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Zhao Qiang Team of Ruijin Hospital Successfully Implements TA-TAVI for Patients with AS Consolidation of Porcelain Aorta

Zhao Qiang Team of Ruijin Hospital Successfully Implements TA-TAVI for Patients with AS Consolidation of Porcelain Aorta

  • Categories:News Channel
  • Author:
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  • Time of issue:2018-03-30 09:38
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(Summary description)

Zhao Qiang Team of Ruijin Hospital Successfully Implements TA-TAVI for Patients with AS Consolidation of Porcelain Aorta

(Summary description)

  • Categories:News Channel
  • Author:
  • Origin:
  • Time of issue:2018-03-30 09:38
  • Views:
Information

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  Doctor team
  ◆ On March 22, 2018, the cardiac team led by Zhao Qiang, the deputy director of Ruijin Hospital, Shanghai Jiaotong University, successfully completed TA-TAVI surgery with the support of the Department of Anesthesia, Ultrasound, and Radiology.
  Patient data

 

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  ◆ The patient was 77 years old and he had chest tightness and shortness of breath more than 6 years before PCI. Clinical diagnosis: Calcified aortic valve stenosis in the elderly with insufficiency, coronary atherosclerotic heart disease (three branches), coronary stent implantation, cardiac function class III, hypertension class 3, type 2 diabetes mellitus Peripheral atherosclerosis
  ◆ Supercardiac tip: The aortic valve is significantly thickened, calcified, and has limited opening. The blood flow velocity is approximately 3.8m/s. The maximum valve-valve pressure difference is 57mmHg. The average transvalvular pressure difference is 30mmHg and EF is 65%.
  ◆ Chest CT Tip: Porcelain Aorta

 

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  ◆ coronary CTA tips: aortic valve tri-lobe, valve thickening, there is severe calcification. The distribution of calcification was uneven, mainly distributed in the left coronary and non-coronal leaflet free edges. There was no calcification in the annulus and left ventricular outflow tract. The circumference of the aortic valve is 24.4mm.

 

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  ◆After discussion in the department, a transapical TAVI will be performed using the 23mm J-Valve? interventional valve.
  The operation was performed in the hybrid operation room of Ruijin Hospital. After intravenous anesthesia, a temporary pacing lead was placed through the jugular vein to connect the temporary pacemaker. Under fluoroscopy, select the apex of the heart from the fifth intercostal space, expose the apex, select the best puncture point, and sew the heart purse. After systemic heparinization (ACT>250s), a straight Pigtail was placed. Adjust the position of the DSA head based on the CTA results to show the position of the best aortic valve.

 

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  ◆ under perspective, from the left ventricular apex puncture, into the 260mm muddy guide wire, with a single bend catheter, the guide wire through the left ventricle, aortic valve to the abdominal aortic bifurcation. After exchanging the 260mm Amplaz superhard guidewire, dilate the apical puncture with a dilation sheath. A NuMed 23x40mm balloon was delivered for pre-dilation at the aortic valve. The 23 mm J-Valve@ interventional valve was then delivered at the tip of the heart and released.

 

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  Release process
  1.Release the locator and pull back to the three aortic sinuses. The angiography confirms that the locator is in the correct position.

 

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  2. Withdrawal of the valve, the stent valve enters the aortic valve area under the guidance of the positioning element.
  3. The valve opens (since it is a self-expanding valve, RVP and any hemodynamic fluctuations are not required throughout the procedure).
  4. Release the valve and recover the implanter. The contrast and TEE real valve position is good and there is a mild to moderate paravalvular leak. The NuMed 23x40mm balloon was inserted into the aortic valve and then expanded. After the expansion, the valve was leaked and the transvalvular pressure difference was

 

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  5.The operation was successful, then all catheters were withdrawn, the apex of the heart was purse-stringed, and the chest drainage tube was placed in place to close the incision and the operation was completed.
  to sum up
  ◆The J-Valve artificial interventional bioprosthetic heart valve is a new generation of invasive valves. It was approved for clinical use by the State Food and Drug Administration in April 2017. Its indications include aortic stenosis, aortic insufficiency, and aortic stenosis complications. Insufficient closure is currently the only interventional valve in the world that is officially approved for the treatment of aortic insufficiency and is a one-stop solution for aortic valve disease.

 

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