title: Periaortic hematoma after transcatheter aortic valve replacement: description of a new complication.
abstract: We report a case series of three patients with periaortic hematomas following transcatheter aortic valve replacement (TAVR). The TAVRs were performed by either trans-apical or transfemoral approach. An intraprocedural transesophageal echocardiogram (TEE) was performed in all patients. Clinical features of all three cases included advanced age, female gender, and small body weight. In addition, the following characteristics were present in all cases: presence of bulky calcification of the noncoronary cusp (NCC) of the aortic valve, mismatch between the annulus and device diameter, and severe intraprocedural hypertension immediately following TAVR. These characteristics may be potential causative factors. Early recognition of this complication by intra-procedural TEE was integral to the initiation of rapid and appropriate therapy, resulting in a favorable outcome. Herein, we present possible theories for the occurrence of this rare complication.
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10032, USA. pg2295@columbia.edu
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.forename: George R
authors.initials: GR
authors.lastname: Reiss
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.forename: Mathew R
authors.initials: MR
authors.lastname: Williams
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
mesh_terms: D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index