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Here we present a novel repair strategy of a rare aortic complication following transcatheter aortic valve repair (TAVR). A 73-year-old man with a history of mitral valve replacement secondary to endocarditis underwent a TAVR for severe aortic insufficiency at an outside hospital (Medtronic Evolut R 34 mm Valve). After a routine follow-up, echocardiogram showing abnormal colour flow in the ascending aorta, a CT scan revealed TAVR leaflet thrombosis (requiring anticoagulation) and a 3.5×3 cm pseudoaneurysmal sac with two communications into the ascending aorta just distal to the TAVR scaffold (figure 1: aortography—top, CT scan—bottom; figure 4: top—pre-procedure echo images with red arrow pointing towards the pseudoaneurysm).
Heart team evaluation of the case determined that thoracic endovascular aortic repair was not possible given the proximity of the pseudoaneurysm to the TAVR structure. A 6-French JR4 guide was used to engage the inferior neck of the pseudoaneurysm sac (figure 2) through the TAVR scaffold. An initial attempt at percutaneous coiling of the sac with a 20 mm Nestor vascular coil (Cook Medical, Bloomington, IN) failed to fill the cavity completely and was removed. Definitive repair of the sac was achieved using a 22 mm Amplatzer Vascular Plug 2 (St. Jude Medical, Saint Paul, MN). One month and 6 months post-procedure CT and echocardiogram showed a fully thrombosed and sealed off pseudoaneurysm sac with no residual communication with the ascending aorta (figure 3: aortography—top, CT scan—bottom; figure 4: bottom—post-procedure echo at 1 month with blue arrow pointing at the sealed PSA).
To our knowledge, this is the first reported case of transcatheter aortic valve repair-induced ascending aortic pseudoaneurysm.
Our novel approach for percutaneous repair using an Amplatzer Vascular Plug 2 device appears to be both safe and efficacious.
Contributors SPS, HA, CME and VSM: planning, conduct, reporting, conception and design, acquisition of data or analysis and interpretation of data.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Obtained.
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