Aortic Valve Leaflet Rupture Causing Delayed Left Main Coronary Ostial Obstruction During Valvuloplasty Preceding TAVR

Abstract

A 69-year-old man with mediastinal radiation history underwent balloon valvuloplasty before transcatheter aortic valve replacement, which caused aortic leaflet rupture leading to unstable severe aortic regurgitation and subsequent left main ostial obstruction. A balloon-expanding valve was implanted to capture the ruptured leaflet and a left main stent was placed. ( Level of Difficulty: Advanced. )

Radiation-Induced Aortic Stenosis

“…This led to severe aortic regurgitation and left main ostial obstruction, which were corrected with implantation of the valve capturing the ruptured leaflet and a left main stent. 39 While TAVR is usually safe in patients with radiation-induced AS, these cases illustrate that tissues having received radiation are often very calcified, and unusual complications such as fistulization and tissue rupture may arise. More research is needed to assess complications of TAVR specific to patients having previously received radiation therapy to the chest.…”