Trancustaneous Aortic Valve Implantation for Severe Aortic Regurgitation Post Aortic Root Replacement

Mrs Neama M. 31 years old has a Marfan syndrome, Her father and brother underwent aortic root replacement. She desired to be pregnant. The dimension of aorta was 44 mm with mild aortic regurgitation. The mitral regurgitation was moderate to severe with normal arterial pressure. After concertation, the pregnancy was not allowed until the repair of aortic aneurysm. The patient underwent repair of pectus excavatum in 2015. In 2016, she underwent aortic root replacement with valve sparing and repair of mitral valve. In 2017, she developed severe shortness of breath and fever. The echocardiogram showed dramatic increase of aortic regurgitation, a thrombus in left appendage and reduced Left Ventricular Function. The serology of Barthonella and q fever was positive. The treatment antibiotic intravenous was immediately given without any improvement. The surgical treatment was denied because of high surgical risk due to the precarious hemodynamic condition. According to the heart team decision, N. underwent aortic valve replacement by Transcutaneous Valve Implantation (TAVI) which was challenging due to the absence of aortic calcifications. The shortness of breath disappeared, the left ventricular function improved, the clot disappeared and the clinical status improved. TAVI saved the life of this patient.