Contrast-zero ultrasound-guided transcatheter aortic valve replacement: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DONG Jie ^1,2 , OUYANG Wenbin ^1,2 , LI Zefu ^1,2 , ZHANG Fengwen ^1,2 , XU Donghui ^1,2 , WANG Jiande ³ , XIE Yongquan ^1,2 , HU Xiaopeng ^1,2 ,  PAN Xiangbin ^1,2

1. Department of Structural Heart Disease, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P. R. China;
2. National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P. R. China;
3. Department of Echocardiography Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

PAN Xiangbin, Email: panxiangbin@fuwaihospital.org

Keywords：

Transcatheter aortic valve replacement; aortic stenosis; echocardiography; contrast agent allergy; case report

DOI：

10.7507/1007-4848.202210019

Video：

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Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography, and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve. However, iodine-containing contrast agent possibly damages the patient’s kidney, and even induces the acute kidney injury. We reported a 75-year-old patient diagnosed with severe aortic valve stenosis, moderate regurgitation, and chronic renal failure. We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent. Seven days after surgery, the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.

Citation： DONG Jie, OUYANG Wenbin, LI Zefu, ZHANG Fengwen, XU Donghui, WANG Jiande, XIE Yongquan, HU Xiaopeng, PAN Xiangbin. Contrast-zero ultrasound-guided transcatheter aortic valve replacement: A case report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(2): 320-324. doi: 10.7507/1007-4848.202210019 Copy

1.	Xu B, Mottram PM, Lockwood S, et al. Imaging guidance for transcatheter aortic valve replacement: Is transoesophageal echocardiography the gold standard? Heart Lung Circ, 2017, 26(10): 1036-1050.
2.	Hayek SS, Corrigan FE, Condado JF, et al. Paravalvular regurgitation after transcatheter aortic valve replacement: Comparing transthoracic versus transesophageal echocardiographic guidance. J Am Soc Echocardiogr, 2017, 30(6): 533-540.
3.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
4.	Reardon MJ, Adams DH, Coselli JS, et al. Self-expanding transcatheter aortic valve replacement using alternative access sites in symptomatic patients with severe aortic stenosis deemed extreme risk of surgery. J Thorac Cardiovasc Surg, 2014, 148(6): 2869-2876.
5.	Sinning JM, Ghanem A, Steinhäuser H, et al. Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2010, 3(11): 1141-1149.
6.	Rodés-Cabau J, Webb JG, Cheung A, et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: Acute and late out- comes of the multicenter Canadian experience. J Am Coll Cardiol, 2010, 55: 1080-1090.
7.	Wessely M, Rau S, Lange P, et al. Chronic kidney disease is not associated with a higher risk for mortality or acute kidney injury in transcatheter aortic valve implantation. Nephrol Dial Transplant, 2012, 27(9): 3502-3508.
8.	Conrotto F, Salizzoni S, Andreis A, et al. Transcatheter aortic valve implantation in patients with advanced chronic kidney disease. Am J Cardiol, 2017, 119(9): 1438-1442.
9.	Castriota F, Nerla R, Micari A, et al. Contrast-zero transcatheter aortic valve replacement for patients with severe renal dysfunction: A single-center experience. JACC Cardiovasc Interv, 2018, 11(8): 820-822.
10.	Arrigo M, Maisano F, Haueis S, et al. Transcatheter aortic-valve implantation with one single minimal contrast media injection. Catheter Cardiovasc Interv, 2015, 85(7): 1248-1253.
11.	Eskandari M, Aldalati O, Byrne J, et al. Zero contrast transfemoral transcatheter aortic valve replacement using fluoroscopy-echocardiography fusion imaging. Am J Cardiol, 2016, 117(11): 1861-1862.
12.	Pendyala LK, Minha S, Barbash IM, et al. Commercial versus PARTNER study experience with the transfemoral Edwards SAPIEN valve for inoperable patients with severe aortic stenosis. Am J Cardiol, 2014, 113(2): 342-347.
13.	Aljohani S, Alqahtani F, Almustafa A, et al. Trends and outcomes of aortic valve replacement in patients with end-stage renal disease on hemodialysis. Am J Cardiol, 2017, 120(9): 1626-1632.
14.	李卓仁, 蔡妙贞, 赵文强, 等. 经食道多普勒超声心动图估测冠状动脉血流储备. 中华内科杂志, 1994, 33(9): 628-629.
15.	Hakim D, Ghimire G, Alli OO, et al. Large-field intravascular ultrasound for annular sizing and predicting paravalvular regurgitation during TAVR: Comparisons with multidetector computed tomography and transoesophageal echocardiography. Eur Heart J Cardiovasc Imaging, 2017, 18(12): 1404-1413.

1. Xu B, Mottram PM, Lockwood S, et al. Imaging guidance for transcatheter aortic valve replacement: Is transoesophageal echocardiography the gold standard? Heart Lung Circ, 2017, 26(10): 1036-1050.
2. Hayek SS, Corrigan FE, Condado JF, et al. Paravalvular regurgitation after transcatheter aortic valve replacement: Comparing transthoracic versus transesophageal echocardiographic guidance. J Am Soc Echocardiogr, 2017, 30(6): 533-540.
3. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
4. Reardon MJ, Adams DH, Coselli JS, et al. Self-expanding transcatheter aortic valve replacement using alternative access sites in symptomatic patients with severe aortic stenosis deemed extreme risk of surgery. J Thorac Cardiovasc Surg, 2014, 148(6): 2869-2876.
5. Sinning JM, Ghanem A, Steinhäuser H, et al. Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2010, 3(11): 1141-1149.
6. Rodés-Cabau J, Webb JG, Cheung A, et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: Acute and late out- comes of the multicenter Canadian experience. J Am Coll Cardiol, 2010, 55: 1080-1090.
7. Wessely M, Rau S, Lange P, et al. Chronic kidney disease is not associated with a higher risk for mortality or acute kidney injury in transcatheter aortic valve implantation. Nephrol Dial Transplant, 2012, 27(9): 3502-3508.
8. Conrotto F, Salizzoni S, Andreis A, et al. Transcatheter aortic valve implantation in patients with advanced chronic kidney disease. Am J Cardiol, 2017, 119(9): 1438-1442.
9. Castriota F, Nerla R, Micari A, et al. Contrast-zero transcatheter aortic valve replacement for patients with severe renal dysfunction: A single-center experience. JACC Cardiovasc Interv, 2018, 11(8): 820-822.
10. Arrigo M, Maisano F, Haueis S, et al. Transcatheter aortic-valve implantation with one single minimal contrast media injection. Catheter Cardiovasc Interv, 2015, 85(7): 1248-1253.
11. Eskandari M, Aldalati O, Byrne J, et al. Zero contrast transfemoral transcatheter aortic valve replacement using fluoroscopy-echocardiography fusion imaging. Am J Cardiol, 2016, 117(11): 1861-1862.
12. Pendyala LK, Minha S, Barbash IM, et al. Commercial versus PARTNER study experience with the transfemoral Edwards SAPIEN valve for inoperable patients with severe aortic stenosis. Am J Cardiol, 2014, 113(2): 342-347.
13. Aljohani S, Alqahtani F, Almustafa A, et al. Trends and outcomes of aortic valve replacement in patients with end-stage renal disease on hemodialysis. Am J Cardiol, 2017, 120(9): 1626-1632.
14. 李卓仁, 蔡妙贞, 赵文强, 等. 经食道多普勒超声心动图估测冠状动脉血流储备. 中华内科杂志, 1994, 33(9): 628-629.
15. Hakim D, Ghimire G, Alli OO, et al. Large-field intravascular ultrasound for annular sizing and predicting paravalvular regurgitation during TAVR: Comparisons with multidetector computed tomography and transoesophageal echocardiography. Eur Heart J Cardiovasc Imaging, 2017, 18(12): 1404-1413.

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