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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