Right coronary occlusion following transcatheter aortic valve implantation: two case reports

Abstract

This paper discusses two male patients with severe aortic stenosis, whose right coronary arteries (RCA) were completely occluded during transcatheter aortic valve implantation (TAVI), leading to fatal hemodynamic disorder. Occlusions of RCA complicated by TAVI are rare. In addition, emergency cardiopulmonary bypass (CPB) played a critical role in rescuing our second patient. Both patients were admitted for “severe aortic stenosis,” and TAVIs were performed. The first patient’s blood pressure immediately dropped to 70/40 mmHg after the balloon expansion and did not increase much after the administration of aramine or fluid therapy. He did not receive emergency surgery and died after 1.5 h of resuscitation. The second patient’s blood pressure fluctuated greatly for several minutes after the valve implantation, ranging from 170/100 mmHg to 60/40 mmHg. Angiography revealed a total occlusion of RCA. Thoracic surgery with CPB was performed, and the patient survived.

Keywords

aortic stenosis / transcatheter aortic valve implantation / right coronary occlusion / cardiac group

References

[1] Ribeiro HB, Nombela-Franco L, Urena M, Mok M, Pasian S, Doyle D, DeLarochellière R, Côté M, Laflamme L, DeLarochellière H, Allende R, Dumont E, Rodés-Cabau J. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv 2013; 6(5): 452–461

[2] Wang MY, Xu L, Pei HJ, Teng SY, Zhang HT, Lv B, Wang H, Yang YJ, Wu YJ. Aortic root imaging and clinical application in 15 patients with transcatheter aortic valve implantation — a single center early experience. Chin Circ J (Zhongguo Xun Huan Za Zhi) 2014; 29: 714–717

[3] Pasic M, Unbehaun A, Buz S, Drews T, Hetzer R. Annular rupture during transcatheter aortic valve replacement: classification, pathophysiology, diagnostics, treatment approaches, and prevention. JACC Cardiovasc Interv 2015; 8(11 Pt A): 1–9

[4] Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary—a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 10; 63(22):2438–2488

[5] Stabile E, Sorropago G, Cioppa A, Cota L, Agrusta M, Lucchetti V, Rubino P. Acute left main obstructions following TAVI. EuroIntervention 2010; 6(1): 100–105

[6] Seipelt RG, Hanekop GG, Schoendube FA, Schillinger W. Heart team approach for transcatheter aortic valve implantation procedures complicated by coronary artery occlusion. Interact Cardiovasc Thorac Surg 2012; 14(4): 431–433

[7] Franco A, Gerli C, Ruggeri L, Monaco F. Anaesthetic management of transcatheter aortic valve implantation. Ann Card Anaesth 2012; 15(1): 54–63

[8] Ribeiro HB, Webb JG, Makkar RR, Cohen MG, Kapadia SR, Kodali S, Tamburino C, Barbanti M, Chakravarty T, Jilaihawi H, Paradis JM, de Brito FS Jr, Cánovas SJ, Cheema AN, de Jaegere PP, del Valle R, Chiam PT, Moreno R, Pradas G, Ruel M, Salgado-Fernández J, Sarmento-Leite R, Toeg HD, Velianou JL, Zajarias A, Babaliaros V, Cura F, Dager AE, Manoharan G, Lerakis S, Pichard AD, Radhakrishnan S, Perin MA, Dumont E, Larose E, Pasian SG, Nombela-Franco L, Urena M, Tuzcu EM, Leon MB, Amat-Santos IJ, Leipsic J, Rodés-Cabau J. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol 2013; 62(17): 1552–1562

[9] Rodés-Cabau J, Webb JG, Cheung A, Ye J, Dumont E, Feindel CM, Osten M, Natarajan MK, Velianou JL, Martucci G, DeVarennes B, Chisholm R, Peterson MD, Lichtenstein SV, Nietlispach F, Doyle D, DeLarochellière R, Teoh K, Chu V, Dancea A, Lachapelle K, Cheema A, Latter D, Horlick E. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 2010; 55(11): 1080–1090

[10] Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, Eggebrecht H, Rubino P, Michev I, Lange R, Anderson WN, Wendler O. Thirty-day results of the SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) Registry: a European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 2010; 122(1): 62–69 doi:10.1161/CIRCULATIONAHA.109.907402 PMID:20566953

[11] Crimi G, Passerone G, Rubartelli P. Trans-apical aortic valve implantation complicated by left main occlusion. Catheter Cardiovasc Interv 2011; 78(4): 656–659

[12] Ruggeri L, Gerli C, Franco A, Barile L, Magnano di San Lio MS, Villari N, Zangrillo A. Anesthetic management for percutaneous aortic valve implantation: an overview of worldwide experiences. HSR Proc Intensive Care Cardiovasc Anesth 2012; 4(1): 40–46

RIGHTS & PERMISSIONS

Higher Education Press and Springer-Verlag Berlin Heidelberg