We report a successful transcatheter aortic valve replacement (TAVR) in an inoperable patient with a post-balloon aortic valvuloplasty (BAV) annular pseudoaneurysm. A 90-year-old woman treated 2 weeks earlier with BAV (Figure 1) for severe aortic stenosis was admitted for acute heart failure. Transesophageal echocardiogram showed a mobile, saccular, and pulsatile structure at the left ventricular outflow tract (LVOT)/aortic annulus (Figures 2A to 2C). Cardiac computed tomog- raphy demonstrated the presence of an aortic annulus pseudoaneurysm, probably related to the BAV, with significant annular/LVOT calcification (Figures 2D to 2F and 3). Upon heart team recommendation, TAVR was performed with low valve implantation neither with predilatation nor postdilatation to exclude the pseudoaneurysm. At the baseline aortic angiogram, the pseudoaneurysm was visible posteriorly to the aortic valve(Figures 4A and 4B). A 27-mm Portico prosthesis (Abbott) was implanted via a transfemoral approach without complications (Figures 4C to 4F, 5A, and 5B). The hospital stay was uneventful, and predischarge cardiac computed tomography showed good prosthesis position with almost complete exclusion of the annulus pseudoaneurysm (Figures 5C and 5D). This experience highlights the importance of multimodality cardiac imaging and multidisciplinary discussion for the diagnosis and management of intriguing, uncommon findings in patients with severe aortic stenosis.
Successful Transcatheter Aortic Valve Replacement in Patient With Aortic Annulus Pseudoaneurysm After Balloon Aortic Valvuloplasty
Caglioni, Serena;
2022
Abstract
We report a successful transcatheter aortic valve replacement (TAVR) in an inoperable patient with a post-balloon aortic valvuloplasty (BAV) annular pseudoaneurysm. A 90-year-old woman treated 2 weeks earlier with BAV (Figure 1) for severe aortic stenosis was admitted for acute heart failure. Transesophageal echocardiogram showed a mobile, saccular, and pulsatile structure at the left ventricular outflow tract (LVOT)/aortic annulus (Figures 2A to 2C). Cardiac computed tomog- raphy demonstrated the presence of an aortic annulus pseudoaneurysm, probably related to the BAV, with significant annular/LVOT calcification (Figures 2D to 2F and 3). Upon heart team recommendation, TAVR was performed with low valve implantation neither with predilatation nor postdilatation to exclude the pseudoaneurysm. At the baseline aortic angiogram, the pseudoaneurysm was visible posteriorly to the aortic valve(Figures 4A and 4B). A 27-mm Portico prosthesis (Abbott) was implanted via a transfemoral approach without complications (Figures 4C to 4F, 5A, and 5B). The hospital stay was uneventful, and predischarge cardiac computed tomography showed good prosthesis position with almost complete exclusion of the annulus pseudoaneurysm (Figures 5C and 5D). This experience highlights the importance of multimodality cardiac imaging and multidisciplinary discussion for the diagnosis and management of intriguing, uncommon findings in patients with severe aortic stenosis.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
