Balloon Rupture After Subannular Slippage During Transcatheter Aortic Valve Replacement in Extremely Calcified...

Direct implantation of balloon-expandable transcatheter aortic valves without predilatation is increasingly performed. In patients with extreme asymmetric aortic valve calcification, this strategy may lead to rare but serious mechanical complications.

A 77-year-old man with symptomatic severe aortic stenosis and extreme asymmetric valvular and subannular calcification underwent transfemoral transcatheter aortic valve replacement using a 29-mm balloon-expandable valve without predilatation. During valve deployment, the balloon slipped toward the left ventricular outflow tract and ruptured. Despite this complication, the valve was fully deployed with no paravalvular regurgitation. After heart team discussion, urgent surgical extraction of the ruptured balloon was performed, as percutaneous retrieval was not considered suitable.

Balloon rupture during transcatheter aortic valve replacement is an exceptionally rare but potentially life-threatening complication. Extreme asymmetric calcification with subannular extension may predispose to balloon slippage and rupture. Careful preprocedural computed tomographic assessment, selective predilatation, and readiness for either percutaneous retrieval or immediate surgical bailout are essential in high-risk anatomy.