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D7
Extra-anatomic TAVI in a GUCH patient with a Rastelli channel

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INTRODUCTION

An increasing number of grown ups with congenital heart defects (GUCH) are in need of secondary procedures.

Sometimes a third or fourth sternotomy is needed.

These are very complex procedures with abnormal anatomy.

The transcatheter valve technology is evolving and ”custom made” extraanatomical procedures may be an alternative.

 

 

PATIENT HISTORY

 

Male, 31 years

180cm, 84kg

ASD, VSD, double outlet right ventricle, transposition of great arteries and pulmonary atresia

Hepatitis C postitive

 

Now, aortic regurgitation and dilatation of the left ventricle.

 

 

SURGICAL HISTORY

 

*GOBT-shunt to right and left pulmonary artery

*Septalization of atrium and ventricle and re-routing of left ventricle to aorta (am Rastelli) with a Gore-tex patch

*ICD

*Reconstruction of the right ventricular outflow tract as well as the aortic root am Yacoub

 

RESULT

A 23mm Carbomedics (CM) sizer fitted the 3D print of the Rastelli tunnel. The CM sizer has a  measured diameter of 24.2 mm.

 An Edwards Sapien S3 26 mm was choosen for the transapical procedure.

The function was perfect.

CT scan postoperative showed good position of the THV.

 

CONCLUSION

 

*Extra-anatomical placement of catheter valves is possible

*Proper evalutation of valve size and access is to be done by CT reconstruction

*3D print may be useful to test in advance

*The technique can be useful in complex redo heart surgery, especially in the growing population of GUCH patients

 

 

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