Abstract
An 80-year-old man with severe aortic stenosis, who declined aortic valve replacement several times since 2011 and had recurrent syncope after balloon aortic valvuloplasty, was admitted because of symptomatic aortic stenosis. A percutaneous strategy for his aortic stenosis was decided. Transcatheter aortic valve replacement using a balloon-expandable Edwards Sapien XT valve was performed under rapid ventricular pacing. After valve deployment, an aortic dissection of ascending aorta was noticed. There was no coronary flow compromise, no acute aortic root and ascending aorta dilatation, no pericardial effusion, and paravalvular aortic regurgitation was mild. After consultation with cardiovascular surgeon, interventional radiologist and invasive cardiologist we decided for conservative approach, with very good outcome and no additional disabilities in the follow up of more than two years.
Highlights
Symptomatic severe aortic stenosis (AS) is associated with significant mortality when managed only with optimal medical treatment [1]
We report a case of ascending aortic dissection complicating Transcatheter aortic valve replacement (TAVR) that was managed conservatively with a good outcome
Picture D: First computer tomography angiography showed dissection of ascending aorta extending from TAVR valve 3 cm in ascending aorta- yellow arrow
Summary
Symptomatic severe aortic stenosis (AS) is associated with significant mortality when managed only with optimal medical treatment [1]. Picture B: We noticed ascending aorta dissection before deploying a TAVR valve- blue arrow. Picture D: First computer tomography angiography showed dissection of ascending aorta extending from TAVR valve 3 cm in ascending aorta- yellow arrow. There were problems of optimal positioning the valve, which jumped 4 times in the ventricle or ascending aorta and we had to reload a TAVR pusher (Figures 1a and 1b). Ascending aorta, TAVR valve was successfully deployed with a mild Para: valvular leak, patient was hemodynamically stable (Figure 1c). A contrast computer tomography (CTA) was done that showed an intimal flap extending from artificial aortic valve to ascending aorta in length of 3 cm, with parallel blood flow in true and false lumina (Figure 1d). Control CTA showed no progression of the dissection and no significant dilatation of ascending aorta (Figures 2a and 2b). During follow up of more than two years he was asymptomatic and without complaints
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