In 18th of April, Dr. Ge Junbo, academician of Zhongshan Hospital of Fudan University, has completed a 'one-stop' Transcatheter aortic valve replacement + Percutaneous Transluminal Septal Myocardial Ablation (TAVR+PTSWMA) operation with his team.
The operation was performed on a 77-year-old woman, who has severe aortic valve stenosis (mean transprosthetic pressure gradient 45mmHg) , left ventricular hypertrophy (wall-thickness 16-25mm) and mitral valve regurgitation revealed by her preoperative echocardiogram. And her CT image showed that aortic root is suitable for TAVR.
26mm Venous-A valve is successfully implanted via right femoral artery. Aortic root angiography proved appropriate valve stent location and clear coronary angiography with mild periprosthetic leakage.
However, her blood pressure decreased significantly (70/40mmHg) with pulmonary edema occurred. Esophageal ultrasound showed severe mitral regurgitation, mitral valve forward to ventricular septum (SAM), which caused left ventricular outflow tract obstruction (catheter pressure differential pressure 60mmHg).
After careful assessment and repeated discussion, Dr. Ge decide to operate Percutaneous Transluminal Septal Myocardial Ablation (PTSMA).
After several attempts, XB 3.5 catheter was inserted to left coronary ostial through stent mesh for angiography. After injection of anhydrous alcohol 2ml, myocardial ablation was performed at the first interval. After 2 mins of ablation, the blood pressure increased to 160/90mmHg. Esophageal ultrasound showed mitral valve regurgitation turned to mild and SAM was relieved. Now patient has returned to normal and under recovery.
Hypertrophic obstructive cardiomyopathy (HOMC) is regarded as contraindications to TAVR procedure. This operation showed that TAVR+PTSMA is feasible for patient with aortic valve stenosis and HOMC. For patient with aortic valve stenosis, left ventricle outflow tract obstruction is easy to be concealed, at the same time, left ventricle outflow tract obstruction after TAVR will aggravate even lead to emergency risk. This operation provides good experiences(references).