortic diastolic pressure and AR index.
Conclusion:
This case illustrates a successful, novel use of a 0.014-inch polymer-jacketed, non-tapered-tip coronary guidewire and outlines its future consideration in treatment of PVL from a prior TAVR.