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Clinical case

REC Interv Cardiol. 2020;1:49-50

Simultaneous transfemoral TAVI and angioplasty of unprotected trifurcated left main coronary artery

Procedimientos simultáneos de TAVI transfemoral y angioplastia de tronco común trifurcado no protegido

Beatriz Toledano, Xavier Carrillo, Oriol Rodríguez-Leor, Victòria Vilalta, Josepa Mauri, and Eduard Fernández-Nofrerías

Servicio de Cardiología, Instituto del Corazón, Hospital Germans Trias i Pujol, Badalona, Barcelona, España

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Simultaneous transfemoral TAVI and angioplasty of unprotected trifurcated left main coronary artery. Case resolution
Beatriz Toledano, Xavier Carrillo, Oriol Rodríguez-Leor, Victòria Vilalta, Josepa Mauri, Eduard Fernández-Nofrerías

CASE PRESENTATION

Eighty-two year-old-woman with a past medical history of high blood pressure, dyslipidemia, primary hypothyroidism, iron deficiency anemia, chronic renal disease, a glomerular filtration rate of 52 mL/min, an episode of ischemic colitis resolved using conservative therapy 2 years ago and documented peripheral arterial disease with carotid artery atheromatous plaque without significant stenosis.

The patient showed long-term degenerative aortic valve disease with double aortic lesion with severe stenosis (mean flow velocity, 4.1 m/s; mean gradient, 42 mmHg; valve area, 0.98 cm2) and mild-to-moderate regurgitation, with preserved left ventricular ejection fraction, and symptomatic in class II of the New York Heart Association for dyspnea. The patient complained of episodes of non-exertional angina for which she required several hospital admissions over the last few months.

The coronary angiography revealed coronary artery disease of the left main coronary artery and 2 vessels: calcified and elongated left main coronary artery with a borderline significant distal lesion affecting the bifurcation with the anterior descending coronary artery, 2 ramus medianus and the circumflex coronary artery; the anterior descending coronary artery with a severely calcified ostial lesion, first and second ramus medianus with significant calcified ostial lesions, and circumflex coronary artery with a moderate ostial lesion (figure 1, figure 2 and video 1 of the supplementary data) with a narrow-caliber and short distal vessel. The aortogram showed a calcified tricuspid aortic valve with limited opening of the leaflets and mild aortic regurgitation and nondilated aortic regurgitation root and ascending aorta without significant atheromatosis (figure 3 and video 2 of the supplementary data). The arteriography of the lower limbs showed a non-calcified, non-tortuous iliac-femoral axis with a minimum diameter of 7.3 mm in the right common femoral artery and a minimum diameter of 7.7 mm in the left common femoral artery. The short-term risk according to the Society of Thoracic Surgeons was 10.79%.

Figure 1. Coronary angiography in caudal left-anterior-oblique view showing significant distal left main coronary artery disease with damage to the anterior descending coronary artery and two intermediate branches.

Figure 2. Coronary angiography in caudal right-anterior-oblique view.

Figure 3. Aortogram showing one tricuspid aortic valve with moderate calcification of the leaflets, nondilated aortic root and ascending aorta without significant atheromatosis.

SUPPLEMENTARY DATA


Video 1. Toledano B. DOI:10.24875/RECICE.M19000047

Video 2. Toledano B. DOI:10.24875/RECICE.M19000047

Corresponding author: Instituto del Corazón, Hospital Germans Trias i Pujol, Carretera Canyet s/n, 08916 Badalona, Barcelona, Spain.
E-mail address: beatriztoledanoleon@gmail.com (B. Toledano).

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