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Related Experiment Videos

"Twin Icicle" Calcifications Cause Aortic Annular Rupture.

Masato Tochii1, Takashi Muramatsu2, Kentaro Amano1

  • 1Department of Cardiovascular Surgery, Fujita Health University, Toyoake, Aichi, Japan.

The Annals of Thoracic Surgery
|April 8, 2018
PubMed
Summary

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Aortic annular rupture after transcatheter aortic valve implantation is rare but fatal. Unique "twin icicle" calcifications, not prosthesis oversizing, may trigger this complication.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
  • Aortic annular rupture is a rare but life-threatening complication following TAVI.
  • Predictors and mechanisms of aortic annular rupture remain incompletely understood, though prosthesis oversizing and severe annular calcification are suspected risks.

Observation:

  • A case of aortic annular rupture occurred post-TAVI.
  • The aortic annulus exhibited two severe calcifications resembling "twin icicles" near the rupture site.
  • Prosthesis oversizing was not identified as a contributing factor in this case.

Findings:

  • Severe annular calcifications, specifically the "twin icicle" morphology, may act as a trigger for aortic annular rupture during TAVI.

Related Experiment Videos

  • This finding suggests that specific anatomical features of calcification, beyond general severity or prosthesis size, can predispose to annular rupture.

    • Implications:

    • Highlights the importance of detailed pre-procedural imaging to identify high-risk calcification patterns.
    • Suggests a need to refine risk stratification models for TAVI to include specific calcification morphologies.
    • May inform procedural techniques or device selection in patients with challenging aortic annulus anatomy to prevent catastrophic rupture.