Transcatheter aortic valve replacement (chest x-ray)

Case contributed by Kirollos Bechay

Presentation

History of 2-vessel coronary artery disease and severe symptomatic aortic stenosis.

Patient Data

Age: 75 years
Gender: Male

Mild bilateral bronchial wall thickening and mild irregular bibasilar opacities are likely fibro-atelectasis and chronic findings. No discrete focal consolidations, effusions, pneumothorax or free air in the upper abdomen.

The aortic valve prosthesis is in the appropriate position in this patient with known history of aortic stenosis status-post transcatheter aortic valve replacement (TAVR). Heart is mildly enlarged.

Case Discussion

The transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that deploys an expandable replacement valve to treat aortic stenosis (AS). TAVR has emerged as a viable option for patients with aortic stenosis who were considered to be inoperable, as it provides symptomatic improvement and a mortality benefit 1,2. TAVR was first FDA-approved for severe aortic stenosis in 2011, then expanded for "valve-in-valve" failed bioprosthetic valves in 2015. 

Contraindications for TAVR include life expectancy of less than 12 months, myocardial infarction (MI) within 30 days, stroke/TIA within 6 months, end-stage renal disease, and decreased cardiac reserve 3. Complications for TAVR procedures include bleeding, infection, MI, AKI, cardiac tamponade, and stroke 4. However, studies tend to favor TAVR over surgical aortic valve replacements with decreased mortality, complications and length of stay; TAVRs tended to cause higher rates of vascular injury and need for permanent pacemaker

Chest x-ray can demonstrate the deployed aortic valve as seen in the present case. 

This case was submitted with supervision and input from:
Soni C Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center

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