Delivery balloon rupture during transcatheter heart valve alignment procedure in extreme descending aorta tortuosity

Abstract

Transcatheter aortic valve replacement (TAVR) is an alternative to surgery to treat severe aortic stenosis (AS) in patients at high surgical risk. In specific cases in which the descending aorta is highly curved, TAVR is often attempted with a transfemoral approach [1]. Rupture of the balloon during TAVR is a rare complication but is potentially fatal. Several cases of balloon rupture due to sharp calcification of the aortic valve have been reported [2,3]. We report a case of balloon rupture during TAVR with successful retrieval, and we review this complication. Case report A 79-year-old man with a history of partial resection of the lung and the bladder for cancer had repeated episodes of heart failure because of severe AS. Echocardiography showed a severely stenotic, calcified bicuspid valve with an area of 0.7 cm 2 , a peak velocity of 4.2 m 2 /s, left ventricular diastolic diameter of 56 mm, and a low left ventricular ejection fraction of 35%. The N-terminal pro-brain natriuretic peptide level was elevated at 3567 pg/ml. The diagnosis was New York Heart Association class III heart failure due to severe AS. He also had hypertension and dyslipidemia. Diagnostic coronary angiography indicated no significant coronary artery disease. The logistic EuroSCORE and Society of Thoracic Surgeons scores were 9.0% and 5.2%, respectively. Preoperative multislice computed tomography revealed a valve annulus area of 598 mm 2 and circumference-derived diameter of 88.5 mm. There was extreme tortuosity of the descending aorta (Fig. 1A). After