Transcatheter aortic valve implantation causing left ventricular perforation may be associated with an aberrant right...

Left ventricular perforation is an uncommon complication in transcatheter aortic valve implantation (TAVI). And a case of left ventricular perforation associated with an aberrant right subclavian artery (ARSA) has rarely been reported. An 86-year-old female attended our hospital with symptomatic severe aortic stenosis. Because of the patient's advanced age, and that she was a long-term steroid user, we treated her using TAVI. Although the presence of ARSA was noted, the aortic arch was a smooth arc on images of computed tomography (CT) along the axis of the aortic arch. A trans-femoral TAVI was performed. When the TAVI device passed through the aortic arch, the angle of the delivery system suddenly changed, and the guidewire was pushed in, which caused left ventricular perforation. We had to open the chest and perform a repair procedure. There was an enlarged space at the ARSA origin in three-dimensional (3D) CT, and this space may have caused the unexpected guidewire movement. The TAVI device may move in unexpected ways in presence of ARSA. It is necessary to carefully evaluate the access route using 3D CT as part of the preoperative evaluation to determine the safest treatment strategy.

The online version contains supplementary material available at 10.1007/s12055-022-01429-9.