Fig. 6.1
CT scan preoperative evaluation of annulus and left main ostium height. Annulus size fits in between Edwards Sapien 23 and 26 mm. Huge calcification in left ventricle outflow tract is clearly visible
Fig. 6.2
Annulus size was checked again with injection during balloon valvuloplasty with 23-mm balloon. It appeared slightly small, so 26-mm valve was preferred
Fig. 6.3
Prosthesis deployment
Fig. 6.4
Aortogram showed contrast medium exited into pericardial space (black arrow)
Fig. 6.5
Selective catheterization with contrast medium injection through the breakdown into the pericardial space using 6-Fr Amplatz left 1.0 guiding catheter
Fig. 6.6
Multiple coil embolizations into the pericardial space through the Amplatz left guiding catheter
Fig. 6.7
Final angiogram showing complete sealing of the hole
6.4 Discussion
Vascular complications after TAVI are frequent and reported as 22 % [2]. The incidence of catastrophic complications such as annulus or aortic root rupture is rarely reported and varies according to the papers as 0.6–4.2 % [1, 3–5]. Once annulus and aortic root rupture occurs, cardiac tamponade and hemodynamic collapse are instantaneous.
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