Correction of a Malpositioned Portico Transcatheter Aortic Valve Using a Snare Maneuver: A Case Report

Abstract

A 75-year-old woman with severe aortic stenosis underwent transcatheter aortic valve replacement using a 23-mm self-expanding Portico valve (Abbott). It was unacceptably low after complete deployment, with considerable paravalvular regurgitation. Using the snare motion, the valve was successfully dragged upward to the correct position. During TAVR with self-expanding valves, the absence of extensive annular calcification is a risk factor for device malpositioning. Even though there are no prior reports, our case proves that using the snare maneuver to correct malpositioned Portico valves is safe and feasible. The presence of a stiff central wire across the TAVR gives stability during the single snare maneuver.