Percutaneous transapical pseudoaneurysm closure following transcatheter aortic valve replacement.
Left ventricular pseudoaneurysm (LVP) formation is a rare but potentially life-threatening complication of transapical transcatheter aortic valve replacement (TAVR). Conventionally, a pseudoaneurysm has been treated surgically; however, improved transcatheter technique and device technology have made a percutaneous closure of LVP an increasingly viable option, especially in a patient unfavorable for surgery. A TAVR candidate is most likely at increased surgical-risk or inoperable. Therefore a percutaneous closure can be a reasonable strategy for LVP, but its experience following this emerging aortic valve procedure remains limited. We describe a case of LVP formation after TAVR in which it was efficiently treated with a percutaneous closure using a transapical approach via LVP. The first attempt was performed with a transfemoral approach. Pre-closure angiography revealed an eccentric shape of a LVP neck like a "chicken leg". This shape caused serious difficulty to cross LVP with a wire and it was not accomplished. However, the LVP location was at the apex and we could access from a chest wall through the pseudoaneurysm in the second attempt. This approach allowed a close and coaxial wire manipulation and the neck of LVP was finally crossed. After that, a closure device was deployed and the second procedure was successfully completed. An approach selection often contributes to a procedural success. This is the first case of a percutaneous LVP closure following TAVR using a transapical access and may suggest this approach as a possible option for this catheter closure in TAVR candidates. © 2016 Wiley Periodicals, Inc.
Cedars-Sinai Medical Center, Heart Institute, Los Angeles, California.
Kazuaki
K
Okuyama
Cedars-Sinai Medical Center, Heart Institute, Los Angeles, California.
Tarun
T
Chakravarty
Cedars-Sinai Medical Center, Heart Institute, Los Angeles, California.
Raj R
RR
Makkar
D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation; D017548:Echocardiography, Transesophageal; D005260:Female; D006322:Heart Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
complications; interventional cardiology; valvular heart disease