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Aortic Valve Replacement Case Study

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Successful management of balloon rupture during Transcatheter aortic valve replacement (TAVR) We present a case of an unusual complication encountered during percutaneous transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. This case was complicated by balloon rupture during deployment and entanglement of the balloon in a heavily calcified area of the aorta, which necessitated the surgical removal of the deployment device. Although there is literature supporting the efficacy of TAVR over surgical aortic valve replacement in some high risk patients, TAVR is not without complications [1]. A 88-year-old male was admitted to the hospital for elective TAVR. His pre-operative transesophageal echocardiogram (TEE) demonstrated a left ventricular EF of 60-65%, a severe aortic stenosis with a mean/peak gradient of 30 mmHg/51 mmHg, and an aortic valve…show more content…
The patient was taken to the operating room (OR) and was placed under general endotracheal anesthesia. After cannulating the left femoral artery, the valve was positioned and deployed using the TAVR deployment device. During deployment of the new aortic valve, the balloon used to expand the valve was noted to rupture on fluoroscopy and TEE. Diagnostics, performed by the anesthesiologist using TEE, demonstrated the proper placement of percutaneous valve resulting in correction of the aortic stenosis; the mean/peak gradients were reduced to 2mmHg/4mmHg and the AVA increased to 2.69 cm2. Upon attempting to remove the deployment device, cardiology team encountered significant resistance; fluoroscopy determined that the ruptured balloon had become trapped on something. They attempted to free the balloon from its entanglement using a snare, and also by
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