title: The pyramid of danger: the value of TEE in detecting risk of aortic perforation during TAVI.
abstract: An 87-year-old man undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis was noted to have bulky calcification of the noncoronary aortic cusp, extending into the corresponding sinus, on transesophageal echocardiography (TEE). During balloon valvuloplasty, TEE demonstrated displacement of this calcium into the aortic wall, producing a distinctive pyramidal indentation and indicating threatened focal aortic perforation. Importantly, this hazard was not evident on corresponding x-ray cine-angiography and emphasizes the value of TEE in guiding TAVI procedures. This information allowed alteration in deployment technique for the TAVI valve and forewarned the team to increased risk of a major hazard at this stage.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sirker
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrne
authors.forename: Mark
authors.initials: M
authors.lastname: Monaghan
mesh_terms: D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging* / Q000293:injuries; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005268:Femoral Vein; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome