Aortic and right ventricular rupture in a patient after transcatheter aortic valve implantation; The direction of the calcification predicts aortic annulus rupture

Abstract

Severe aortic valve stenosis (AS) is related significantly to morbidity and mortality, if untreated. The recent reports showed that TAVI for severe AS is feasible, associated with similar rate of major adverse events with surgery, and results in improved functional status in these patients. Transcatheter aortic valve implantation (TAVI) procedure has been applied in increasing amounts as a novel alternative choice of treatment in patients with aortic valve disease in case of high risk of cardiac surgery. But, there are possible dangerous and life-threatening complications at any moment during the TAVI procedure [ 1 Seiffert M. Conradi L. Baldus S. Schirmer J. Blankenberg S. Reichenspurner H. Diemert P. Treede H. Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach. Eur. J. Cardiothorac. Surg. Sep 2013; 44: 478-484 Crossref PubMed Scopus (37) Google Scholar , 2 Sgroi C. Gulino S. Attizzani G.F. Immè S. Patanè M. Ohno Y. Cannata S. Giarratana A. Aruta P. Bottari V. Barbanti M. Deste W. Giannazzo D. Tamburino C. Valve rupture after balloon aortic valvuloplasty successfully managed with emergency transcatheter aortic valve implantation. Int. J. Cardiol. Sep 20 2013; 168: e13-e14 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 3 Griese D.P. Reents W. Kerber S. Diegeler A. Babin-Ebell J. Emergency cardiac surgery during transfemoral and transapical transcatheter aortic valve implantation: incidence, reasons, management, and outcome of 411 patients from a single center. Catheter. Cardiovasc. Interv. Nov 1 2013; 82: E726-E733 Crossref PubMed Scopus (27) Google Scholar , 4 Pavicevic J. Nguyen T.D. Caliskan E. Reser D. Frauenfelder T. Plass A. Stähli B.E. Maier W. Seifert B. Maisano F. Falk V. Corti R. Grünenfelder J. Emmert M.Y. Aortic valve calcium score is a significant predictor for the occurrence of post-interventional paravalvular leakage after transcatheter aortic valve implantation — results from a single center analysis of 260 consecutive patients. Int. J. Cardiol. Feb 15 2015; 181: 185-187 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar , 5 Montarello N. Copus B. Prakash R. Worthley S.G. Peripheral embolization of aortic valve calcium following trans-femoral Sapien XT valve implantation requiring emergency surgical embolectomy. Int. J. Cardiol. Feb 15 2015; 181: 17-18 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ]. The aortic annulus and other structures of the aortic root may be damaged iatrogenically at various levels during the balloon inflation and valve implantation. Rupture of the aortic root during and after percutaneous valve implantation is a rare and potentially lethal complication. So, the landing zone of the valve and the direction of the annular calcification are very important to predict the aortic annulus rupture. Although there is enough time to repair of the aortic annulus during standard surgical procedure, it is very difficult to control this complication during TAVİ procedure. For this reason, it is very important to recognize and be aware of this event and take all preventive actions to prevent the complications on time. The treatment of the aortic annulus rupture is difficult or even mostly untreatable and the only treatment option for this complication is surgical replacement of the aortic root. Herein, we report a case of a 74-year-old woman with aortic annulus and right ventricular rupture after successful TAVI procedure.