Project description:The management of type A aortic dissection (TAAD) during transcatheter aortic valve replacement (TAVR) is challenging because TAVR is often performed in elderly patients with significant surgical risk. We present a case of extensive TAAD that developed during the TAVR procedure, which resolved spontaneously with medical treatment. (Level of Difficulty: Intermediate).
Project description:A 57 year old female underwent transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Mild iatrogenic mitral stenosis was noted intraoperatively. Attempts to reposition the device were hampered by aortic angulation. One year later, severe mitral stenosis was confirmed on transoesophageal echocardiography. It is important to recognise that iatorgenic mitral stenosis due to TAVR may progress over time. Care should be taken to minimise the risk of this rare complication.
Project description:Ventricular septal defect (VSD) rarely occurs following transcatheter aortic valve implantation (TAVI). We report two patients who developed VSD following TAVI. One case was a Gerbode defect treated by percutaneous closure, and the second was a restrictive perimembranous VSD managed conservatively.
Project description:We present 2 cases of significant mitral regurgitation secondary to pericardial patch avulsion from the anterior mitral valve leaflet after aortic valve replacement with aortic annulus enlargement. Both cases were successfully managed by transcatheter repair with off-label implantation of occluder devices.
Project description:An 86-year-old male with multiple medical comorbidities was referred for an elective transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis with an ejection fraction of 35%. A self-expanding valve was deployed successfully, but intraoperative transesophageal echocardiography (TEE) confirmed an acute type A aortic dissection (ATAAD), necessitating immediate intervention. Multiple intraoperative imaging modalities were utilized for deployment of a conformable GORE TAG (cTAG) stent graft for thoracic endovascular aortic repair (TEVAR). This case demonstrates TEVAR as an effective, minimally invasive option for immediate repair of ATAAD as a complication of TAVR in a high-risk surgical patient.
Project description:BackgroundTranscatheter aortic valve implantation (TAVI) has been established as an effective and safe treatment for patients with severe aortic stenosis (AS). It is reported that vascular complications, especially aortic dissection, are rare. However, aortic dissection may be a serious consequence if it occurs. We experienced a case of delayed onset of ascending aortic dissection after TAVI.Case summaryAn 82-year-old woman presented with dyspnoea and general fatigue. Echocardiography revealed severe AS and she was diagnosed with heart failure associated with AS. She had difficulty controlling heart failure and required the intervention of the aortic valve. We evaluated the aortic valve and access routes with contrast-enhanced computed tomography (CT), which showed marked dilatation of the ascending aorta. Transcatheter aortic valve implantation was performed and the procedure was completed without major complications. Transoesophageal echocardiography during the procedure did not detect any obvious arterial injury. However, on the second postoperative day, the patient suddenly became unconscious and a CT indicated an ascending aortic dissection. Unfortunately, she passed away. An autopsy revealed the fragility of the ascending aorta.ConclusionPatients with AS and aortic root dilatation may develop delayed onset of ascending aortic dissection after TAVI.
Project description:Transcatheter aortic valve implantation (TAVI) has been increasingly used in symptomatic patients with severe aortic stenosis who are at high risk for conventional open heart surgery. However, it might be associated with serious complications. We report a case with an iatrogenic ventricular septal defect as a rare complication following TAVI procedure. <Learning objective: To highlight a rare complication of iatrogenic ventricular septal defect (VSD) following transcatheter aortic valve implantation procedure and its treatment with percutaneous interventional VSD closure.>.