Perforation of the Membranous Interventricular Septum After Transcatheter Aortic Valve Implantation

Paravalvar aortic regurgitation (AR) is frequently observed after transcatheter aortic valve implantation (TAVI) for aortic stenosis.1–3 In case of malapposition or underexpansion, AR is usually corrected by balloon dilatation of the frame. We describe a perforation of the membranous interventricular septum (IVS) after TAVI with the CoreValve ReValving System after dilation with a larger balloon.An 89-year-old man (weight, 66 kg; height, 171 cm) was referred for TAVI because of symptoms of dyspnea on effort due to severe aortic stenosis. A transthoracic echocardiography revealed a heavily calcified stenotic aortic valve and a hypertrophic left ventricle with preserved systolic function (Table). His logistic EuroScore was 15%. A multidetector computed tomography (MDCT) revealed a thick muscular IVS (20 mm) with a large membranous IVS, extending up to 13 mm below the aortic annulus (Figure 1). View this table:Table. Echocardiographic Indices at Baseline and Posttreatment at Days 1 and 7 Figure 1. The membranous interventricular septum extends for 13 mm below the aortic annulus (nadir of the 3 cusps, dotted line) as …