JACC: CARDIOVASCULAR INTERVENTIONS

VOL. 7, NO. 9, 2014

ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION

ISSN 1936-8798/$36.00

PUBLISHED BY ELSEVIER INC.

http://dx.doi.org/10.1016/j.jcin.2014.02.018

Left Anterior Descending Coronary Artery Occlusion During Transcatheter Pulmonary Valve Implantation Successful Rescue Percutaneous Revascularization Alban-Elouen Baruteau, MD, Jérôme Petit, MD, Philippe Brenot, MD, Jean-Yves Riou, MD, Claude-Yves Angel, MD

A

34-year-old woman was referred for trans-

second aortography showed no coronary compres-

catheter pulmonary valve implantation. She

sion (Figure 1B). A 23-mm Edwards SAPIEN pulmonic

had been exposed to radiotherapy for Hodg-

valve (Edwards Lifesciences, Irvine, California) was

kin’s disease and underwent a Ross procedure 16 years

implanted, followed by intractable ventricular fibril-

before for post-endocarditis aortic regurgitation.

lation that was due to left anterior descending coro-

Test-balloon angioplasty with a 22  20-mm Atlas

nary artery occlusion (Figure 1C, Online Video 2).

balloon (Bard Peripheral Vascular, Tempe, Arizona)

Extrinsic compression was attributed to a medi-

inflated to 14 atm, showed no coronary compression

astinal

(Figure 1A, Online Video 1). Pre-stenting of the right

implantation. Under chest compressions, rescue

ventricular outflow tract with a 36-mm Intrastent

percutaneous coronary revascularization was per-

LD-Max (EV3, Plymouth, Minnesota) mounted on a

formed (Figures 1D and 1E, Online Video 3) with

22  45-mm BIB balloon-in-balloon catheter (Numed,

implantation of a bare-metal stent in the proximal

Hopkinton,

left anterior descending artery. After 2 years of

New

York)

was

uneventful,

and

FIGURE 1

a

tissue

block

displacement

during

valve

Successful Recanalization of an Occluded Left Anterior Coronary

Artery Occlusion During Transcatheter Pulmonary Valve Implantation

Aortography during test-balloon angioplasty (Online Video 1) (A) and after prestenting (B) showed no coronary artery compression. Pulmonary valve implantation was followed by occlusion of the proximal left anterior descending coronary artery at coronary angiography (Online Video 2) (C). Coronary artery revascularization attested by coronary angiography and cardiac computed tomography (Online Video 3) (D and E). (A) Test-balloon angioplasty before pre-stenting). (B) Aortography after prestenting of the right ventricular outflow tract. (C) Left anterior descending coronary artery occlusion. (D) Successful coronary artery revascularization (coronarography). (E) Successful coronary artery revascularization (computed tomography scan).

From Marie Lannelongue Hospital–M3C, Paediatric and Congenital Cardiac Surgery, Paris Sud University, Le Kremlin Bicêtre, Paris, France. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Manuscript received January 24, 2014; revised manuscript received February 18, 2014, accepted February 26, 2014.

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Baruteau et al.

JACC: CARDIOVASCULAR INTERVENTIONS VOL. 7, NO. 9, 2014 SEPTEMBER 2014:1073–4

Pulmonary Valve Replacement and Coronary Occlusion

follow-up, the patient is alive, and her coronary

normal coronary anatomy and normal test-balloon

angiography is normal. Coronary artery compression

angioplasty.

may be observed in 5% of patients during testballoon angioplasty (1). This complication is asso-

REPRINT REQUESTS AND CORRESPONDENCE: Dr.

ciated with abnormal coronary anatomy, especially

Alban-Elouen Baruteau, Département de Chirurgie

in patients with tetralogy of Fallot or transposi-

des Cardiopathies Congénitales, Centre Chirurgical

tion of the great arteries (1). According to our

Marie Lannelongue, 133 avenue de la Résistance, 92350

exceptional case, caution should also be applied

Le Plessis-Robinson, France. E-mail: a.baruteau@

in

gmail.com.

patients

with

a

radiated

chest,

even

with

REFERENCE 1. Morray BH, McElhinney DB, Cheatham JP, et al. Risk of coronary artery compression among patients referred for transcatheter pulmonary valve implantation: a multicenter experience. Circ Cardiovasc Interv 2013;6: 535–42.

KEY WORDS cardiac arrest, cardiac catheterization, myocardial infarction, Ross procedure, transcatheter pulmonary valve implantation

AP PE NDIX For supplemental videos, please see the online version of this article.