Transcatheter Valve-in-Valve Aortic Valve Replacement in Stented Coarctation With Restenosis: A Case Report

TL;DR

This case report describes a complex heart procedure involving a patient with a history of aortic coarctation and a degenerated aortic valve.

Contribution

The paper presents a novel approach to managing TAVR in patients with a stented coarctation and a porcelain aorta.

Findings

A patient with a stented coarctation and degenerated aortic valve was successfully treated with TAVR.

The underexpanded coarctation stent was balloon dilated before TAVR with a self-expandable valve.

Abstract

Combination of bicuspid aortic valve and coarctation of aorta (CoA) is common. With the widespread use of transcatheter aortic valve replacement (TAVR), cases associated with either untreated or treated CoA forms an important subset and pose specific challenges. We discuss a case of a patient with previously stented coarctation presenting with degenerated aortic bioprosthesis considered for TAVR due to porcelain aorta. The CoA stent was significantly underexpanded, which was balloon dilated, followed by TAVR with a self-expandable valve. We discuss the factors determining sequence of management, choice of CoA management, access and valve choice for TAVR in this subset.

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