case_images: PMC3575297_01
case_images: A) A computed tomography scan showing the left ventricular apical diverticulum: note the absence of thrombi. B) Intraoperative view of the cardiac apex: macroscopically, there is no evidence of a diverticulum, whereas the palpation reveals a soft portion. C) Careful preparation of a double pledgeted 3-0 Prolene purse-string suture around the diverticulum.
case_images: 1749-8090-8-3-1.jpg
case_images: PMC3575297_01_1749-8090-8-3-1.jpg
case_images: F1
case_images: Diameters were 13 mm and 16 mm (Figure 1A). From a surgical point of view, the apical approach was uneventful: macroscopically (Figure 1B), we did not observed any external sign of the presence of the diverticulum, whereas the apical palpation revealed a thinner wall in a 2 cm2 wide region. Then, the delivery system (Ascendra  2) was introduced, uneventfully, in the left ventricle through the diverticulum (Figures 1C and 2A).
case_images: A) Intraoperative view showing the introduction of the delivery system (Ascendra  2) in the apex. B) Fluoroscopic view of the stent-valve deployment under rapid pacing. C) Postoperative computed tomography scan showing the good result with partial exclusion of the diverticulum.
case_images: 1749-8090-8-3-2.jpg
case_images: PMC3575297_01_1749-8090-8-3-2.jpg
case_images: F2
case_images: Then, the delivery system (Ascendra  2) was introduced, uneventfully, in the left ventricle through the diverticulum (Figures 1C and 2A). Following the standard technique a 23 mm Sapien  XT stent-valve (Edwards Lifesciences Inc., Irvine, CA) was successfully implanted with final trans-valvular mean and peak gradients of 10/4 mmHg (Figure 2B). A postoperative scan confirmed the stent-valve placement with absence of residual diverticulum in the apex (Figure 2C).