Transcript

 - Congratulations to those of you who have guessed the problem, but just to recap, we had a 72 year old caucasian female who had had a prior transcatheter aortic valve implant, who had presented to UT Southwestern with symptoms of recurrent aortic stenosis and heart failure, and an echo that confirmed that she had severe aortic steniosis. And so the answer to the question, or this lady's diagnosis was that she had an embolized TAVR valve that was in the LVOT. This is her native aortic valve with a lot of calcification in it. But look at the valve, it's actually below the plane of the aortic valve, so the valve is actually the transcatheter valve. As far as the implant, it looks like it has embolized into the LVOT. We took her to the cath lab and we decided to confirm this on angiography, and here is the TAVR valve that is completely embolized, just hanging free in the LVOT at this point. The interesting thing was that this had embolized three years after the surgery, not immediately after implant, as is typically been described. And also when speaking with multiple colleagues across the country, this was one of the first times that an event like this had happened, and so we struggled a lot about the best way to treat this. She was not an operative candidate at all, and so we had to plan for a transcatheter approach, and we implanted another valve inside this valve that actually took care of both the problems and so thankfully she did really well with the procedure. So in some ways it was a very challenging case, both from a diagnostic standpoint, as well as a management standpoint, but you know, thanks to the wealth of expertise that we have in our structural team here, this case ended well, and the patient had a successful outcome.