Anatomical findings after amplatzer occluder to treat aortic regurgitation on left ventricular assist device patient

A 57-years-old woman, with HeartMate II left ventricular assist device (LVAD) as a bridge to transplant for a coronary arteries disease presented 6 months after implantation with severe haemolysis, new-onset aortic insufficiency (AI) and pulmonary oedema. On the transoesophageal echocardiography (TEE,) the aortic valve showed increased thickening, valve leaflet fusion without opening and moderate to severe central regurgitation. Despite diffuse arteriopathy, a 25-mm Amplatzer "Cribiform" septal occlude was delivered across the aortic valve via a percutaneously placed 9-F TorqVue catheter. With TEE guidance, the device was positioned across the valve, resulting in decreased AI without mitral obstruction. A transthoracic echocardiography performed two weeks later demonstrated decreased end diastolic left ventricular diameter and disappearance of aortic regurgitation. The haemolysis ceased and clinical status improved. 4 months later, the patient again developed severe haemolysis leading to global heart failure without AI. Thrombosis in the device was suspected and emergency cardiac transplantation was undertaken. During the procedure, after cardiectomy, the aortic valve was checked (figure) and found totally closed and watertight when submitted to the water test; the aortic leaflets disappeared under layers of fibrosis. The Amplatzer was complety endothelialized on both the aortic and the ventricular side without thrombus apposition or obstruction of ostial coronary arteries. The left ventricular output chamber was free without anomaly of mitral valve motion. Trans-catheter closure of the native aortic valve with an Amplatzer occluder can offer an easy way to treat new-onset severe AI on LVAD patients. ![Figure][1] Figure 1. Amplatzer on aortic valve [1]: pending:yes