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Transapical aortic valve replacement complicated by periaortic hematoma
Echo Research & Practice volume 2, pages I13–I14 (2015)
A 77-year-old woman with severe symptomatic aortic stenosis (aortic valve areaZ0.6 cm2 and mean gradientZ 53 mmHg) was deemed inoperable for surgical aortic valve replacement due to a porcelain aorta, and was scheduled for transcatheter aortic valve replacement via an apical approach. A 23 mm valve was selected based on a computerized axial tomographic angiography derived area of 360 mm2; valve oversizing was 15.4%. Baseline transesophageal echocardiography revealed severe protruding atheroma within the lumen of the ascending aorta. Immediately following deployment of the Sapien pericardial tissue valve (Edwards Life Sciences, Irvine, CA, USA), a large posterior periaortic hematoma was noted (1.3 cm in maximum width, and w4 cm in length) (see Fig. 1 and Videos 1, 2, 3, 4). Protamine was administered, and the hematoma was observed by transesophegeal echocardiography for w30 min with no change in size; function of the bioprosthetic valve was normal without regurgitation. In the immediate post-operative period, anti-platelet agents were withheld, and blood pressure was aggressively lowered. The remainder of her hospital course was uncomplicated, and a tranthoracic echocardiogram w1 month later demonstrated resolution of the hematoma. Periaortic hematoma and aortic root rupture are recognized potential major complications of transcatheter aortic valve replacement (1, 2). Severe left ventricular outflow tract calcification and annular over sizing are both risk factors for these complications. Careful transesophageal echocardiographic examination post valve deployment may lead to early recognition and treatment of this potentially fatal complication (3). In this case, presence of severe protruding atherosclerotic plaque pre-procedure likely predisposed to this complication.
Généreux P, Reiss GR, Kodali SK, Williams MR, Hahn RT 2012 Periaortic hematoma after transcatheter aortic valve replacement: description of a new complication. Catheterization and Cardiovascular Interventions 79 766–776. (doi:10.1002/ccd.23242)
Barbanti M, Yang TH, Rodès Cabau J, Tamburino C, Wood DA, Jilaihawi H, Blanke P, Makkar RR, Latib A, Colombo A et al. 2013 Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation 128 244–253. (doi:10.1161/CIRCULATIONAHA.113.002947)
Zamorano JL, Badano LP, Bruce C, Chan KL, Gonçalves A, Hahn RT, Keane MG, La Canna G, Monaghan MJ, Nihoyannopoulos P et al. 2011 EAE/ASE Recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. Journal of the American Society of Echocardiography 24 937–965. (doi:10.1016/j.echo.2011.07.003)
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Naji, D.I., Chhatriwalla, A., Cohen, D.J. et al. Transapical aortic valve replacement complicated by periaortic hematoma. Echo Res Pract 2, I13–I14 (2015). https://doi.org/10.1530/ERP-15-0016