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Dual Percutaneous Repair for Aortic Annulus Rupture After Balloon-Expandable TAVR
Charles Vidoni1, Benoît Guillon1, Romain Chopard2
1Department of Cardiology, University Hospital Besancon, Besancon, France.
Background:
Aortic annulus rupture is a rare but life-threatening complication of transcatheter aortic valve replacement (TAVR), often linked to balloon-expandable valves and anatomic risk factors.
Case Summary:
An 85-year-old man with severe aortic stenosis underwent successful transfemoral TAVR. Two hours later, he developed tamponade because of a supra-annular rupture. A second, higher-positioned valve was implanted, followed by a third prosthesis after valve migration. Days later, a subannular rupture with pseudoaneurysm was identified. Coil embolization via radial access achieved complete exclusion.
Discussion:
Annulus rupture may occur at various levels (supra-, intra, or subannular) and requires individualized management. This case highlights a staged rupture progression and successful percutaneous management, offering a less invasive alternative for high-risk patients.
Take-Home Messages:
Annulus rupture is a rare but critical TAVR complication. Rapid diagnosis and multidisciplinary coordination are essential. Percutaneous strategies, including valve-in-valve and coil embolization, may be lifesaving in selected cases.
