Lots of interesting abstracts and cases were submitted for TCTAP & AP VALVES 2020 Virtual. Below are accepted ones after thoroughly reviewed by our official reviewers. Don¡¯t miss the opportunity to explore your knowledge and interact with authors as well as virtual participants by sharing your opinion!

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CASE20191113_007
STRUCTURAL HEART DISEASE - Valvular Intervention: Aortic
TAVI in Ebstein¡¯s Anomaly Patient and Bicuspid Aortic Valve
Luca Testa1, Matteo Casenghi1
IRCCS San Donato Hospital, Italy1,
[Clinical Information]
- Patient initials or identifier number:
C.A.
-Relevant clinical history and physical exam:
A 56-year-old male, smoker, with a history of hypertension and dyslipidemia was admitted to our hospital in 2013 for acute heart failure. During hospitalization, a diagnosis of Ebstein¡¯s Anomaly with severe tricuspid regurgitation and bicuspid aortic valve with moderate aortic stenosis was made. In 2015 after a second episode of acute heart failure a surgical correction was indicated but the patient refused. In 2017, due to a mixed cardiogenic and septic shock he was referred again to our center
-Relevant test results prior to catheterization:
The echocardiogram showed a severely reduced LV ejection fraction (EF 20%) with severe aortic stenosis (mean gradient 80 mmHg) and severe tricuspid regurgitation (Fig.1)After 28 days in ICU the patient was ¡°sliding fast¡± despite i.v. inotropes and he became CVVH and cPAP dependent. After Heart Team discussion, he was listed for TAVR. Pre-procedural CT scan showed no significant coronary artery disease, no iliac or femoral stenosis and a severely calcified bicuspid aortic valve (BAV) (Fig.2). 

- Relevant catheterization findings:
[Interventional Management]
- Procedural step:
BAV, characterized by asymmetry of valve opening, extensive calcification and difficult angiographic implantation view, together with the LV apical thrombus represents a very challenging scenario for TAVR implantation. We hence planned to release a Triguard embolic protection device (Figure 1), which is the only CE marked device providing full protection of all 4 brain vessels,  and to use a hand pre-formed 1 cm super-stiff wire (Figure 2) and rapid pacing to minimize thrombus mobilisation. After pre-dilatation with 21 mm a Sapien 23 mm valve overexpanded with 2 ml over-filled balloon to safely accommodate the elliptic 24 mm BAV annulus was implanted with excellent results. Three months follow-up showed good performance of bioprosthetic valve with mean gradient of 9 mmHg. 


- Case Summary:
To our knowledge is the first case of TAVI in Ebstein¡¯s Anomaly and TAVI was a life- saving procedure in this patient. LV apical thrombus is not an absolute contraindication Embolic protection devices could be particularly useful when treating patients with LV thrombus.
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