DISCUSSION
TAVR procedure for pure AR remains to be considered as a relative
contraindication 1. To overcome the limitation of
current TAVR devise, J-Valve® was designed to treat
patients with PAR, and have demonstrated good early and mid-term
outcomes for patients with PAR 2, 3. In the case, the
challenges were not only the valve deployment face with positioning
inaccurate and anchoring difficult, but also the effect of stainless
steel stent-graft on visual field of operation. The
J-Valve® has three Anchor Ring, which correspond to
the three cusps of native aortic valve and provides proprietary locating
and self-alignment feature for the valve and secure the cusps into the
valve complex providing additional nonradial fixation of the cusps.
Therefore, the advantages of J-Valve® system probably
feasible for aortic valves when angiography did not provide complete
clarity of valve annular position as demonstrated in this case. The
strategy of grasping the aortic valve leaflets to treatment pure AR has
been reported 4, 5, but those device lack of
self-alignment feature and need angiogram to confirm the correct
position.
The use of J-Valve® system in the treatment of PAR and
the type III endoleak is one option when surgical treatment is not
allowed. Proper image guidance dedicated device and TEE be used to
confirm valve positioning should be utilized to enable the best results.
This case demonstrated that J-Valve implantation may be an option for
patients with the effect of stainless steel stent-graft on visual field
of operation.
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