Author + information
- Received June 21, 2016
- Revision received November 16, 2017
- Accepted November 21, 2017
- Published online January 31, 2018.
- Hirofumi Hioki, MD∗ (, )
- Yusuke Watanabe, MD, PhD,
- Shintaro Takamura, MD and
- Ken Kozuma, MD, PhD
- ↵∗Address for correspondence:
Dr. Hirofumi Hioki, Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-0003, Japan.
An 88 years-old woman admitted undergoing transcatheter aortic valve replacement (TAVR) because of severe aortic valve stenosis. Pre-procedural computed tomography demonstrated that annulus area was 345 mm2 (Figure 1A) and minimum diameter of Valsalva was 27.4 mm (Figure 1B). Calcification was present between the left atrium (LA) and aortic root (Figure 1C). Diameter of the lower limbs were suitable for transfemoral access. Based on these findings, transfemoral TAVR was performed under general anesthesia with transesophageal echocardiography guidance. After pre-dilatation using 20-mm balloon, a SAPIEN XT 23-mm (Edwards Lifesciences, Irvine, California) at 1 cm3 underfilling was successfully implanted under rapid pacing. However, after that, the patient became hemodynamically unstable and transesophageal echocardiography demonstrated pericardial effusion. Surgical repair was performed to achieve hemostasis and identified bleeding from the LA (Figure 1D). Post-procedural computed tomography showed that calcification was pushed away in the direction of LA (Figure 1E). Seven days after surgical repair, she was discharged without further complications.
Although cardiac tamponade occurs in ≤5% of TAVR (1), this is the first description of cardiac tamponade of LA perforation. With insight of periprocedural images, we presumed that combination of protruded calcification and high valve calcification index might increase risk of LA injury during TAVR.
Dr. Watanabe has served as a proctor for Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 21, 2016.
- Revision received November 16, 2017.
- Accepted November 21, 2017.
- 2018 American College of Cardiology Foundation