Lethal Aorto-Right Ventricular Defect After Transcatheter Aortic Valve Implantation in a Patient With Radiation-Induced Porcelain Aorta: Notes of Caution.
A 47-year-old man with severe radiation-induced aortic stenosis was rejected for cardiac surgery because of porcelain aorta. We successfully implanted an Edwards SAPIEN valve (Edwards Lifesciences, Irvine, CA), but the patient was readmitted 3 weeks later for heart failure with a continuous murmur on auscultation. Echocardiography showed a small defect between the aorta and the infundibulum of the right ventricle, which was also confirmed with aortography and computed tomography. Medical therapy was optimized; however, he died unexpectedly a few weeks later. We concluded that irradiated tissues are particularly fragile and require specific attention during transcatheter aortic valve implantation. Furthermore, this case suggests that a more aggressive closure should have been applied.
Department of Interventional Cardiology, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France; Valvular Heart Disease Unit, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France. Electronic address: lionel.leroux@chu-bordeaux.fr.
Lionel
L
Leroux
Valvular Heart Disease Unit, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France.
Marina
M
Dijos
Valvular Heart Disease Unit, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France.
Julien
J
Peltan
Department of Interventional Cardiology, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France.
Frederic
F
Casassus
Department of Interventional Cardiology, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France.
Benjamin
B
Seguy
Department of Interventional Cardiology, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France.
Makoto
M
Natsumeda
Valvular Heart Disease Unit, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France.
Stephane
S
Lafitte
Valvular Heart Disease Unit, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France.
Louis
L
Labrousse
Department of Interventional Cardiology, University of Bordeaux, Hôpital cardiologique du Haut-Lévêque, Pessac, France.
Pierre
P
Dos Santos
D001013:Aorta, Thoracic / Q000293:injuries* / Q000528:radiation effects; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography; D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology*; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology*