Descending Aorta Rupture During Transcatheter Aortic Valve Replacement

A 88-year-old woman with a permanent VDD pacemaker and severe aortic stenosis underwent elective transcatheter aortic valve replacement because of high surgical risk (logistic Euroscore of 35.3%). Aortic valve area was 0.5 cm2, mean gradient was 86 mm Hg, and left ventricular ejection fraction was 64% on transthoracic echocardiography. Aortic annulus sizing was 23.5 and 23.7 mm by transesophageal echocardiography and multidetector computed tomography, respectively. Femoral and iliac arteries evaluated by angiography and computed tomography were straight with mild calcification and had adequate internal diameters. Great tortuosity of the aorta was also observed in computed tomography, with the presence of a double angle in the descending thoracic aorta and a very pronounced curve in the distal part of the aortic arch (Figure 1). The procedure took place via right transfemoral access with the use of a percutaneous closure device. A self-expandable 29-mm Core Valve prosthesis (Medtronic, Inc., Minneapolis, MN) was advanced, encountering a high resistance at the level of the distal part of the aortic arch that precluded the progress. When advancement …