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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
1   Cardiothoracic Surgery, Ruhr-University of Bochum, Germany
,
Matthias Bechtel
1   Cardiothoracic Surgery, Ruhr-University of Bochum, Germany
,
Markus Schlömicher
1   Cardiothoracic Surgery, Ruhr-University of Bochum, Germany
,
Michael Lindstaedt
2   Cardiology, Ruhr-University of Bochum, Bochum, Germany
,
Justus T. Strauch
1   Cardiothoracic Surgery, Ruhr-University of Bochum, Germany
› Author Affiliations
Further Information

Publication History

03 February 2012

12 March 2012

Publication Date:
20 November 2012 (online)

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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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