HUFNAGEL PROCEDURE RECONVERTED BY ENDOVASCULAR LEAFLET DISLOCATION AND EXTIRPATION

Before the development of standard aortic valve replacement, Hufnagel treated aortic insufficiency by implanting a ball-valve prosthesis in the descending thoracic aorta. In a patient who, after four major thor acic procedures, ultimately received two mechanical bileaflet valves i n series (one in the ascending and one in the descending aorta), the d ownstream prosthesis became progressively immobilized, with total bloc kage of the leaflets in the open position due to insufficient transval vular negative pressure gradient, After evaluation of this particular situation in an experimental model, we predicted blockage of the downs tream prosthesis, once the ascending valve had regained normal functio n, and easily cleared the blockage of the distal valve by removing the two leaflets using balloon inflation. Normal circulation was clinical ly restored in three separate steps. (a) Normal function was re-establ ished surgically in the ascending aorta position. (b) A second thoraco tomy was avoided by endovascular dislocation of both blocked descendin g thoracic leaflets through endovascular balloon inflation. (c) Both l eaflets embolized to the level of the left common iliac artery, where the nearly intact leaflets were removed. surgically, finally creating a near-normal circulatory situation.