Late left ventricular pseudoaneurysm following transfemoral transcatheter aortic valve replacement

A 79-year old woman, with a transfemoral transcatheter aortic valve replacement (TAVR) using a 29-mm CoreValve® prosthesis 12 months before, shows on echocardiographic follow-up a new left ventricular (LV) apical pseudoaneurysm (Fig. 1A and B; Videos 1 and 2). We hypothesize, however, micro-injury of the LV apex endothelium with subsequent myocardial infiltration caused by the super-stiff wire used during transfemoral TAVR. Surgical aneurysm resection represents the successful treatment (Fig. 1C).

Figure 1:

Initial transthoracic echocardiography revealed a perfused cavity (A1 and A2) and CT scan showed an left ventricular (LV) apical pseudoaneurysm (B1 and B2). Operative findings show the opened pseudoaneurysm and closure of LV perforation with felt-pledgeted sutures after resection of the pseudoaneurysm (C1 and C2). CT: computed tomography.

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