Duggal, Sumit, MD

Nawaz, Yassir, MD

Qureshi, Ataul, MD

Raghunandan, Muppidi, MD

Subrayappa, Navin K, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of MedicinePulsating Left Breast After Trans-Apical AorticValve Implantation: An Ominous SignYassir Nawaz MDLehigh Valley Health Network, Yassir.Nawaz@lvhn.orgNavin K. Subrayappa MDLehigh Valley Health Network, Navin_K.Subrayappa@lvhn.orgSumit Duggal MDLehigh Valley Health Network, Sumit.Duggal@lvhn.orgAtaul Qureshi MDLehigh Valley Health Network, Ataul.Qureshi@lvhn.orgMuppidi Raghunandan MDLehigh Valley Health Network, Raghunandan.Muppidi@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/medicinePart of the Cardiology Commons, and the Medical Sciences CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtNawaz, Y., Subrayappa, N., Duggal, S., Qureshi, A., & Muppidi, R. (2014, June 23-27). Pulsating left breast after trans-apical aortic valveimplantation: An ominous sign. Poster presented at: The 10th annual Complex Cardiovascular Catheter Therapeutics: AdvancedEndovascular and Coronary Intervention Global Summit, Orlando, FL.Lehigh Valley Health Network, Allentown, PennsylvaniaYassir Nawaz MD, Navin Subrayappa MD, Sumit Duggal MD,  Ataul Qureshi MD, Raghunandan Muppidi MDIntroduction•		Transcatheter aortic valve implantation (TAVI) by femoral or apical route is a new procedure and is becoming more popular compared to surgical aortic valve replacement especially in high risk patients.•		Complications from these relatively new procedures are currently being reported in the literature. •		Complications Include stroke, vascular access site complications,  (bleeding, pseudoaneurysms, arterial rupture), valve embolization or migration, perivalvular regurgitation, myocardial infarction and infection.•		We report a case of a giant iatrogenic left ventricular apical pseudoaneurysm after a trans-apical TAVI that presented as pulsating left breast.Pulsating Left Breast After Trans-Apical Aortic Valve Implantation: An Ominous Sign© 2014 Lehigh Valley Health NetworkCase•		A 63 YO female presented to the hospital with progressive shortness of breath and syncope.•		She had a past history of coronary artery disease status post CABG and aortic stenosis status post bioprosthetic aortic valve replacement done nine years ago.•		A transthoracic echocardiogram showed severe prosthetic aortic valve stenosis with a mean gradient of 63 mmHg and aortic valve area of 0.5 cm. A cardiac catheterization showed patent bypass grafts. •		Transapical TAVI was recommended due to poor vascular access for femoral approach and high risk for traditional surgical replacement. •		She underwent successful trans-apical TAVI with a 23mm Edwards Scientific Sapien valve.•		She presented four months after the procedure complaining of a pulsatile left breast. •		A CT scan of the chest showed a large apical pseudoaneurysm measuring 9.7cm x 6.6cm extending through the 4th and 5th rib space into the anterior chest wall [Figure	1]. •		A transthoracic echocardiogram confirmed the findings [Figure	2].	 •		The pseudoaneurysm neck measured 1.17cm [Figure	3].	•		There was bidirectional flow represented by continuous wave and color doppler [Figures	3,	4,	5].•		Patient was transferred to a specialized centre where she underwent open repair of the pseudoaneurysm.Discussion•		Apical pseudoaneurysm after trans-apical TAVI is a rare complication with a reported incidence of around 2% in one series1. •		Although there are reported cases of this condition, to the best of our knowledge, a pseudoaneurysm of this big size is not reported before as a complication of trans-apical TAVI. •		Most of the reported pseudoaneurysms are small with narrow necks 2,3. •		Depending upon size, the pseudoaneurysms can be managed conservatively or closed either surgically or percutaneously1, 2, 3.References:1.	 	Bleiziffer	S1,	Piazza	N,	Mazzitelli	D,	Opitz	A,	Bauernschmitt	R,	Lange	R.	Apical-access-related	complications	associated	with	trans-catheter	aortic	valve	implantation.	Eur	J	Cardiothorac	Surg.	2011	Aug;40(2):469-74.2.	 	Bortnick	AE1,	Gordon	E,	Gutsche	J,	Anwaruddin	S,	Szeto	WY,	Desai	N,	Vallabhajosyula	P,	Bavaria	JE,	Herrmann	HC.	Percutaneous	closure	of	a	left	ventricular	pseudoaneurysm	after	Sapien	XT	transapical	transcatheter	aortic	valve	replacement.	JACC	Cardiovasc	Interv.	2012	Dec;5(12):e37-8.3.	 	Vanezis	AP1,	Baig	MK,	Mitchel	IM,	Shajar	M,	Naik	SK,	Henderson	RA,	Mathew	T.	Pseudoaneurysm	of	the	left	ventricle	following	apical	approach	TAVI.	J	Cardiovasc	Magn	Reson.	2011	Dec	12;13:79.Disclosures:   None.Figure 1Large Left Ventricular Apical PseudoaneurysmFigure 2Apical four chamber view showing apical pseudoaneurysmFigure 3Color doppler showing flow into the pseudoaneurysm in systoleFigure 4Color doppler showing flow out of the pseudoaneurysm in diastoleFigure 5Continuous wave Doppler showing flow in and out of pseudoaneurysmApical Pseudoaneurysm

Pulsating Left Breast After Trans-Apical Aortic Valve Implantation: An Ominous Sign

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Pulsating Left Breast After Trans-Apical Aortic Valve Implantation: An Ominous Sign

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