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Transcatheter aortic valve implantation complicated by acute pericardial tamponade.

Możeńska O, Suwalski P, Pawlak A, Kulawik T, Byczkowska K, Gil RJ - Postepy Kardiol Interwencyjnej (2014)

Bottom Line: Despite its more widespread adoption as a treatment option and increasing experience of centers, TAVR is still associated with several complications.We therefore report a case of TAVR complicated by acute pericardial tamponade, one of the most severe potential complications of this procedure.We describe the way we approached the problem and we try to give a potential take-home message for others who might encounter such a situation in their own cath lab.

View Article: PubMed Central - PubMed

Affiliation: Department of Noninvasive Cardiology and Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.

ABSTRACT
Transcatheter aortic valve replacement (TAVR) is now an accepted standard of care for patients with symptomatic severe aortic stenosis who are not candidates for surgery or have high surgical risk. Despite its more widespread adoption as a treatment option and increasing experience of centers, TAVR is still associated with several complications. We therefore report a case of TAVR complicated by acute pericardial tamponade, one of the most severe potential complications of this procedure. We describe the way we approached the problem and we try to give a potential take-home message for others who might encounter such a situation in their own cath lab.

No MeSH data available.


Related in: MedlinePlus

A – Severe abdominal hernia on abdominal computed tomography (CT). B – Acute cardiac tamponade shown with transesophageal echocardiography (TEE). C, D – Successful implantation of Core Valve™ 26 mm
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Figure 0001: A – Severe abdominal hernia on abdominal computed tomography (CT). B – Acute cardiac tamponade shown with transesophageal echocardiography (TEE). C, D – Successful implantation of Core Valve™ 26 mm

Mentions: A 78-year-old obese female with coronary artery disease, hypertension, hyperlipidemia, and diabetes mellitus type 2 underwent TAVR due to severe aortic valve (AV) stenosis (Figure 1A). She presented clinically with NYHA class III, and CCS class III/IV. The patient was excluded from surgical AV repair due to concomitant diseases and the presence of a large abdominal hernia threatening with necrosis in case of cardiac pulmonary bypass use. The patient's EuroSCORE was 9.36%, logistic EuroSCORE was 12.69% and STS for isolated AV replacement showed a mortality risk of 22.883%. On transthoracic echocardiography AV parameters were: AVA 0.7 cm2, peak gradient 82 mm Hg, mean gradient 54 mm Hg and EF 60%. Transcatheter aortic valve replacement was performed through a transfemoral approach. During the procedure, while the operator was manipulating with the Amplatz Extrastiff wire, immediately after balloon predilatation, the patient's blood pressure dropped, bradycardia appeared and the patient went into cardiac arrest. Transesophageal echocardiography (TEE) showed features of acute cardiac tamponade (Figure 1B). Aortic ring rupture or aortic root rupture was suspected. Immediate sternotomy was performed and perforation of the left ventricle (LV) lateral wall was indentified and repaired with mattress sutures with pledgets. After achieving full hemostasis a decision about further proceeding with TAVR was made. A Core Valve™ 26 mm was successfully implanted (Figures 1C and 1D).


Transcatheter aortic valve implantation complicated by acute pericardial tamponade.

Możeńska O, Suwalski P, Pawlak A, Kulawik T, Byczkowska K, Gil RJ - Postepy Kardiol Interwencyjnej (2014)

A – Severe abdominal hernia on abdominal computed tomography (CT). B – Acute cardiac tamponade shown with transesophageal echocardiography (TEE). C, D – Successful implantation of Core Valve™ 26 mm
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4007294&req=5

Figure 0001: A – Severe abdominal hernia on abdominal computed tomography (CT). B – Acute cardiac tamponade shown with transesophageal echocardiography (TEE). C, D – Successful implantation of Core Valve™ 26 mm
Mentions: A 78-year-old obese female with coronary artery disease, hypertension, hyperlipidemia, and diabetes mellitus type 2 underwent TAVR due to severe aortic valve (AV) stenosis (Figure 1A). She presented clinically with NYHA class III, and CCS class III/IV. The patient was excluded from surgical AV repair due to concomitant diseases and the presence of a large abdominal hernia threatening with necrosis in case of cardiac pulmonary bypass use. The patient's EuroSCORE was 9.36%, logistic EuroSCORE was 12.69% and STS for isolated AV replacement showed a mortality risk of 22.883%. On transthoracic echocardiography AV parameters were: AVA 0.7 cm2, peak gradient 82 mm Hg, mean gradient 54 mm Hg and EF 60%. Transcatheter aortic valve replacement was performed through a transfemoral approach. During the procedure, while the operator was manipulating with the Amplatz Extrastiff wire, immediately after balloon predilatation, the patient's blood pressure dropped, bradycardia appeared and the patient went into cardiac arrest. Transesophageal echocardiography (TEE) showed features of acute cardiac tamponade (Figure 1B). Aortic ring rupture or aortic root rupture was suspected. Immediate sternotomy was performed and perforation of the left ventricle (LV) lateral wall was indentified and repaired with mattress sutures with pledgets. After achieving full hemostasis a decision about further proceeding with TAVR was made. A Core Valve™ 26 mm was successfully implanted (Figures 1C and 1D).

Bottom Line: Despite its more widespread adoption as a treatment option and increasing experience of centers, TAVR is still associated with several complications.We therefore report a case of TAVR complicated by acute pericardial tamponade, one of the most severe potential complications of this procedure.We describe the way we approached the problem and we try to give a potential take-home message for others who might encounter such a situation in their own cath lab.

View Article: PubMed Central - PubMed

Affiliation: Department of Noninvasive Cardiology and Hypertension, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.

ABSTRACT
Transcatheter aortic valve replacement (TAVR) is now an accepted standard of care for patients with symptomatic severe aortic stenosis who are not candidates for surgery or have high surgical risk. Despite its more widespread adoption as a treatment option and increasing experience of centers, TAVR is still associated with several complications. We therefore report a case of TAVR complicated by acute pericardial tamponade, one of the most severe potential complications of this procedure. We describe the way we approached the problem and we try to give a potential take-home message for others who might encounter such a situation in their own cath lab.

No MeSH data available.


Related in: MedlinePlus