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Percutaneous Closure of Left Ventricular Apex Perforation After Transcatheter Aortic Valve Replacement Valve-in-Valve
Andrew Moussad1, Kaleab Asrress2, Ata Doost3
1Department of Cardiology, Nepean Hospital, Kingswood, New South Wales, Australia; Nepean Clinical School, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Camperdown, New South Wales, Australia; Department of Cardiology, Macquarie University Hospital, Macquarie Park, New South Wales, Australia.
Background:
Transcatheter aortic valve replacement (TAVR) valve-in-valve (ViV) is a less invasive alternative to redo surgery for high-risk patients with failed bioprosthetic aortic valves. Left ventricular (LV) perforation is a rare but potentially life-threatening complication, typically requiring surgical repair. Percutaneous closure is seldom reported.
Case Summary:
An 80-year-old man with NYHA functional class III symptoms from severe degenerative transvalvular bioprosthetic aortic regurgitation underwent TAVR ViV. Postprocedure transthoracic echocardiogram and computed tomography scan revealed a small, contained LV apex perforation, likely iatrogenic from guidewire manipulation. This was successfully closed percutaneously using an Amplatzer Vascular Plug II.
Discussion:
This case highlights importance of high-quality post-TAVR ViV transthoracic echocardiography and safety of percutaneous closure of LV apex perforation compared with surgical repair.
Take-Home Messages:
LV apex perforation is a rare but serious complication of TAVR. Percutaneous closure may avoid high-risk surgery in suitable cases.
