Author + information
- Received May 12, 2016
- Revision received June 6, 2016
- Accepted June 20, 2016
- Published online September 26, 2016.
- Yoshiaki Katada, MD, PhDa,b,
- Joji Ito, MDa,
- Kentaro Shibayama, MDc,
- Daisuke Nakatsuka, MDa,
- Yuji Kawano, MDa,
- Hiroyuki Watanabe, MDc and
- Minoru Tabata, MD, PhD, MPHa,∗ ()
- aDepartment of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Tokyo, Japan
- bDepartment of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
- cDepartment of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Tokyo, Japan
- ↵∗Reprint requests and correspondence:
Dr. Minoru Tabata, Tokyo Bay Urayasu Ichikawa Medical Center, Department of Cardiovascular Surgery, 3-4-32 Todaijima, Urayasu-Shi, Chiba 279-0001, Japan.
A 74-year-old woman underwent reconstruction of the infected annulus and redo aortic valve replacement with a bioprosthetic valve for prosthetic valve endocarditis. Post-operative computed tomography revealed a pseudoaneurysm of the posterior left ventricular outflow tract (LVOT) (Figure 1).
The ventricular apex was exposed with a left minithoracotomy. A 9-F, 10-cm sheath was inserted into the left ventricle, and a 6-F, 45-cm guiding sheath was inserted into the pseudoaneurysm. Under the guidance of transesophageal echocardiography (Figure 2), a 10-mm Amplatzer Vascular Plug II (St. Jude Medical, St. Paul, Minnesota) was deployed by placing the first disk in the LVOT and the other 2 disks in the pseudoaneurysm. No blood flow and clot formation inside the pseudoaneurysm were confirmed intraoperatively (Figures 2 and 3). Pre-operative computed tomography confirmed complete occlusion of the pseudoaneurysm cavity (Figure 4).
Compared with the percutaneous transseptal approach (1), the transapical approach provides shorter and more linear access to the LVOT (2). Heart team transapical closure is an efficient and safe option for LVOT pseudoaneurysm.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 12, 2016.
- Revision received June 6, 2016.
- Accepted June 20, 2016.
- American College of Cardiology Foundation
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