Clinical
Edwards SAPIEN 3 Transcatheter Heart Valve Implantation in a Native Bicuspid Aortic Regurgitation

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Abstract

Transcatheter aortic valve replacement over the last few years has revolutionized the way severe aortic stenosis patients are being managed [[1], [2], [3], [4]]. Randomized clinical trials commonly excluded bicuspid aortic valves and pure native severe aortic regurgitation [2,4]. We present a case with severe acute aortic regurgitation complicated by refractory pulmonary oedema successfully managed by transfemoral transcatheter aortic valve replacement using a Sapien 3 valve.

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Case

A 71-year-old lady with a background of Turners syndrome had been followed up for a bicuspid aortic valve (Type 0 Sievers Classification [5]) with mild aortic regurgitation (AR). However, she was lost to follow up and presented to hospital 7 years later with acute pulmonary oedema requiring intubation and mechanical ventilation. Computed tomography imaging revealed large bilateral pleural effusions and evidence of pulmonary congestion. Her electrocardiogram demonstrated sinus tachycardia with

Discussion

TAVR in Bicupsid aortic valves is technically far more challenging given the concomitant aortopathy and the increased risk aortic injury [[6], [7], [8]]. Evidence of TAVR in the native pure aortic regurgitation is limited to registry data [[6], [7], [8], [9]]. A recent meta-analysis [9] of 638 individuals suggested higher device success and lower mortality with second generation valves. The majority of cases performed in these registries were with self-expanding valves. A TAVR specifically

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