Annular Rupture Leading to Fatal Complications in an Elderly Patient with Calcified Aortic and Mitral Annulus Undergoing Transapical Aortic Valve Implantation

Peter L. Haldenwang; Matthias Bechtel; Markus Schlömicher; Michael Lindstaedt; Justus T. Strauch

doi:10.1055/s-0032-1322612

The Thoracic and Cardiovascular Surgeon, Inhaltsverzeichnis

Thorac Cardiovasc Surg 2013; 61(05): 425-427
DOI: 10.1055/s-0032-1322612

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Annular Rupture Leading to Fatal Complications in an Elderly Patient with Calcified Aortic and Mitral Annulus Undergoing Transapical Aortic Valve Implantation

Peter L. Haldenwang

¹Cardiothoracic Surgery, Ruhr-University of Bochum, Germany

,

Matthias Bechtel

¹Cardiothoracic Surgery, Ruhr-University of Bochum, Germany

,

Markus Schlömicher

¹Cardiothoracic Surgery, Ruhr-University of Bochum, Germany

,

Michael Lindstaedt

²Cardiology, Ruhr-University of Bochum, Bochum, Germany

,

Justus T. Strauch

¹Cardiothoracic Surgery, Ruhr-University of Bochum, Germany

› Institutsangaben

Abstract

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Abstract

This case illustrates the awareness that must be taken of the high morphological risk due to the calcifications of both, the aortic and mitral annulus in elderly patients when performing transapical aortic valve implantation. In an 86-year-old, multimorbid woman (logistic EuroSCORE = 27%) with symptomatic aortic stenosis (annular diameter = 23.4 mm) and severe mitral annular calcification, the implantation of a 26-mm Edwards SAPIEN (Edwards Lifesciences, Irvine, California, United States) valve in aortic position was primary successful, with no paravalvular leakage, valve instability, or coronary malperfusion. Second, a persisting transmural bleeding led to hypovolemic shock, which could not be stabilized even after going on cardiopulmonary bypass, and the patient died in the operation room. The autopsy showed a subvalvular ventricular rupture due to a transmural perforation of the calcified fibrotic annulus during valvuloplasty.

Keywords

aortic valve and root - heart valve - transapical - surgery - complications - outcomes - elderly

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Referenzen

References
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