An 84-year-old woman underwent transcatheter aortic valve implantation (TAVI). Preprocedural computed tomography (CT) had revealed no extensive calcification in the aortic root (Figure A; Supplementary Movie 1) and no injury to the left atrium anterior wall (LAAW) (Figure B). A 26-mm Evolut R (Medtronic, Minneapolis, MN, USA) was successfully implanted. During TAVI, hemodynamics were stable, and transthoracic echocardiography (TTE) showed no pericardial effusion just after TAVI, but sudden hemodynamic collapse occurred 5 h later. TTE revealed pericardial effusion, leading to a diagnosis of cardiac tamponade from cardiac injury. After pericardial drainage of arterial blood, hemodynamics stabilized immediately. Post-pericardiocentesis CT showed no obvious findings of annular rupture or left ventricular perforation, but CT and transesophageal echocardiography (TEE) revealed that the LAAW was affected by calcification (Figure C–E; Supplementary Movie 2) accompanied by swelling (Figure F), suggesting that injury to the LAAW from projecting calcification may have caused delayed cardiac tamponade.
LA injury following TAVI is a life-threatening but extremely rare complication.1
Self-expandable valves are less likely to cause cardiac tamponade during TAVI, but may cause delayed cardiac tamponade due to the valve’s radial force.
Disclosures
The authors declare that there are no conflicts of interest.
Supplementary Files
Supplementary Movie 1.
Pre procedual CT of aortic root.
Supplementary Movie 2.
TEE images (2D and 3D) after valve deployment.
Please find supplementary file(s);
http://dx.doi.org/10.1253/circj.CJ-20-0820
Reference
- 1.
Hioki H, Watanabe Y, Takamura S, Kataoka A, Sawamura S, Kozuma K. Unexpected cardiac tamponade due to bleeding from the left atrium during transcatheter aortic valve replacement. J AmColl Cardiol Intv 2018; 11: e27–e28.
