Iatrogenic type-A aortic dissection due to transcatheter aortic valve implantation.

An 86-year-old female was referred to the Cardiology Department for further treatment due to symptomatic severe aortic stenosis. Given her old age as well as chronic obstructive pulmonary disease, coronary artery disease, hypertension, chronic kidney disease (Stage III), and frailty, the Heart Team recommended transcatheter aortic valve implantation (TAVI). Transfemoral TAVI was smoothly performed with a 26 mm self-expanding valve VenusA (Venus Medtech, Hangzhou, China; self-expanding) using pre-dilatation of 20 mm Z-MED balloon (NuMED, Hopkinton, NY, USA) and post-dilatation of 22 mm Z-MED balloon. However, on the post-implantation aortogram, it was detected that the outflow part of the stent frame seemed to outreach the aortic wall (Video 1), and a transoesophageal echocardiography revealed a Stanford type-A dissection (Video 2), which on computed tomography scan extended to the abdominal aorta without compromising blood flow in the neck vessels or abdominal organs (, Video 3). Since the patient was haemodynamic stable and surgical intervention associated with high risk, conservative treatment was undertaken. Under close surveillance, strict heart rate and blood pressure control were maintained with intravenous drugs during index hospitalization and oral medications after discharge. The patient was fortunately alive at 1-year and 2-year follow-up. Computed tomography angiogram at 1-year follow-up showed stable aortic dissection with partial thrombosis inside the false lumen (, Supplementary material online, Videos S1 and S2).

Computed tomography angiogram before discharge.

Computed tomography angiogram at 1-year follow-up showed stable aortic dissection with partial thrombosis inside the false lumen.

Though TAVI has proved its non-inferiority or even superiority over surgical aortic valve replacement, vascular complication remains as one of the major concerns., Aortic dissection is a rare, but potentially fatal vascular complication. In this case, iatrogenic aortic dissection occurred acutely during TAVI procedure, and injuries to the aortic wall brought by devices delivery (balloons, prosthesis, etc.) are the most plausible interpretation. Currently, many of these TAVI patients are frail with co-morbidities and therefore better served with conservative management, particularly in those very elderly patients.

Supplementary material

Supplementary material is available at European Heart Journal - Case Reports online.

Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance.

Conflict of interest: none declared.

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