"Aortic Annulus Rupture and Iatrogenic VSD: Rare Complications of Trans" by Ela Ahmad, Zachary Dean Demertzis et al.
 

Aortic Annulus Rupture and Iatrogenic VSD: Rare Complications of Transcatheter Aortic Valve Replacement Procedure

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

Journal of the American College of Cardiology

Abstract

Background: TAVR has emerged as a life-saving alternative in severe aortic stenosis patients with high surgical risk. Despite its excellent safety profile, it still carries the risk of serious complications. Here we present a TAVR case complicated by annular rupture and iatrogenic VSD. Case: A 67 year old male presented as a transfer for management of TAVR complications. TAVR was performed at an outside hospital using a 29 mm Sapien Ultra valve and was immediately complicated by tamponade requiring emergent pericardiocentesis. Following the procedure, Echo revealed a continuous communication between the LVOT and the RV. This was also noted on TEE and cardiac CTA. Decision-making: Right and left heart cath confirmed the aorta-RV communication with left to right shunt at the level of the aortic valve, QP/QS 1.75. Patient underwent surgical repair and was found to have a large defect in the annulus below the RCA extending across the nadir of the right sinus of Valsalva through the interventricular septum into the muscular septum. TAVR valve was replaced by a surgical 25 Inspiris valve, and pericardial patches were used for aortoplasty and repair of the ruptured annulus and VSD. Conclusion: Aortic annular rupture is a rare but catastrophic complication of TAVR with an incidence of 0.4-2.3% and a 30-day mortality as high as 67%. It often leads to acute circulatory collapse and requires surgical repair. Post-TAVR patients require close monitoring and any signs of hemodynamic compromise warrant immediate evaluation.

Volume

85

Issue

12 Suppl

First Page

2911

Comments

American College of Cardiology Meeting, March 29-31, 2025, Chicago, IL

DOI

10.1016/S0735-1097(25)03395-9

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