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Aortic root rupture during balloon-expandable transcatheter aortic valve replacement in a patient without recognized risk factors for aortic root rupture: a case report.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-4.EH

Abstract

Background

Aortic root rupture is a severe complication of balloon-expandable transcatheter aortic valve replacement (TAVR). Although previous studies have revealed several risk factors for this complication, predicting this complication is occasionally difficult.

Case summary

A 78-year-old male patient underwent TAVR via a transfemoral approach using a 29-mm balloon-expandable valve. No recognized risk factors for aortic root rupture existed in pre-procedural multi-detector computed tomography (MDCT) analysis. However, after the valve deployment, sudden haemodynamic collapse occurred. Transoesophageal echocardiography revealed pericardial effusion, which led to an immediate diagnosis of cardiac tamponade following aortic root rupture. Following pericardial drainage via a subxiphoid approach, the haemodynamics were immediately stabilized. After 10 days of close observation, the patient was discharged on Day 39 without additional problems. He was still alive at the 6-month follow-up without sequelae.

Discussion

Established risk factors for aortic root rupture include >20% area oversizing, bicuspid aortic valve, small annulus (<20 mm), shallow sinus of Valsalva (SOV) compared with the aortic annulus, and massive annular or subannular calcification. Our patient did not have any of the recognized risk factors for aortic root rupture, suggesting the existence of other factors. Pre-procedural MDCT showed a flat calcification orthogonal to the aortic root wall, and post-procedural MDCT revealed that this calcification penetrated the SOV with extravasation. Thus, we suggest that a flat calcification orthogonal to the aortic root wall might be an additional risk factor for aortic root rupture.

Authors+Show Affiliations

Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita 565-0871, Japan.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617490

Citation

Tsuda, Masaki, et al. "Aortic Root Rupture During Balloon-expandable Transcatheter Aortic Valve Replacement in a Patient Without Recognized Risk Factors for Aortic Root Rupture: a Case Report." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-4.
Tsuda M, Mizote I, Mukai T, et al. Aortic root rupture during balloon-expandable transcatheter aortic valve replacement in a patient without recognized risk factors for aortic root rupture: a case report. Eur Heart J Case Rep. 2020;4(3):1-4.
Tsuda, M., Mizote, I., Mukai, T., & Sakata, Y. (2020). Aortic root rupture during balloon-expandable transcatheter aortic valve replacement in a patient without recognized risk factors for aortic root rupture: a case report. European Heart Journal. Case Reports, 4(3), 1-4. https://doi.org/10.1093/ehjcr/ytaa073
Tsuda M, et al. Aortic Root Rupture During Balloon-expandable Transcatheter Aortic Valve Replacement in a Patient Without Recognized Risk Factors for Aortic Root Rupture: a Case Report. Eur Heart J Case Rep. 2020;4(3):1-4. PubMed PMID: 32617490.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aortic root rupture during balloon-expandable transcatheter aortic valve replacement in a patient without recognized risk factors for aortic root rupture: a case report. AU - Tsuda,Masaki, AU - Mizote,Isamu, AU - Mukai,Takashi, AU - Sakata,Yasushi, Y1 - 2020/05/26/ PY - 2019/11/11/received PY - 2019/12/19/revised PY - 2020/03/12/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Aortic stenosis KW - Calcification KW - Case report KW - Complication KW - Computed tomography KW - TAVR SP - 1 EP - 4 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - Background: Aortic root rupture is a severe complication of balloon-expandable transcatheter aortic valve replacement (TAVR). Although previous studies have revealed several risk factors for this complication, predicting this complication is occasionally difficult. Case summary: A 78-year-old male patient underwent TAVR via a transfemoral approach using a 29-mm balloon-expandable valve. No recognized risk factors for aortic root rupture existed in pre-procedural multi-detector computed tomography (MDCT) analysis. However, after the valve deployment, sudden haemodynamic collapse occurred. Transoesophageal echocardiography revealed pericardial effusion, which led to an immediate diagnosis of cardiac tamponade following aortic root rupture. Following pericardial drainage via a subxiphoid approach, the haemodynamics were immediately stabilized. After 10 days of close observation, the patient was discharged on Day 39 without additional problems. He was still alive at the 6-month follow-up without sequelae. Discussion: Established risk factors for aortic root rupture include >20% area oversizing, bicuspid aortic valve, small annulus (<20 mm), shallow sinus of Valsalva (SOV) compared with the aortic annulus, and massive annular or subannular calcification. Our patient did not have any of the recognized risk factors for aortic root rupture, suggesting the existence of other factors. Pre-procedural MDCT showed a flat calcification orthogonal to the aortic root wall, and post-procedural MDCT revealed that this calcification penetrated the SOV with extravasation. Thus, we suggest that a flat calcification orthogonal to the aortic root wall might be an additional risk factor for aortic root rupture. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617490/Aortic_root_rupture_during_balloon-expandable_transcatheter_aortic_valve_replacement_in_a_patient_without_recognized_risk_factors_for_aortic_root_rupture:_a_case_report DB - PRIME DP - Unbound Medicine ER -
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