Apical defect following Tendyne valve placement
- PDF / 4,394,294 Bytes
- 3 Pages / 593.972 x 792 pts Page_size
- 94 Downloads / 195 Views
Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, OH
Received Nov 2, 2020; accepted Nov 3, 2020 doi:10.1007/s12350-020-02440-6
INTRODUCTION
CASE SUMMARY
The Tendyne mitral valve system is a novel therapy for treatment of mitral regurgitation in patients who are at prohibitive risk for surgery.1 It is placed transapically and tethered to an apical pad that anchors the device and assists with apical closure (Figure 1). In this article, we present a fixed apical perfusion defect without fluorodeoxyglucose (FDG) uptake demonstrated on positron emission tomography (PET) following Tendyne valve placement.
A 69-year-old male with a history of lung cancer treated with chest radiation and chemotherapy complicated by radiation heart disease presented with worsening heart failure. His pertinent cardiac history included coronary artery disease and ischemic cardiomyopathy status post coronary artery bypass surgery and valvular heart disease manifesting as mitral stenosis and mitral regurgitation. He underwent transcutaneous mitral valve replacement with the Tendyne mitral valve system. A few months after the procedure he began to experience symptoms concerning for stable angina along with a drop in his ejection fraction, so he underwent a PET stress and viability study, which revealed a fixed perfusion defect in the apex without FDG uptake (Figures 2 and 3). DISCUSSION This case demonstrates an apical defect due to transapical access and the apical pad after placement of the Tendyne valve system. Because the Tendyne valve system is approved for commercial use in the European Union and undergoing a large phase III trial in the United States,2 this finding is important to recognize. Furthermore, the incidence of transapical access for cardiac interventions is likely to increase as new technologies in structural heart disease emerge. Prior studies have demonstrated increased apical dysfunction on echocardiography and magnetic resonance imaging after transapical procedures,3 but there are limited reports on the findings after such interventions among nuclear cardiology studies.
Funding: There was no funding. Reprint requests: Travis Howard, MD, Cleveland Clinic Heart, Vascular and Thoracic Institute, Cleveland, OH ; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Howard et al Apical defect following Tendyne valve placement
Journal of Nuclear CardiologyÒ
Figure 1. Reconstructed cardiac computed tomography image of a Tendyne valve system. A Sagittal view from the left atrium. B Axial view with a red arrow highlighting the apical cap that is tethered to the valve.
Figure 2. Positron emission tomography demonstrating a fixed apical perfusion defect without FDG uptake.
Journal of Nuclear CardiologyÒ
Howard et al Apical defect following Tendyne valve placement
Figure 3. Fusion images demonstrating the apical cap and corresponding fixed apical perfusion defect.
Disclosures None of the authors have conflicts of interest to declare.
References 1. Mu
Data Loading...
