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Aborted TAVR following aortic balloon valvuloplasty
Khaled D Algarni1, Kevin L Greason, Rakesh M Suri
1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Journal of Cardiac Surgery
|September 10, 2014
Summary
Balloon aortic valvuloplasty (BAV) can cause aortic cusp fenestration rupture, a complication identified during transcatheter aortic valve replacement (TAVR). This finding necessitated surgical aortic valve replacement (SAVR) in an elderly patient.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Severe aortic valve stenosis necessitates intervention, with transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) being primary options.
- Balloon aortic valvuloplasty (BAV) is sometimes used as a bridge to TAVR or as a standalone procedure.
Observation:
- An 80-year-old male with severe aortic valve stenosis underwent TAVR referral post-BAV.
- During TAVR, a mobile mass on the aortic valve's right cusp was detected via transesophageal echocardiography, leading to procedure abortion.
- Subsequent SAVR revealed the mass to be an aortic cusp fenestration rupture.
Findings:
- The identified aortic cusp fenestration rupture was causally linked to the preceding BAV procedure.
- This complication mimicked vegetations or thrombus on initial echocardiographic assessment.
Implications:
- BAV can lead to iatrogenic aortic valve injury, including cusp rupture, which may be mistaken for other pathologies.
- Careful pre-procedural imaging and consideration of BAV-induced complications are crucial for patients undergoing aortic valve interventions.
- Accurate diagnosis of BAV-related complications is essential for appropriate management, potentially involving SAVR instead of TAVR.
