Author + information
- Received October 5, 2015
- Accepted October 8, 2015
- Published online February 8, 2016.
- Tetsuro Oda, MDa,
- Takayuki Okamura, MDa,∗ (, )
- Yosuke Miyazaki, MDa,
- Takeshi Nakamura, MDa,
- Akihito Mikamo, MDb,
- Yasuaki Wada, MDa,
- Atsuo Yamashita, MDc,
- Masaya Takahashi, MDb,
- Kentaro Hayashida, MDd,
- Kimikazu Hamano, MDb and
- Masafumi Yano, MDa
- aDepartment of Medicine and Clinical Science, Division of Cardiology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
- bDepartment of Surgery and Clinical Science, Division of Cardiac Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
- cDepartment of Anesthesiology, School of Medicine, Yamaguchi University, Yamaguchi, Japan
- dDepartment of Cardiology, School of Medicine, Keio University, Tokyo, Japan
- ↵∗Reprint requests and correspondence:
Dr. Takayuki Okamura, Department of Medicine and Clinical Science, Division of Cardiology, Yamaguchi University Graduate School of Medicine, Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
The authors performed a transfemoral aortic valve replacement (TF-TAVR) in an 89-year-old woman with severe aortic stenosis. The pre-operative transthoracic echocardiography (TTE) revealed severe aortic stenosis (aortic valve area 0.6 cm2) with huge calcifications at each leaflet. At multislice computed tomography (MSCT), the annulus perimeter was 278 mm2, indicating that the average diameter was 18.8 mm. On the basis of these results, after performing aortic valvuloplasty with a 20-mm balloon, we successfully implanted a 23-mm Sapien XT valve with 2 cc underfilling. Because the intraoperative transesophageal echocardiography (TEE) confirmed moderate paravalvular regurgitation, we performed a post-dilation procedure with 1 cc up. After post-dilation, the TEE showed only trivial paravalvular regurgitation, which was an improvement after the post-dilation procedure.
Seven days after the procedure, the patient suddenly experienced syncope. Both TTE and MSCT confirmed a pericardial effusion and a cavity, which had a flow in both the systolic and diastolic, close to the anterior wall of aortic root, suggesting that it was a pseudoaneurysm (Online Video 1, Figure 1). Because of the high surgical risk and no existence of cardiac shock, we chose a conservative approach: treatment with a single antiplatelet and strict blood pressure control.
The patient was discharged 1 month after the TF-TAVR procedure with a New York Heart Association class II status. One-year after the TAVR, the clinical follow-up was unremarkable, and the reduction of both pseudoaneurysm and pericardial effusion were confirmed by MSCT and TTE, indicating that the conservative strategy may be a feasible option for the treatment of pseudoaneurysm caused by TAVR (Online Video 2, Figure 1).
For supplemental videos, please see the online version of this article.
Dr. Hayashida has reported that he is a clinical proctor for Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 5, 2015.
- Accepted October 8, 2015.
- American College of Cardiology Foundation