Good outcome and valve function despite medtronic-corevalve underexpansion†

An 80-year old nun with severe calcific aortic stenosis and a bicuspid aortic valve was referred for transcatheter aortic valve implantation. She was declined for conventional surgery on the basis of poor left ventricular function, frailty, and a logistic EuroSCORE of 29.66. A 29-mm Medtronic-Corevalve bioprosthesis was implanted by transfemoral route. The inflow portion of the stent frame was grossly underexpanded. However, aortic valve area at 1.3 cm2 was more than satisfactory for a body surface area of 1.29 m2 (indexed area 1.0 cm2/m2, peak gradient 23, and mean 16 mmHg). There was an early sustained improvement in New York Heart Association (NYHA) status, and there was no change in valvular function at 2 year follow-up. This case highlights that gross underexpansion of the Medtronic-Corevalve stent frame is compatible with good bioprosthetic function and excellent symptomatic recovery. © 2010 Wiley-Liss, Inc.