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
Recommended Citation
Ahmad E, Demertzis ZD, Sankar PR, Bilolikar A. Aortic annulus rupture and iatrogenic VSD: rare complications of transcatheter aortic valve replacement procedure. J Am Coll Cardiol. 2025 Apr 1;85(12 Suppl):2911. doi:10.1016/S0735-1097(25)03395-9
DOI
10.1016/S0735-1097(25)03395-9
Comments
American College of Cardiology Meeting, March 29-31, 2025, Chicago, IL