Masaki Miyasaka, Shigeaki Kato, Norio Tada, Matayoshi Tetsutaro, Masahiro Kami, Tatsushi Ootomo and Naoto Inoue
A 78-year-old woman with severe aortic stenosis underwent transcatheter aortic valve implantation (TAVI) with a balloon expandable bioprosthesis: a 23-mm Sapien XT valve (Edwards Life Sciences, Inc., CA, USA). A set of the valve and a balloon (NovaFlex, Edwards Transfemoral Balloon Catheter, Edwards Life Sciences, Inc., CA, USA) was successfully delivered to an optimal position using a 16-French expandable introducer hydrophilic sheath. Inflation of the balloon was commenced, and expansion was initially smooth. However, it ruptured immediately before completion of expansion, resulting in a rapid deterioration in hemodynamics. Even though no migration of the stent valve was observed, transesophageal echocardiography and aortography revealed massive paravalvular aortic regurgitation (AR), suggesting that AR was attributable to insufficient expansion. After post -dilatation of the stent valve using a 23- mm balloon (Edwards Transfemoral Balloon Catheter, Edwards Life Sciences, Inc., CA, USA), the patient’s condition began to improve, and further aortography indicated an improvement in paravalvular AR. This case represented that balloon rupture could led to sudden onset massive paravalvular AR. Interventional cardiologists should recognize it as a significant complication in patients undergoing TAVI using a balloon-expandable bioprosthesis, with the possibility of severe cardiogenic shock.
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