A 52-year-old female was admitted to the hospital with chest tightness and shortness of breath that persisted for three months after an activity. She had a history of severe scoliosis caused by trauma suffered in an accident at 20 (Fig. 1). Physical examination revealed the following: apical beats in the fifth intercostal right anterior axillary line, aortic valve auscultation area, and a diastolic sign-like murmur at the sternal right margin of the second intercostal space. Ultrasound diagnosis showed aortic stenosis with severe regurgitation, left ventricular enlargement, left ventricular diastolic dimension (LVDd) of 61 mmHg, and an ejection fraction (EF) of 56%. Computed tomography angiography (CTA) revealed dextrocardia, aberrant right subclavian artery, tortuous aorta, and bilateral bronchiectasis (Fig. 2).
Further CT evaluation showed a three-leaf type aortic valve with essentially equal leaflets that were slightly thickened and calcified, an aortic annulus circumference conversion diameter of 23.1 mm, and a bilateral coronary artery opening height for the left coronary artery (LCA) of 17.6 mm and right coronary artery (RCA) of 14.9 mm. The best intraoperative angiography angles were found to be right anterior oblique (RAO) at 22° and C-arm projection angle (CRA): 29° (no coronary sinus center) (Fig. 3). Due to the patient’s severe heart failure symptoms, N-terminal pro-brain natriuretic peptide of 2094 pg / ml, followed by diuretics, ventricular rate control, and inhibition of ventricular remodeling, were administered. After excluding surgical contraindications, the patient underwent TAVR on day 14 following admission(video 1–4).
The surgery was successful, and the patient was monitored and treated in the cardiac ICU following surgery. The patient was weaned from the ventilator 16 h postoperatively, and transferred to the general ward for routine care on the first postoperative day. Echocardiography after aortic valve replacement (ARV) showed that the artificial biological valve was functioning well without any noticeable perivalvular leakage in the aortic valve area. The patient was discharged on postoperative day 13.