An uncommon complication of a minimally invasive procedure

Figures

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  Fig. 1. Echocardiogram of the patient who underwent a trans-apical antegrade TAVI procedure for aortic stenosis approximately 4 years ago. Images in different acoustic windows. The echocardiogram showed a slightly enlarged, hypertrophic left ventricle with normal contractility, together with the presence of a rounded image, with hyperechogenic margins and anechoic content, at the apical level of the left ventricle. The trans-prosthetic gradient was also measured at the TAVI level, which was found to be 19 mm Hg

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  Fig. 2. Coronary angiography and computed tomography images. Coronary angiography (A) shows the TAVI with the prosthesis correctly positioned. A computed tomography performed a few months after admission (B–D) for TAVI documented in the CT scans in the intrapericardial area, at the cardiac apex, the appearance of a 40 × 33 mm formation with partially calcified walls, the presence of fibrocalcified atheromatous aorta included in the acquisition volume, severe coronary calcifications, and a right coronary stent. The results of aortic valve replacement were confirmed. The CT scan performed during our admission (E–G) confirmed the presence of a “roundish image in the pericardial area at the apical level of the left ventricle to be referred to probable results of TAVI.” Based on these findings, we diagnosed a cardiac apex aneurysm as a result of TAVI intervention with trans-apical antegrade access

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  Fig. 3. Images with hybrid technique with positron emission tomography-computed tomography (digital PET-CT) with 18F-FDG (219 MBq e.v.). The technique shows the presence of the collection localized near the cardiac apex, characterized by ring-shaped uptake (SUVmax 15.7)