title: Distal left anterior descending coronary artery obstruction: a rare complication of transapical aortic valve implantation.
abstract: Apical complications are considered the "Achilles' heel" of transapical aortic valve implantation, in which laceration and hemorrhage are potentially fatal. We describe the case of a rare complication of the transapical aortic valve implantation procedure, where after apical closure, tension on a distal coronary segment resulted in flow obstruction. Clinicians should be alert to the possibility of distal left anterior descending artery obstruction when ischemia following a transapical procedure is suspected. The exact location of sheath insertion during "transapical" aortic valve implantation is usually apicolateral. A more apical insertion should be avoided since the apex is a relatively weak region and there could be an increased risk of coronary avulsion or apical ventricular septal defect. Nevertheless, a too-lateral insertion could diminish the sheath orientation toward the left ventricular outflow tract and the sheath could also be entrapped with mitral valve chordae. Surgeons should be aware of these factors when deciding on the exact sheath insertion site during tranaspical procedures.
authors.affiliation: Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
authors.forename: Eyal
authors.initials: E
authors.lastname: Porat
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001024:Aortic Valve Stenosis / Q000601:surgery*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications