Abstract
Left ventricular perforation is an uncommon complication in transcatheter aortic valve implantation (TAVI). And a case of left ventricular perforation associated with an aberrant right subclavian artery (ARSA) has rarely been reported. An 86-year-old female attended our hospital with symptomatic severe aortic stenosis. Because of the patient’s advanced age, and that she was a long-term steroid user, we treated her using TAVI. Although the presence of ARSA was noted, the aortic arch was a smooth arc on images of computed tomography (CT) along the axis of the aortic arch. A trans-femoral TAVI was performed. When the TAVI device passed through the aortic arch, the angle of the delivery system suddenly changed, and the guidewire was pushed in, which caused left ventricular perforation. We had to open the chest and perform a repair procedure. There was an enlarged space at the ARSA origin in three-dimensional (3D) CT, and this space may have caused the unexpected guidewire movement. The TAVI device may move in unexpected ways in presence of ARSA. It is necessary to carefully evaluate the access route using 3D CT as part of the preoperative evaluation to determine the safest treatment strategy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Arsalan M, Kim W-K, Linden AV, et al. Predictors and outcome of conversion to cardiac surgery during transcatheter aortic valve implantation. Eur J Cardiothorac Surg. 2018;54:267–72.
Rezq A, Basavarajaiah S, Latib A, et al. Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation: a single-center study. JACC Cardiovasc Interv. 2012;5:1264–72.
Owais T, El Garhy M, Fuchs J, et al. Pathophysiological factors associated with left ventricular perforation in transcatheter aortic valve implantation by transfemoral approach. J Heart Valve Dis. 2017;26:430–6.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics committee approval
Not required.
Informed consent
The patient has provided permission to publish these features of his case, and the identity of the patient has been protected.
Conflict of interest
The authors declare that they have no conflict of interest.
Human and animal rights statement
This article does not contain any experimental studies with humans or animals performed by any of the authors. All stipulations of declaration of Helsinki, 1964, were complied with.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (AVI 19153 KB)
Supplementary file2 (AVI 382 KB)
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Seimei, G., Keijiro, K., Yukihiro, F. et al. Transcatheter aortic valve implantation causing left ventricular perforation may be associated with an aberrant right subclavian artery: a case report. Indian J Thorac Cardiovasc Surg 39, 79–82 (2023). https://doi.org/10.1007/s12055-022-01429-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12055-022-01429-9