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Open Access Case report

Feasibility of transapical aortic valve replacement through a left ventricular apical diverticulum

Enrico Ferrari*, Mathieu Van Steenberghe, Jegaruban Namasivayam, Denis Berdajs, Lars Niclauss and Ludwig Karl von Segesser

Author Affiliations

Department of Cardiovascular surgery, CHUV, University Hospital of Lausanne, Rue du Bugnon 46, Lausanne, CH-1011, Switzerland

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Journal of Cardiothoracic Surgery 2013, 8:3  doi:10.1186/1749-8090-8-3

Published: 7 January 2013

Abstract

Transapical aortic valve replacement is an established technique performed in high-risk patients with symptomatic aortic valve stenosis and vascular disease contraindicating trans-vascular and trans-aortic procedures. The presence of a left ventricular apical diverticulum is a rare event and the treatment depends on dimensions and estimated risk of embolisation, rupture, or onset of ventricular arrhythmias. The diagnosis is based on standard cardiac imaging and symptoms are very rare. In this case report we illustrate our experience with a 81 years old female patient suffering from symptomatic aortic valve stenosis, respiratory disease, chronic renal failure and severe peripheral vascular disease (logistic euroscore: 42%), who successfully underwent a transapical 23 mm balloon-expandable stent-valve implantation through an apical diverticulum of the left ventricle. Intra-luminal thrombi were absent and during the same procedure were able to treat the valve disease and to successfully exclude the apical diverticulum without complications and through a mini thoracotomy. To the best of our knowledge, this is the first time that a transapical procedure is successfully performed through an apical diverticulum.

Keywords:
Aortic valve replacement; Transcatheter aortic valve implantation; Left ventricular apical diverticulum