Transfemoral Transcatheter Aortic Valve Implantation using a Long Sheath
for Chronic Type B Aortic Dissection: A Case Report
A 79-year-old woman with a history of open heart surgery presented with
severe aortic stenosis (AS). Computed tomography (CT) showed chronic
type B aortic dissection (TBAD) between the distal aortic arch and the
left common iliac artery. After careful consideration, we planned
transfemoral (TF)-transcatheter aortic valve implantation (TAVI) using a
20-Fr long sheath to minimize contact with the false lumen of the aorta.
TAVI was performed under general anesthesia, guided by transesophageal
echocardiography (TEE). A transcatheter aortic valve was successfully
implanted. TEE, immediately after valve implantation, showed no
remarkable changes in the descending thoracic aorta. Repeated
post-procedural CT examinations showed no obvious changes in the aorta.
The patient was stable without sequelae at the 12-month follow-up. This
case demonstrates that TF-TAVI using a long sheath under TEE guidance
can be a treatment option for patients with severe AS and chronic TBAD.