title: Aortic Root Rupture during Transcatheter Aortic Valve Implantation in a Patient with Idiopathic Thrombocytopenic Purpura: Utility of Transesophageal Echocardiography in Early Detection and Description of a Semiconservative Surgical Management Approach.
abstract: An 87-year-old man with idiopathic thrombocytopenic purpura and platelet count of 56 × 109/L underwent transesophageal echocardiography (TEE)-guided transcatheter aortic valve implantation using a femoral approach. Post valve deployment, a new pericardial effusion was noted which was successfully drained. Despite this, the patient became hypotensive needing vasopressor support with reaccumulation of pericardial fluid. Emergent sternotomy was performed and a perforation of the right ventricular apex was noted which was sealed with a pledgeted suture. Continued bleeding prompted further exploration; the aorta was seen to be mottled in conjunction with clear aortic root hematoma on TEE and a diagnosis of root rupture was made. This was semiconservatively managed without conversion to a full aortic root repair or replacement procedure. Multiple sutures were applied to the periaortic space and the bleeding sealed with use of BioGlue (Cryolife Inc., Kennesaw, GA) and Surgicel (Ethicon Inc., Somerville, NJ). The postoperative course was stable and the patient remained well at 3-month follow-up.
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Jaya
authors.initials: J
authors.lastname: Chandrasekhar
authors.affiliation: Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
authors.affiliation: Department of Cardiac Anesthesia, University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Nicholson
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Marino
authors.initials: M
authors.lastname: Labinaz
keywords: aortic valve stenosis; emergent sternotomy; percutaneous aortic valve replacement; pericardiocentesis; surgical conversion